How do you treat headaches?

[Anagray]

i am wondering how are headaches/migraines treated in your ers?

in our er docs mostly give narcotics and antiemetics. as an ex-neuro nurse i was very surprised by that, because our neurologists absolutely will not give narcs because it causes rebound headaches. upstairs we did mostly dhe protocol, caffeine, depakote, reglan loading protocol if all of the above didn't work, quiet room, icepacks, darkness, hydration and oxygen,etc.

the er docs explained to me that "we don't have time to do all that, we want to stop the pain and get the person home" (with a lortab prescription usually). none the less, the patients stay at least 4 hours even if they get narcotics, then they come back 2 days later because the pain is back and the neurologist can not see them this week.

nat

[TraumaNurseRN]

I personally take motrin and then drive to work for my 12 hour shift.

Seriously though, there are lots of avenues we use in the ED. Depends on the doc....we even use high flow O2 NRB when it's my patient along with the meds (have had good results with that)....plus a nice cool cloth on the forehead and a darkened room if the patient likes.

[RN0520]

Our protocol is 25mg Benadryl, 10mg Compazine, and 30mg Toradol all IV. We change it up a bit if pt has allergies but rarely does the patient receive narcotics. We have our frequent fliers and depending on the Doc on depends on what they get. I think since this is protocol we possibly get fewer c/o of headaches. Back pain- that's a different story.

[Altra, BSN, RN]

Sorry, new nurse here. Why is it that you wait until after CT to give Toradol?

If the patient does not have a prior hx of migraines or is complaining of "the worst headache of my life," Toradol (an NSAID) may be withheld until a negative CT scan rules out a bleed or other intracranial pathology.

[crb613, BSN, RN]

oh

my

word.....

:icon_roll

My thoughts exactly!

:hhmth: :hhmth: :hhmth:

[ThrowEdNurse, BSN, RN]

I'm scared of licensedcertified.

[RedSox33RN]

I personally take motrin and then drive to work for my 12 hour shift.

Me too!

[MIA-RN]

We use 1 or 2 L NS bolused, compazine, and toradol.

I am curious about using benadryl...I haven't seen that done before. Is headache relief a side effect of the medications, related to anticholinergic effect, or is it just sedating and allows the pt to relax? I am interested and will be googling it to see if we can use it at work, but I'd love to hear more from people who have given it.

Oh, and I gave droperidol once. I was scared of it because we don't have tele, and I had the pharmacist help me ensure the correct dosage. It didn't really help the patient either. Pain went from about a 10 to a 6...better but not the same effect I've seen w/ toradol and compazine.

[aaronrnmedic]

For atypical H/A's in our ED the doctor may order CT of the head, especially if they say the magic phrase "its the worse headache of my life". LP's may be ordered if the CT is negative. The usual blood work is done for this complaint. As far as treatments go we usually give toradol, compazine, or reglan IV. There are some docs who will order Dilaudid but not too often. Normal Saline is given as a 1 liter bolus IV for those without a h/o renal failure or CHF.

[rn-n- 2005]

Benadryl is given so there is less chance of EPS from Comapzine.

[so alive LPN]

for the most part on our m/s floor, we give 1 L NS bolus with 5 of valium, 25 of demerol, and 25 of phenergan (all IV). I know it sounds like a boat load of narcs, but it really helps 99.9% (or the patient is so sleepy s/he sleeps the pain away). In the other cases, I've seen toradol 60 given in place of demerol, or for the REAL stubborn ones, both!

[Larry77, RN]

for the most part on our m/s floor, we give 1 L NS bolus with 5 of valium, 25 of demerol, and 25 of phenergan (all IV). I know it sounds like a boat load of narcs, but it really helps 99.9% (or the patient is so sleepy s/he sleeps the pain away). In the other cases, I've seen toradol 60 given in place of demerol, or for the REAL stubborn ones, both!

Sounds like your MD's need some education..this is very old school and results in major rebound headaches...yikers!

[ringaroundtheposey]

I am still a student but I do get migraines very rarely and when they get out of hand ( lasting longer than 12 hours and after barfing) the best thing for me personally is fluids and gravol and if that doesn't work, a little toradol fixes it.