migraine faker at the ED!

Specialties Emergency

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Last Wednesday I encountered the reason for the sometimes crappy treatment I get in the ED concerning my migraines. I actually met a real life in the flesh migraine faker!:( :

I was waiting in the Ed waiting room, waiting for my boyfriend to get off work, and noticed a couple sitting across from me. They were chatting happily, laughing and pigging out on candy bars and chips and cokes. I noticed the hospital bracelet on the girl and after about 10 minutes, I couldn't help myself.... I asked her what brought her to the ED at 3:00 in the morning. She looked at me and says..."Migraine"

I'm in shock at this point but then I get angry!:eek:

I say" YOU have a migraine and you can EAT and DRINK? Isn't the light bothering your eyes? You do NOT have a migraine and you know it!"

I turn away disgusted. Well....guess what...she goes into "migraine mode". Gone are the chips, the chocolate and the cokes, and out come the dark sunglasses, the cold ice pack and she puts her head down on her boyfriend's shoulder and starts to grimace in "pain" :confused:

I start laughing out loud. :chuckle I could not believe it! I still can't!

I have to drag myself into the ED, feeling half dead, wishing I was, and I get the red flag because the staff encounters people like this girl!

When I finish nursing school I want to work in the ED and I'm guessing I can't do what I did Wed, but I think I'm going to have a hard time keeping my mouth shut.

Honestly, I never quite understood how the cynicism towards migraineurs came about until now. Another part of me can't see how the real thing can be confused with these obvious cases of faking it. A dilemna that shouldn't exist I suppose.

How do you handle people like this? Can you get your license taken away?

Cathy

Specializes in ED/trauma.

I would just like to add that the ER is not a pain clinic-most hospitals have one of those these days to try and ease the problem these people cause in the ER.Unless it's new onset such as AMI or traumatic amputation-GO TO YOUR PCP!!! And I rarely get migranes (but when I do you better look out!) and most of the one's I do get come on during a shift, and are caused by the type of patient talked about here. Migranes do not require ER treatment ever (one exception might be if it is accompanied by unresponsiveness), they are non-emergent, stay home in your bed, turn out the lights, and put a trash can by your bed, that's what I do (when I'm not saving lives that day), and be glad you don't have to suffer through one saying-"I'm sorry your still having pain but if I give you anymore dilaudid/phenergan the pain may go away for EVER!":banghead::banghead::banghead::banghead::banghead:

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Specializes in NICU, Post-partum.
Yes I'm sure there are many people like yourself who can carry on relatively normal behaviour when experiencing a migraine. Lucky ducks.:)

If this was her case, I don't think she would have brought out the sunglasses and all that. I probably shouldn't have said anything but I couldn't help it.

When you are a chronic migraine sufferer, you have different degrees of the pain. I have had them so long I can pretty much gauge when I need to go to the ER for them before the worst of the pain actually hits.

Migraine pain isn't always textbook.

Doctor's in my area are very stingy with pain meds. Mine are triggered when I am excessively worried about something, like an exam, something in my personal life, etc...believe it or not, Ativan works when I am getting ready to have a horrible spell...but a physician won't write me a prescription for it (even though I have only asked them to give me 5 pills only) b/c of the drug abuse issue in my area. Darvocet is the strongest drug I have ever been allowed to keep at home, and when I know I am getting ready to get a "bad one"...I can either take Darvocet for several days (which means I have to miss school and work) or I can go to the ER, get Ativan, sleep it off and be done with it in an afternoon or evening.

It rarely happens...about 3x a year that I get a "bad one".

However, I went out of town on vacation once when I got a "bad one" and I could tell by the look on the nurses faces that they thought I was a drug seeker.

Let's just say she had a very difficult patient that night.

PS: You won't find a physician in my area, even if you are a current patient that will "call in" a prescription for anything. If anyone has ever had a tension headache and a migraine at the same time, the pain borderlines unmanageable and no way in 40 you-know-where's am I going to suffer through the night with something that painful....just so an ER staff can laugh about not administering treatment. I haven't had this problem, thankfully, since I have been in nursing school b/c I have met many members of the staff now.

This is why I for one, am glad that the Joint Commission is huge on the pain assessment.

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Specializes in NICU, Post-partum.
When you had the migraine for 3 days, was there a time when you called your own doctor about this?

The point is...as nurses, it's not up to us to make that call if someone is a drug seeker or not...that has been made CLEAR to us in school and in clinical.

Do the assessment, give the information (verbal and non-verbal to the doctor), let them make the decision and just LET IT GO!

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Specializes in Peds.

I did call my own doctor but he was closed! It started on Christmas eve, Christmas day, and the day after! (Great way to spend the holidays.) I know the ER is not a PAIN CLINIC, but sometimes we migraine suffers have NO OTHER CHOICE.:banghead: I'm a nurse, I've seen the drug seekers. I know how they treat people whose complaint is migraine.

"I_LOVE_TRAUMA" I'm happy you don't have severe migraines, but for those of us that do, there is no going to bed.

And yes sometimes it is too much to bear and does require stronger meds to knock it out. I have been in so much pain they took me back without any wait. This due to the fact my BP was 170/110 and pulse 175. My BP is usually 100/60. And we the migraine suddenly appears, I always have auras, it could be a sign of something more serious happening.

I want to also point out I've had migraines for almost 4 years now and been to the ER twice. It's not our place to disrespect someone who may be in REAL PAIN.

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the point is...as nurses, it's not up to us to make that call if someone is a drug seeker or not...that has been made clear to us in school and in clinical.

do the assessment, give the information (verbal and non-verbal to the doctor), let them make the decision and just let it go!

i don't know how you assess but when i assess someone i always ask if they have been seen and treated by their primary physician. it's information our physicians like to know, and myself frankly. so when a patient comes in with complaints of pain, i ask what remedies they have implemented and if there was relief, etc. it's even part of the pain assessment check off in computerized charting. so...the point with my question was part of the pain assessment we do at my er...

if the nurse cannot assess whether someone is a drug-seeker based on their assessment skills and the answers they receive during the assessment, and all the other reasons listed in all of the previous posts then why the heck do an assessment at all? why don't we just stand outside of the er doors and pass out meds based on any given complaint.

as so many have said prior...... migraines are non-emergent complaints. my question inquiring if she had contacted her pcp was a valid one. nurses are like detectives sometimes. you have to ask certain questions to get answers that provide you with the whole picture. it's not enough to say the patient has chest pain but rather the pain began _, it's nonradiating_, it's rated a _ on the pain scale_, and so on. if you weren't taught that in your nursing school or during your clinicals, that's sad if you ask me. asking the patient if they have been seen and treated by their pcp is part of the assessment.....maybe you missed that day in class or something...:chuckle

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I did call my own doctor but he was closed! It started on Christmas eve, Christmas day, and the day after! (Great way to spend the holidays.) I know the ER is not a PAIN CLINIC, but sometimes we migraine suffers have NO OTHER CHOICE.:banghead: I'm a nurse, I've seen the drug seekers. I know how they treat people whose complaint is migraine.

"I_LOVE_TRAUMA" I'm happy you don't have severe migraines, but for those of us that do, there is no going to bed.

And yes sometimes it is too much to bear and does require stronger meds to knock it out. I have been in so much pain they took me back without any wait. This due to the fact my BP was 170/110 and pulse 175. My BP is usually 100/60. And we the migraine suddenly appears, I always have auras, it could be a sign of something more serious happening.

I want to also point out I've had migraines for almost 4 years now and been to the ER twice. It's not our place to disrespect someone who may be in REAL PAIN.

Sounds like you need to find a doctor who will treat your migraines. Having a 4 year history of migraines without medications used to treat that, such as imitrex, etc., sounds odd.

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Specializes in Neuro ICU and Med Surg.

Have you ever had a migraine? Until you do you will never ever understand the pain it can cause.

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Have you ever had a migraine? Until you do you will never ever understand the pain it can cause.

Yes, I get migraines

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Specializes in Peds.
Sounds like you need to find a doctor who will treat your migraines. Having a 4 year history of migraines without medications used to treat that, such as imitrex, etc., sounds odd.

Maybe you didn't read my previous post, I've had migraines for 4 years AND only went to the ER TWICE.

Of coursse I have meds to treat my migrianes. I take a beta blocker daily to help prevent them and I take Frova to abort them. But if you know about these type drugs the max is usually 2-3 tabs in 24 hours. The incidence I'm referring to I had taken the daily maximum for 3 days and even tried a lortab, which I vomited back up.

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Specializes in ED/trauma.

"the point is...as nurses, it's not up to us to make that call if someone is a drug seeker or not...that has been made clear to us in school and in clinical.

do the assessment, give the information (verbal and non-verbal to the doctor), let them make the decision and just let it go!"

i have to agree with traumanursern, if you are just blindly following md's orders you need to go back to school! i work with a great bunch of intelligent docs, but they make mistakes all of the time, i do not work for them, and it is my license on the line if they screw up. your whole outlook is one of the reasons the er/drug seeking problem has gotten to the magnitude that it has. also.. almost none of the crap that i learned in clinicals and in school have i ever used once since becoming a real nurse, experiences is what make you an expert. you can always tell who has real er experience and who doesn't

"and yes sometimes it is too much to bear and does require stronger meds to knock it out. i have been in so much pain they took me back without any wait. this due to the fact my bp was 170/110 and pulse 175. my bp is usually 100/60. and we the migraine suddenly appears, i always have auras, it could be a sign of something more serious happening."

if you came into to my er with those vitals signs we would draw up adenosine and put pacer pads on you just in case we had to treat your psvt, but no, you still wouldn't get any narcs. i have never had anyone with a migrane with a pulse that high. i don't think i've ever had a neurostorming pt. with a pulse that high, only cardiacs, severe pain caused by traumas, etc... 99% of migrane sufferers have auras-still not an emergency, and no the neuro guys will not find anything more serious if you don't go to their office instead of just seeking drugs when they occur. with those vitals it sounds to me like you were really upset about having to wait so long for you narcs/phenergan. oh yeah, that's were i've seen pulses that high-people in withdrawals.

"have you ever had a migraine? until you do you will never ever understand the pain it can cause."

and as i have said many times in all of the other migrane post-i do get them about 1 a year-they are excruciating, but i haven't taken a narc yet, or gone to the er ever, and i have always managed to finish my shift even, the people who are having emergencies need me. why would i seek treatment? sometimes people just don't understand, especially if they do not work in the er, we wear our big girl panties there.

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Maybe you didn't read my previous post, I've had migraines for 4 years AND only went to the ER TWICE.

Of coursse I have meds to treat my migrianes. I take a beta blocker daily to help prevent them and I take Frova to abort them. But if you know about these type drugs the max is usually 2-3 tabs in 24 hours. The incidence I'm referring to I had taken the daily maximum for 3 days and even tried a lortab, which I vomited back up.

I just asked you a question about whether you had contacted your primary about your 3 day migraine. Protesting a simple question or becoming angry because it is asked, puts up a red flag in the assessment process for me.

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"the point is...as nurses, it's not up to us to make that call if someone is a drug seeker or not...that has been made clear to us in school and in clinical.

do the assessment, give the information (verbal and non-verbal to the doctor), let them make the decision and just let it go!"

i have to agree with traumanursern, if you are just blindly following md's orders you need to go back to school! i work with a great bunch of intelligent docs, but they make mistakes all of the time, i do not work for them, and it is my license on the line if they screw up. your whole outlook is one of the reasons the er/drug seeking problem has gotten to the magnitude that it has. also.. almost none of the crap that i learned in clinicals and in school have i ever used once since becoming a real nurse, experiences is what make you an expert. you can always tell who has real er experience and who doesn't

"and yes sometimes it is too much to bear and does require stronger meds to knock it out. i have been in so much pain they took me back without any wait. this due to the fact my bp was 170/110 and pulse 175. my bp is usually 100/60. and we the migraine suddenly appears, i always have auras, it could be a sign of something more serious happening."

if you came into to my er with those vitals signs we would draw up adenosine and put pacer pads on you just in case we had to treat your psvt, but no, you still wouldn't get any narcs. i have never had anyone with a migrane with a pulse that high. i don't think i've ever had a neurostorming pt. with a pulse that high, only cardiacs, severe pain caused by traumas, etc... 99% of migrane sufferers have auras-still not an emergency, and no the neuro guys will not find anything more serious if you don't go to their office instead of just seeking drugs when they occur. with those vitals it sounds to me like you were really upset about having to wait so long for you narcs/phenergan. oh yeah, that's were i've seen pulses that high-people in withdrawals.

"have you ever had a migraine? until you do you will never ever understand the pain it can cause."

and as i have said many times in all of the other migrane post-i do get them about 1 a year-they are excruciating, but i haven't taken a narc yet, or gone to the er ever, and i have always managed to finish my shift even, the people who are having emergencies need me. why would i seek treatment? sometimes people just don't understand, especially if they do not work in the er, we wear our big girl panties there.

:yeah::yeah::yeah::yeah::yeah:you go girl! tell it like it is!...lovin it!

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