Migrane Headache Treatment in the ED

AngelGirl · Mar 20, 2003

prmenrs

I believe that NSS means Normal Saline Solution

angelbear · Mar 21, 2003

I too suffer with migraines. Being a nurse myself I know alot think FF right off the bat. Unfortunately because of this I tend to wait too long. For me it is usually only after hours of agony and every OTC known to man that I go to ER. Toradol does not work dont know why. Very glad to hear about dilauded supps. I have never been offered that. If it is true that you dont get the "high" with them that would be great as I do get that tunnel thing which freaks me out. I hate that feeling. I wonder, can you request that instead of IM or is it not commonly on hand.

RN always, BSN, RN · Mar 21, 2003

I have a friend who had a severe migraine and the ED gave her imitrex and she went into cardiac arrest and ended up in ICU for a week. Imitrex should not be given if pt has HTN. Good thread, very informative!

webbiedebbie · Mar 21, 2003

Please see my thread on the General Nursing discussion board regarding migraines.

Thanks,

flashpoint · Mar 23, 2003

We give a lot of demerol and phenergan. Once in a while, we'll see the docs order fluids or a migraine cocktail (compazine 10 mg, reglan 20 mg, and benadryl 50 mg IV followed by ergotamine) but usually, we just go straight for the narcs...guess our docs are fat and lazy or something. Some of our FFs think the know the system so well, they'll bypass triage and just put themselves in the first room they see open and start sceraming for their shot...LOL.

KKERRN · Mar 26, 2003

Just used Stadol 2 mg IV, Reglan 10 mg IV and Benadryl 25 mg IV this weekend and it also seemed to work quickly for this patient. Each of our docs seem to have their own remedy to try.

KKERRN

prmenrs, RN · Mar 27, 2003

I KNOW what NSS means. [biting tongue very hard and refraining from inappropriate, smart-alecky remarks.]

Why is it useful in treating migraines? Is it a hydration issue? I am genuinely trying to understand.

jetsetter · Apr 2, 2003

I work with a doc who seems to have a lot of luck with benadryl , reglan, and toradol IV, has had a lot of success with this. we are unable to get compazine at our hospital anymore, were told unavailble. any one else heard this? I'm anxious to see if the docs will try the intranasal lidocaine, sounds cool!

Sarah, RNBScN · Aug 20, 2003

Migraine protocol:

dark room

IV NS 500 cc bolus

stemetil 10 mg IV

maxeran 10 mg IV * safe in pregnancy

If relief...D/C home.

No relief

consider 2nd dose of stemetil ( one hour after initial dose)

DHE 1 mg SQ

If no relief,

consider narcotic and alternate diagnosis.

This is our advance medical directive to follow BUT depends on the doctor that you are working with. As always, I let the doctor know what we have and what I have started with first.

Hope this helps.

----------------------

NSS is to hydrate the individuals. No question is dumb prmenrs.

Liddle Noodnik · Aug 20, 2003

I too will ask, WHY is normal sterile saline bolus an effective treatment for migraines??

My scenario: I have had headaches nearly every month (premenstrual), onset the day before menses through 2nd day of menstrual period. Treating with tylenol, Ibuprofen, naproxen all ineffective (never HEARD of using BENADRYL!) I would just grin and bear it.

Of late (the last 6 mo) they've gotten worse, are NOT related to my period, and do not follow any pattern. Two months ago I walked into the ER (first time with it), BP 198/90 (my bp had already been normally 140/80-90), left arm and left facial weakness.

I was scared to death cuz of course I thought STROKE. I was made to wait at the checkin desk for 15 minutes before I said, "scuse me, this could be serious," and explained. I was triaged but then sat in the waiting room for another 45 minutes.

When they took me in they inserted a saline lock and used THAT to draw my blood work (all they drew was a Lithium level cuz I am on that; I'm also on thyroid med but they didn't draw that either). Never heard of drawing blood thru a lock and they worked and worked at doing so for about 45 min! God knows what quality of blood they eventually got!

I did get my CT scan an hour after my arrival (negative), I had refused narcs unless absolutely necessary cuz I'm a recovering alcoholic. So I got NO med, essentially NO lab work, and I got a referral to a neurologist who gave me Axert which works ok. I did feel better because they had r/o'd stroke (altho' wouldn't an MRI be better or helpful in addition?).

My family doc (now it's what, 2 months later?) is gonna follow up cardiac and stroke wise.

I feel ok, altho I have been having these, not so severe, quite frequently.

It just amazes me that my tx was so much different from what you guys all do! What are all the different meds for (anything other than pain control and nausea? any secondary effects helpful for migraine?). The benadryl?

Are there any routines labs for your protocols or should I not have expected any?

And don't forget to answer the NS question! Why would we need hydration?

petiteflower · Aug 21, 2003

ED migraines--ooh sore subject with me. We get many ff, 99% who are allergic to everything but the drug of choice. I have one that even will tell you that they can't take Toradol IM because it bother's the ulcers.

Some of our docs are really bad about giving them what they DEMAND and letting them go just to shut them up. It drives me nuts. There are other alternatives than narcotics.

Our hospital has a policy that if there are over so many visits to ER a month for migraine looking for narcotics then the family doctor has to present a plan of care that other alternatives and follow ups are attempted. Is this working? I don't know.

Some of them doctor shop.

Do I believe that migraine pain should be treated? Of course I do.

But narcotics often cause a rebound headache that is almost as bad as the migraine.

Occasionally we do get a real migraine--they are the ones that tell you they will try ANYTHING to make the pain go away.

I don't mean to sound uncaring, but after the patient has been in for the 4th time in a week demanding Demerol, and does everything but jump up and down like a little kid throwing a fit to get it---it gets a little old. Or they ask---how much did you give me this time?? Only 50mg, I need at least 75 mg to kick it. Or when they have scars from so many IMs. Or they act almost orgasmic (and I am not exaggerating) when you give them the shot---I feel more like a drug dealer than a nurse, I sometimes feel like we are supporting a habit or an addiction rather than really treating pain.

I am going to take some of these treatments that other hospitals are using, and present them to our docs.

Sorry, I didn't mean to get off on a tangent.

Liddle Noodnik · Aug 21, 2003

Originally posted by petiteflower
Sorry, I didn't mean to get off on a tangent.

You didn't :)

Thanks.

I don't know if I said but I certainly got treated better when I stated I didn't WANT narcotics! Then it seemed they took me more seriously. Sad really cuz there are those who really do need them.