what treatment do patients who present with migraines......

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to your ER recieve????

were i used to work it was just the usual peth and maxalon im injection. but this stopped about 3 years ago and now they only give chlorpromazine infusion. since doing this the number of migraine presentations dropped by about 80%

now in the place i work which is out in the country the Dr seems to only give peth. ive given him the literature on this and that we shouldnt be giving narcotics but he still does. so what im wanting to know is what have you guys found most effective?

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We had a migraine protocol:

Included a few meds, not all were given, sometimes a combo or just one:

Metoclopramide

Ondansterone

Caffiene by IV infusion

Occasional narcs.

Most seekers get very annoyed with this, but I've seen it work really well for several people as well.

We also occasionally use the imitrex/zomig type drugs with some effect. Again it sort of depends ont he patient.

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caffiene by infusion????? ive never heard of that one before

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Specializes in ER, NICU, NSY and some other stuff.

Current regimeine at most of the places that I work at

Reglan 10

toradol 30

Benedryl 50

500cc ns

At another facillity

It is valium 5

benedry 25

toradol 30

another addition may be compazine

I tseems to work very well for many.

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caffiene by infusion????? ive never heard of that one before

I hadn't either, but its a level one trauma center, does a ton of research.

if comes in a powder vial and is mixed 500 mg in one liter of NSS. Infuse over about an hour (I'd have to look it up). monitor BP during the infusion, and heart rate...obviously. It works for some patients. Others...well, they complain that it is not dilaudid.

I've never seen it used elsewhere. Then again, at one facility they have a "special" GI cocktail mix (which really is not that special) named specifically for that MD...

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Specializes in ER, OR, Cardiac ICU.

We do Zofran, Toradol (for those that aren't *allergic* to it) and Phenergan. Then we'll add mag sulfate and valproate acid IV (Depakote) which works very well. Imitrex IM is sometimes used, as is 4% lidocaine intranasally. Very rarely are narcs given; in fact, we tell our migraines we have a narc-free protocol and that does a very good job on weaning the migraines from the drug-seekers.

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do you guys give toradol iv or im, i heard from one US dr we had that they used to give it iv quiet alot but out here ive never seen it given iv

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Specializes in ER, NICU, NSY and some other stuff.

30 mg is ok IV but if they order 60 it would be IM. The larger doses can impair renal function.

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30 mg is ok IV but if they order 60 it would be IM. The larger doses can impair renal function.

the most they'll give here is 30mg im

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Ugh...in my ED we give a IM combo of :

Narcotic:

Demerol

Dilaudid

Morphine

and one anti-emetic

Phenergan

Reglan

Zofran

there is an occasional Toradol slipped in there for pt's who are not *allergic* to every NSAID or non-narcotic pain reliever known to man.

And the MD's wonder why we have such a drug seeking problem.

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and we usually give Toradol 30mg for IV use and 60mg for IM use.

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Specializes in Emergency & Trauma/Adult ICU.

Most often it's Compazine 10mg & Toradol 30mg IV. And depending on the doc ... a head CT.

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