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

LuvDaTrauma, BSN, RN · Jan 25, 2006

We have a boat load of flyers - so one doc likes to give thorazine and benadryl. Guess it helps them sleep if nothing else!!

tridil2000, MSN, RN · Jan 25, 2006

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?

toradol 30mg iv

reglan 10 mg iv

benadryl 50 mg iv

if *allergic* to toradol

we try 12.5mg of phenergan iv

dilaudid 1mg iv

Victoriakem · Jan 27, 2006

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.

I always like to give "Ketoralac". Don't call it toradol. The drug seekers know what toradol is but not ketoralac.

:chuckle :chuckle :chuckle :chuckle :chuckle :chuckle :chuckle

TinyNurse, RN · Jan 28, 2006

i'm a traveler so i see ALL of the treatments...........the best working so far is reglan/benedryl/1 liter .9ns

so sad this isn't used everywhere................so sad i can't talk the docs into it.

patients really are very very happy after this.........

Jen

ED RN 911 · Jan 28, 2006

No such thing as .9ns It is 0.9 NaCl

Possum · Feb 16, 2006

My ED we use Chlorpromazine 12.5mg in 1lt of N/Saline over about 1hr. Sometimes we use also Toradol 10 or 30mg IM. Australia that is. We can tell the Drug seekers who come in with a so called Migraine. Close the room make it nice and dark and leave them alone helps also.

leave me a message if u would like more info. Tks

noc_owl · Feb 17, 2006

Our docs almost always order a narcotic and anti-emetic IV or IM. Even for the FF's that we ALL KNOW are coming just for the fix. These are the patients that never come below 8-9/10 pain scale while they talk andlaugh with their friends, and wail that we're "starving" them because they haven't eaten all day and we have not provided a meal in the hour they've been with us.

Then we got a new bright eyed, bushy tailed doc and for the first time in 3 years I gave Imitrex to a migraine patient. What a novel idea! And it worked!

Unfortunately, none of the other docs are on board with this.

allnurses Guide · Feb 17, 2006

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.

We do the same - usually Demerol and phenergan.

steph

flashpoint · Feb 17, 2006

Our clinic has a migraine protocol for when their patients present to either the clinic or ER...

IV 1000 mL saline bolus

Compazine 10mg SLOW IV

Benadryl 50 mg IV

Reglan 20 mg IV

If nothing else, this puts people to sleep...if we don't get good pain relief, we give 30 of toradol.

We try really hard not to give narcotics...it helps keep the drug seekers away and it prevents rebound headaches (sometimes). :)

Pedi-ER-RN, RN · Feb 17, 2006

Reglan and Magnesium IV, plus a bolus of saline for the kids with migraines. Occasionally we give imitrex. For the GYN pts with HA, usually 2 esgic plus (acetaminophen/caffeine/butalbatol) unless it is a spinal HA and then we do IVF's and a blood patch OUCH!

AggieNurse2B · Feb 17, 2006

I used to get migraines literally DAILY several years ago for a period of about a year. When it would get unbearable, my husband would take me into my neurologist's office and they would give me an infusion. The neurologist was a complete quack, and she would give me some cocktail with heaven only knows what it in. I finally got an answer one day as to SOME OF what was in it--there were about four drugs, two of which were phenergan and some kind of synthetic opium. What the #$%@??? Synthetic opium??? Anyway, the point to my story is, I found a new neurologist who is just great. Before he would really put me on any type of drug--beta blocker, etc.--he asked me take 250 mg-500 mg of vitamin B1 and/or B2 for two weeks. I thought the guy must be crazy, but I did it to appease him b/c I was desperate for help. Low and behold, I took 500 mg of B1 for a week, and it worked wonders. I went from daily headaches to one headache a month to about two headaches a year. I can handle two headaches a year! The new neuro told me that it works for a limited number of people (sometimes works with B1 and sometimes with B2), but he always tries it before pulling out the old Rx pad. Just food for thought for any of you migraine sufferers...

ayndim · Feb 17, 2006

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

Wow, I hadn't either. I am always joking that I want a caffiene IV. Gosh I could really become a frequent flier with that available.

About 2 or 3 times a year, I have been getting migraines so bad that I end up in the ER. Truthfully, demerol doesn't do a thing for them just makes you sleepy. And yet that is what they always want to start with at my local ER. And if you say "Demerol doesn't work" they think you want a different narc. I for one would prefer a non-narc, since I have three kids I have to take care of. And I really don't like feeling "high." Anyway, I once went to the ER and they insisted demerol was it and I was in no mood to argue. When I said that my migraine was still there, the nurse actually refused to tell the dr because "He already wrote your discharge papers." I felt like crying. So my hubby took me to the urgent care (about 1 hour drive) where they gave me an injection and something for nausea. Since I am still a nursing student, I hadn't been able to figure out what it was. After reading this thread, I realized it was probably toradol. Thanks guys. The ER here acts like there is no good non-narc pain relief for a migraine. I am assuming that toradol isn't a narc. Since I was still full of demerol, I wouldn't have known the difference.