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

[froghair]

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?

[HAPPYNPROUD]

i worked as a medical asst years ago before going to nursing school in a doctors office and i could have sworn they used some type of histamine iv drip weekly for chronic migraine pts--has anyone heard of this?--we use a lot of compazine and toradol to start in the ed i work in, hadn't used demerol in years--some times morphine 2mg, dilaudid 1mg if they insist in addition to the fluid bolus, and if they keep it up, they can be guaranteed a lumbar puncture---that usually miraculously heals the drug seekers after the explaination of the procedure and consent are presented

[moonchild20002000]

I wonder why ER docs don't use meds like Zomig,Imitrex and others that are

for migraines?

Any ER nurses have any thoughts on this?

[teeituptom, BSN, RN]

I wonder why ER docs don't use meds like Zomig,Imitrex and others that are

for migraines?

Any ER nurses have any thoughts on this?

Because the patients come in saying they are allergic to them.

[KatieBell]

Because the patients come in saying they are allergic to them.

exactly.

and in some smaller ED's the MD's seem to be pretty old school.

[teeituptom, BSN, RN]

personally Im all for just giving them a menu, giving what works best for them and sending them home.

[CEN35]

Ours was doc dependant. 90% Compazine. If they are allergic to compazine (allegedly), Demerol vistaril.

After CT Toradol.

Always the variance of triptans and sometimes DHT.

[ayndim]

I wonder why ER docs don't use meds like Zomig,Imitrex and others that are

for migraines?

Any ER nurses have any thoughts on this?

Imitrex can be pretty nasty, imho. I had a shot of it once and felt like my head was on fire. You know like when your hand falls asleep and then "wakes" back up. The pain was worse than the migraine. Okay not really but it still hurt like :angryfire . I wouldn't say I was allergic but I wouldn't want it again.

[pickledpepperRN]

I get migraines and Imitrex is a miracle to me.

Back when it was subcu I would get tingling around my mouth. It made me almost normal in about 30 minutes. Good enough to go to work.

The tablets take up to two hours without side effects.

I've never been to the ER for a migraine because I can usually sleep anyway. Tylenol PM knocks me out if it gets too bad.

I have spent as many as five days in bed with my eyes covered and vomiting into a trash can every few hours.

Not for the last decade thanks to Imitrex. Originally I spent $$$ to see a neurologist at a headache clinic. Now my family practice Doc prescribes it. AND Inderal, B vitamins, lots of fluids, and minerals too. I thought stress from an extra busy night made a migraine when I finally got home. Turns out it was dehydration from not eating or drinking for a 12 hour night.

Perhaps some ER doc will try triptans.

[teeituptom, BSN, RN]

one of our docs always gives

Reglan 10

Benadryl 25

toradol 30

Dilaudid 2

decadron 10

and 2 liters NS

cures them or kills them

would you believe some always want more dilaudid

[elizabells, BSN, RN]

Imitrex can be pretty nasty, imho. I had a shot of it once and felt like my head was on fire. You know like when your hand falls asleep and then "wakes" back up. The pain was worse than the migraine. Okay not really but it still hurt like :angryfire . I wouldn't say I was allergic but I wouldn't want it again.

Me too. I think. The one time I've been to the ER with a migraine I got...something, and for the life of me I don't know what it was and couldn't even tell you if it was IM or IV - I get really out of it with a bad one. All I know is I thought someone lit my hair on fire. Once that went away, the migraine went with it, but it was definitely scary.

[LoveTheNICU]

i worked as a medical asst years ago before going to nursing school in a doctors office and i could have sworn they used some type of histamine iv drip weekly for chronic migraine pts--has anyone heard of this?--we use a lot of compazine and toradol to start in the ed i work in, hadn't used demerol in years--some times morphine 2mg, dilaudid 1mg if they insist in addition to the fluid bolus, and if they keep it up, they can be guaranteed a lumbar puncture---that usually miraculously heals the drug seekers after the explaination of the procedure and consent are presented

As a past chronic migraine sufferer who was treated at the Diamond Headache Clinic in Chicago, I can tell you that they used to use histamine treatments for people who suffered from cluster headaches, rather than migraines... inpatient, it was like a 3 to 7 day cycle of q8 bags, but I know that some people received them outpatient prophylactically.

[flashpoint]

Imitrex sends me into SVT...I would rather have a migraine than feel my heart rate racing up to 180...:)