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

Specialties Emergency

Published

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?

Our docs tend to use narcs (grr) ... but one started using imitrex ... until 2 weeks in a row the patient died! (Unknown, pre-existing aneurisms that blew). Please just know that it is not an inoccuous drug!

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Specializes in ER, OR, Cardiac ICU.

It is important not to lose sight of the big picture here. We should assume a patient is being honest about their migraine unless we have actual knowledge that they are not (not just suspicion). It is better to make sure that the patient's pain is relieved whatever medication or combination of meds it takes - If a few drug seekers get mixed in oh well. At least the real patients were cared for not just treated with suspicion and under-medicated "just in case they might be a drug seeker". A migraine can be excruciatingly painful.

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Specializes in OB, lactation.
It is important not to lose sight of the big picture here. We should assume a patient is being honest about their migraine unless we have actual knowledge that they are not (not just suspicion). It is better to make sure that the patient's pain is relieved whatever medication or combination of meds it takes - If a few drug seekers get mixed in oh well. At least the real patients were cared for not just treated with suspicion and under-medicated "just in case they might be a drug seeker". A migraine can be excruciatingly painful.

:yeahthat:

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Havne't read all the responses but we do:

Benadry

Pepcid

Compazine or Zofran

Toradol

And then top it off with Dilaudid or Morphine occassionally. That and a 2 liter bolus of NS. If that doesn't work then a caffeine infusion.

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Specializes in ED, ICU, PSYCH, PP, CEN.

no protocals, each doctor is different and it seems like most of them just give the patient whatever they want. After all we are healthcare workers, not cops or narcs and it's impossible to tell who the drugseekers are and who the real patients are.

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Specializes in Day Surgery/Infusion/ED.

I just love how people mock pts. who "claim to be allergic to Toradol." Guess what? I am allergic to it. I had a rash, scratchy throat, and itching after getting it IM. So sure, go ahead and sneak it into me to see if I'm a faker. Hope you have a good malpractice atty.

I try to avoid the ED at all costs because of the contempt I've rec'd in the past. I worked ED, so yes, I know there are people out there looking for a fix. I also know that for every one of those pts. are probably five who have been treated poorly by staff who assume they're guilty of being a seeker.

Migraines are complex; what works for one doesn't necessarily work for all.

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Specializes in Day Surgery/Infusion/ED.
Our docs tend to use narcs (grr) ... but one started using imitrex ... until 2 weeks in a row the patient died! (Unknown, pre-existing aneurisms that blew). Please just know that it is not an inoccuous drug!

It's not really funny, but this made me laugh. It sounds like the same pt. died two weeks in a row.

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Specializes in ER, ICU, L&D, OR.

just give them a menu

the specialty of the day is...................................................

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Specializes in Emergency.

benadryl, regalan, and a liter of .9 wide open. the patients usually feel ALOT better in 10 minutes.

in my ER we give toradol at 15mg increments........studies have shown no increased therapeutic effect with higher doses.

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why is it the most true migraine sufferers only go the the ED when the migraine has lasted greater then a day and only after they have exhausted every pain relieving method. (food for thoughtAs a migraine sufferer,morpine does not work.Studies agree with me

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Specializes in ER, OR, Cardiac ICU.

Well morphine works for some people...it just depends on the person. Each person responds differently to the different methods.

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