I have chronic migraines (about 25 a month), and occasionally go to the local ER when my meds don't help and the pain lasts for 2 or more days. The first couple times I went, the drs were happy to give me dilaudid, but the last couple of time, the drs (a different dr each time) refused to give me anything but a Benedryl cocktail, which doesn't work. I've gone to the ER a total of 5 times in the past year and a half. Is there any advise on how to get the meds I need without seeming like a drug addict?
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Q: I need advice on how to make sure I get the pain meds I need and actually work on the few times I go
Answers (3)
11/ 6/11 2:26pm
Shannon,
-:¦:-•:*'""*:•.-:¦:-•*Welcome to MyMigraineConnection!*•-:¦:-•:*'""*:•.-:¦:-
There really is no way to be sure of anything when you go to the ER. Different hospitals have different policies, and different doctors respond differently. Many ERs and doctors will not administer opioids for Migraine, for multiple reasons.
First, opioids can't abort a Migraine. All they can do is mask the pain for a few hours during which, hopefully, the Migraine will end on its own.
Second, ANY use of opioids increases our risk of developing transformed or chronic Migraine. For more on this, take a look at Transformed Migraine - Risk Increased by Some Medications.
Lastly, the "bad apples" have made things more difficult for everyone. When true drug seekers go to the ER trying to get opioids, the top complaint they use is Migraine. One reason is that there's no diagnostic test to confirm that a person has Migraine, so they think faking a Migraine is the way to go.
What does your specialist say about your ER visits? He or she should be willing to prescribe rescue medications for you to take at home when Treximet and Cambia fail.
If you must go to the ER, try asking them about an IV infusion of magnesium sulfate. It can abort a Migraine and is safe and innocuous. There are other medications that can also be used in IV infusion. You can find more information on that in IV Treatment of Refractory Migraines.
I hope this helps!
Welcome again,
Teri
11/ 5/11 1:35pm
Do you have a migraine specialist that is working with you to help get your pain under control? Are you on a preventative medication? It's really not surprising that ER doctors do not want to prescribe dilaudid when you go in. I know that the ER at the hospital I work at has a new policy in the last 6 months or so to not prescribe more than 15 tablets of any controlled substance and give the patient a referral to a specialist for their complaint for ongoning treatment, it seems that this is the trend at many hospitals now. If you do have a migraine specialist, have you talked to them about prescribing something you can take when you would normally go to the ER?
11/ 5/11 2:44pm
I completely understand the days that the pain is so unbearable that the ER is the only option. I was in the ER quite a bit several years ago and finally ended up switching to a new specialist because I felt like the one I had been seeing didn't care if I was in the ER or not, she didn't think that I needed to change my meds. My new doc immediately prescribed toradol both oral and injectable, which have saved me! I am one of the unlucky people who can't tolerate triptan medications so I don't have a lot of options. I have used DHE 45 injections in the past which helped for about a year then they became not as effective. Ask your doctor if there is a rescue mediation like toradol or fioricet that they can prescribe that you can take along with the meds you already have. Hopefully that will help keep you our of the ER!
11/ 5/11 3:22pm
I have both toradol (for my fibromyalgia) and fioricet (the ER prescribed it the last time I was there). I've had migraines for 20 years, and during the past few years, my doc (who's one of the most highly regarded headache specialists in the country) and I have tried everything on and off-label. We don't want to put me on narcotics long-term, since I'll end up with rebound headaches that are worse than the original migraines (been there, done that). The ER is always the very last resort- Why would I want to sit in a loud, bright ER waiting room for 5 hours if I didn't absolutely have to? I guess what I'm asking is how I should approach the ER docs; am I saying or doing something that makes them think I'm faking it? Is the problem me, or is it them?
11/10/11 3:46pm
I'm so sorry for your constant pain. I've suffered migraines since the age of 12 (I'm 52), but they got worse as I went into perimenopause in my early to mid 40's... almost daily. I found a new, wonder neurologist who put me on baclofen (10mg at bedtime). He also gave me a prescription for Relpax (one of the new triptans). I, too, had tried everything. Topamax was a nightmare. So, I was skeptical.
The first thing I noticed is that I slept so much better (Baclofen is a muscle relaxer and is non-addicting). After a month I realized that I was no longer waking up with headaches in the morning. If I did get one, the Relpax aborted it within an hour. It's now 2 1/2 years later and I haven't had a migraine in 2 years. I still take the baclofen every night (still 10mg). It's been a miracle for me. Please mention it to your doctor. And good luck!!
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By Shannon— Last Modified: 11/10/11, First Published: 11/03/11
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Yes, I do have a headache specialist, who has me on a number of meds, including preventatives and abortives. The only times I've gone to the ER is when both abortives (Treximet and Cambia) have not helped. Since I can't take both the Cambia and Treximet on the same day, this means that I only show up at the ER when the migraine has lasted more than 48 hours. But now I'm afraid to go to the ER out of fear that they're going to treat me like a junkie. It's hard enough to get a layperson to understand what my migraines are like; I shouldn't have to fight so much with doctors who should know better.
Also, the only reason I've asked for dilaudid is because I know it works. I'm completely open to anything that's NOT a narcotic, however it seems the only trick up their sleeve is the Benedryl cocktail, which NEVER works. Any suggestions would be wonderful.