First I quote an answer given on this forum, then some about me, comments, and my experience/suggestions:
"A: Yes! You can go to the hospital if you are in severe pain and it will not stop and you can't manage the pain. It is especially important to go to the hospital if you feel like you are going to be at risk to yourself or others because of the pain. Hospitals in different countries and different areas of different countries all have different protocols for treating severe migraines, so I can't answer what types of treatment you will get for sure. Although, for the most part, emergency departments will treat severe migraines with at least one of the following medications or a combination of the following:
- If you have not already used two doses of triptans in the last 24 hours, they may give you an injection of sumatriptan.
- They may give you an antiemetic medication by IV that is called metoclopramide.
- They may give you IV fluids, such as normal saline
- They may give you an ergot alkaloid.
- They may give you oral pain killers or pain killers by IV. The pain killers could be tylenol/acetaminophen, morphine or dilaudid/hydromorphone.
- They may leave you to rest in a dark room.
- They may run tests such as a CT scan, an MRI, an EEG, and/or blood tests."
First, let me tell you that I suffered my first migraine at age 11, they went up to 5 to 6 times a year when I got my menses, and became chronic, near daily in 1996. Post-hysterectomy now for over 3 years, I get them about 5 times a month. I have been on drugs in every class of preventative, taken a number of abortive agents and spent more time in the ER than I would have cared to, as well as went for stints of acupuncture, including blowing thousands of dollars on a trip to the Ontario Migraine Clinic out of desperation because of recommendation and what they touted.
Okay, let me say tylenol on its own would never have touched a 10 migraine for me in the ER, so if they suggest that's all they do, please don't waste your kidneys on it. And not mentioned in the answer above, but if they offer you toradol, you might try it once, but I don't know anybody that toradol has helped with a bad migraine, me included. If it doesn't work, I'd forget it in the future (my opinion). If your like me, most anti-nausea meds given IV make me highly nervous, so you might try for one in an IM shot form, like I did with much better success with that problem. And while you are waiting for hours (if you are in a crowded ER like I frequently was) to be called back, be sure and have on hand an emesis basin and ask frequently for ice paks from the front desk to help freeze the pain (if that helps you as it often has me). I learned long ago in nursing school that the sensation of cold trumps the pain sensation. But occasionally, it actually makes my migraines worse, so if that happens, by all means quit fast!
I used to see Dr. Richard Shubin, associated with Fortnasce in CA and he told me morphine was a bad drug for heads and ineffective for migraine pain and my experience with that drug for migraine bore him out- ineffective. I tried sumatriptan shots at home and the second one gave me such horrible abdominal cramps, my migraine paled in comparison (not everybody's experience, I'm sure). They are optimally given when the migraine is first starting, and would I believe far less likely to be effective if they were given when your migraine reached a level 10. You can also get rebound headache potentially from imitrex pills, at least I used to, as well as chest pains (not supposed to be used if you have certain heart problems, which I'm not sure I had, but got chest pain anyway, though what stopped me from taking them was the rebound headache when they stopped being effective.
I was never offered an EEG at an ER or by the neurologist who followed me the longest, who diagnosed me with common, intractible migraines. Nobody ever thought it was warranted for my migraines, so there must be some kind of criteria (like other neurological symptoms that I didn't fit). If it is your first migraine, or it has been five years, they should offer you a cat-scan or MRI when you have a 10 migraine in the ER.
Lastly for now, may I suggest, try to get to where you have an emergency plan where trips to the ER become rare, because your body can get addicted to narcotic medication, as mine did. The one thing that went right about Canada is that I got off the demerol shots (which I was so scared because they were losing their effectiveness with the pain) and a lot of the pain medication to go there. I was sick as a dog and in pain for the 7 weeks I was there and Brendan Cleary could not count me in his claimed 94 percent success rate, or even in his typical failure, which he claimed was where the person got migraines five or six times a year, but I was so desperate and I did get off a lot of medication that may have been driving the headaches on even more. Once I was off most the drugs, I came home with plenty of migraines, got some help for awhile with acupuncture and prescribed "coptis purgefire" by "HealthConcerns", and got to the point where drugs that wouldn't have helped anymore before started to be more effective.
I now take either 2 extra strength tylenol (sometimes with 4 low dose aspirins) or 600 mg ibuprofen and 25 mg phenergan in the evening (or occasionally valium 5 mg at times when TMJ is involved) for migraines, augmented by ice paks. I have demerol, 100 mg tablets, which I take very rarely, as my emergency pain medication. Thanks be to God, Who has kept me out of the ER for migraines for a long while now.
Thank you for all of this added information! It's good to know about different people's different experiences in ER situations!
I based my answer on my own local hospital's protocols for treating acute severe migraines as well as my own experiences and the experiences of those who I had already spoken to. But, as I said, protocols can vary to quite a degree depending on the area you live in and sometimes a hospital might even adjust their regular protocols for returning patients if that patient has a specific treatment plan that works well for them. So, it is always good to hear about the experiences that others have had at the ER and I am glad that you shared this with us!
Personally, I have never been given a triptan in a hospital, as by the time I get to emergency I will have already taken the recommended dose of triptans, but it is always the first thing they ask me. My personal treatment plan at the ER always includes hydromorphone, metoclopramide (by IV) and IV fluids (normal saline), which has been the only thing that has ever worked to completely relieve my pain. Metoclopramide is an unusual antiemetic as it is used as a migraine medication, not only to treat nausea but to treat migraine pain as well.
I put that note in there about acetaminophen because I have been offered OTC medications such as acetaminophen while waiting to see a doctor in emergency before, as that is all the nurses are allowed to give to patients. So, I just thought I'd warn people that they may get offered medications that they could have taken at home when at the hospital and they can also ask for these types of medications too if desperate, as such medications usually don't need a doctor to sign off on them, depending on what country or area you live in. But, you are so very right that an OTC pain killer would most probably do nothing for a severe migraine headache!!! I never touch OTC pain killers anymore (well, for migraines) for that very reason! I just stopped seeing the point!
As for the EEG test, both EEGs (brain/seizure test) and ECG (heart test) are sometimes done if someone comes into the ER with stroke, seizure or heart-attack-like symptoms that can sometimes accompany a migraine. Many of our forum members here have had "unusual" symptoms with their migraines before or they suffer from Hemiplegic Migraine or Basilar Migraine and so they always have stroke-like symptoms with their migraines. The first time someone has "unusual" symptoms, the ER doctors tend to take it seriously and tend to want to rule out stroke, seizure and heart attack.. so they may run tests like an EEG or an ECG. The first time I had a Hemiplegic Migraine, the ER doctors did a CT scan and an MRI in the same night (even though I had an MRI done very recently), and an ECG and they referred me for an EEG at a later date. So, you are right, usually for a common or classic migraine, these sorts of tests would not be done and only a CT scan or an MRI would be done, although it is possible that in some circumstances other tests might be run as well in order to rule out another more serious.
Anyway, thank you so much for sharing your ER experiences! And, I am so glad that you haven't been to the ER for a long time now!! I also haven't been to the ER for a while either, actually a whole year now and I am so grateful for it as well!! Not having to go to emergency is a wonderful thing!! :)
I now live in a small city in a different state, but I think the environment of the ER of Southern California can be so stressful and exhausting in itself, with all the waiting. One patient commented jokingly about the waiting room- why do they have one if it's an emergency?
As migraine sufferers, it is not considered life threatening oftentimes when one goes in (never has been for myself) and so I used to often wait for hours to even be given a room in a waiting room with two tvs making noise, often noisy children, squalling babies and even the aggravating sound of a printer behind the desk buzzing away. I wished so bad that they would just give me a shot of the pain med and nausea med and let me sit back in the waiting room for twenty minutes and let me go home- it could be so quick. I was in so much pain as patient after patient would get called in ahead of me, as the nurse triaged. They evidently even had different sections of the ER, because once when I was in tremendous pelvic pain due to an endometrioma pressuring my ovary, I waited hours because they didn't have a room in a particular section designated for cases such as mine.
I wished for and fantasized about a special small migraine clinic at the hospital open 24 hours where it was very dimly lit in a quiet waiting room and help was much quicker in coming. Wouldn't that be marvelous compared to trying to find a seat available in the darkest corner of the brightly lit ER waiting room, not too close to the tv?
You have had a difficult ER past is sounds like. I have to some degree, if they don't do anything. However, the one thing I loved they used was DHE. I am cautious with OTC meds as I tend to get rebound headaches, so am never sure, and don't want to take too much.
Thank you so much for such a good experience for us to hear.
Please, let's open a Migraine clinic!!!!
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