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Tuesday, July 19, 2011

migraineur madness

We have "care plans" in our ER. These are basically "feel free to go into the ER this many times per month and get shot up with narcotics" care plans. They are written agreements between a patient and their doctor for treatment for things like migraines. So and so can come in twice a month and get dilaudid or some other fun drug. And you can be sure that every month, like clockwork these people are there. The first week of the month, they line up at triage.

Most of them are migraineurs. I shit you not when I say that we start IVs and give a combination of drugs to these people. Then they go on their merry way.

My son has migraines. Since he was a kid. All of his life he has refused to take medication mostly because he doesn't like to swallow pills, but also because he just doesn't want to take medication at all. So he just waits them out, sleeps and they go away. He doesn't make a big deal of them. He lives with them. Perhaps, he has a less severe type of migraine than most, I don't know. The thing is he reminds me that there are thousands of people with migraines and they manage them at home or with their own doctor. They don't need "care plans". They aren't addicted to narcs.

15 comments:

Cartoon Characters said...

I get horrific migraines and I have never gone to an ED for one - not even once. Neither have I seen my MD about them either.

I have this little concoction that I whip up: Ibuprofen mixed with benadryl / I pack my head in ice and tie a vice around my head and sleep it off....and then if that doesn't work I throw in some Mersyndol.

I have actually been at work with one - no one to replace me and they wouldn't let me stop for a second - I just throw up and carry on. The auras are unreal.

Honest to god, sometimes it feels like a knife is stuck in my head.

I should probably try one of those fancy schmancy migraine meds they have now...but so far, until I pass out from pain...I will stick with what I have.

Cartoon Characters said...

btw: *apparently* a brain freeze sometimes works for a migraine. I haven't tried it yet, but you could send all the migraineurs down to the local 7/11 for a slurpee and see how it goes for starters.

:) Nothin' like trying good ol' home treatment for starters.....

Nana said...

Inneresting timing...apparently, some staff members have spread word that Michelle Bachman has disabling migraines on a regular basis. We'll be hearing more about how debilitating they are, what (and whether) medications, blah, blah.

Anonymous said...

it depends on the severity of their condition and their response to alternate drugs. They don't always work and sometimes the only alternative is to have the stronger stuff. Frequency of the migraines can also play a part its not unheard of to have 4 a week.So it doesn't suprise me if these poor people get to the end of their tether and seek relief. Most likley they have been in pain for days. It is also very unlikley that a pain doctor would authorise the drugs if they were an addict. They are not stupid. Your son is lucky for now but migraines change over the course of a lifetime so he may even find himself in the position of your patients dealing with blinding pain and unsympathetic staff.

Anonymous said...

it depends on the severity of their condition and their response to alternate drugs. They don't always work and sometimes the only alternative is to have the stronger stuff. Frequency of the migraines can also play a part its not unheard of to have 4 a week.So it doesn't suprise me if these poor people get to the end of their tether and seek relief. Most likley they have been in pain for days. It is also very unlikley that a pain doctor would authorise the drugs if they were an addict. They are not stupid. Your son is lucky for now but migraines change over the course of a lifetime so he may even find himself in the position of your patients dealing with blinding pain and unsympathetic staff.

Nurse K said...

The care plans for migraineurs aren't about the patient. It's to keep them from harassing the primary care doctor for narcotics and turfing them to the ER. Once you're to the point that local ERs need a "care plan" for your headaches, you've probably been a manipulative addict for a long, long time and the doctor is just sick of you.

Dr Killpatient said...

Right Nurse K, Totally true. This is a get the hell out of my office order that for some dumb reason is followed by ER's. I for the most part, use them for toilet paper.

Anonymous said...

I get bad migraines. Vomiting, auras, everything. But what I have learned that HAS helped me is essential oils. I use peppermint oil and lavender oil when one starts. I also drink caffeine when I feel one coming on. I don't drink it any other time so it really works. I feel for people with migraines because it was hell trying to figure out what worked for me. But maybe that will help someone else like it did me.

Anonymous said...

Oh and I have had migraines for a week at a time. Talk about hell. You can't sleep through it. Nothing. So although I have never gone to the ER with a migraine I can see how someone else can. Although not too excessively. I asked a doctor what the causes of migraines were and she said : stress, hormones and lack of sleep. All of which I struggle with. There has to be a delicate balance. But I guess all you have to do is pull up a med list and see what is really going on.

TheTracker said...

I treat migraine in the ED all the time and I'm deadly earnest about it. I come down on that pain like the wrath of God. 2L NS, toradol, zofran, benadryl, compazine, and if that doesn't cut it, straight to the depakote. Decadron if it's a long one. I don't fool around. But I never, ever use narcotics. Ask any neurologist. They are useless. The rebound headache will hit them before they get out of the parking lot. Absolutely futile.

I don't fight with patients about it. I just say those drugs aren't used for migraines. I wouldn't give you an antibiotic for a broken rib, and I won't give you narcotics for a headache.

Anonymous said...

Those of you who call yourselves nurses have been working too long. You have become jaded and have lost your ability to be compassionate.
I am a chronic migrainer. I take several preventatives, abortives, and antidepressants. I have seen internists, neuros, headaches specialists and shrinks. I live in pain. I have a pain plan with my hospital. I get up four shots a month. I do not take narcotics at home...you cannot get addicted to 3 or 4 shots a month (I very seldom use all 4). And by the way a professional would know the difference between addiction and dependence. Pain patients do not become addicted, they build a tolerence as there body needs more medication to handle their pain.
Unfortionatly the chronic pain patient has become the inocent victim of the war on drugs...and people like you are not helping!

TheTracker said...

Anon, narcotics aren't helping you.

Try a different neurologist.

Myron said...

Pretty helpful info, lots of thanks for this article.
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Anonymous said...

Oh man, I just love reading about how health care professionals know nothing about the medical conditions they treat. Would you tell a cancer patient they were just looking for attention? Them why would you tell a migraine patient that they are drug seekers?

I have suffered from migraines for 4 years. I haven't been to the emergency room yet, but I have certainly come close to going and wimped out because I was afraid of the noise and the horrible treatment by assholes like you. So instead I lay in bed praying that I am not dying.

Aside from the pain, there are very legitimate reasons for migraneurs to go to the ER. For example, if you have a migraine for over 72 hours it is considered a static migraine and you need to go to the ER to break it because you are at high risk for a stroke. Hopefully someday you can feel this pain or watch your son feel this pain (because what you describe now does not sound like he has migraines - it sounds like he is a wimp with normal, stress headaches).

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