Wednesday, October 15, 2008

Better Approaches to ER Treatment of Migraine


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A recent Headache and Migraine News Blog post on the use of Demerol for treatment of migraines in the emergency room sparked a thoughtful conversation on the best ways to approach treatment of unrelenting migraines that spread to other blogs.

Demerol for Migraine in the Emergency Room

Ridin' That Train

The Big "D"

Demerol is sometimes used for hard to treat migraines in the emergency department. While it works just fine for some people, there are some real problems associated with its use in treating migraines that have nothing to do with the potential for dependence or addiction.

You can read more about that by following the above links. I'd like to talk specifically about good alternatives that you should know about.

If you haven't already tried triptans to treat the attack and can take them, this is probably a good place to start. Triptans are specifically designed to abort migraine attacks and do a good job for most people. However, if you've already taken triptans and the migraine has not gone away, you will need something else.

There are a number of highly available options that can be administered by IV to abort your migraine. Depacon (valproate sodium), dexamethasone (a steroid), magnesium, lidocaine and antinausea medications such as Reglan (metochlopramide) and Phenergan (promethazine) are all options. Some doctors may also be interested in trying a pain reliever such as morphine.

Dr. John Claude Krusz and Teri Robert have prepared an informative, thorough article about the use of IV therapy for difficult to treat migraine attacks.

Effectiveness of IV Therapy in the Headache Clinic for Refractory Migraines

If you find yourself heading to the ER (or even just to your doctor) for treatment, you might want to consider bringing along a copy of the article. Most doctors will already know how to develop an effective plan for treating the pain and other symptoms of your attack, but if not, it would be helpful to have that information on hand to share so you can receive the right treatment to deal with your condition. Asking for IV therapy up front may also help clarify for the ER staff that you are not a drug seeker pretending to have a migraine attack.

Have you been to the emergency room for treatment of an unrelenting migraine? What were you treated with and how well did it work?

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