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"Question Re: "Migraine Cocktail" at E.R."

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Brenda14 Click to EMail Brenda14Click to check IP address of the poster Sep-16-07, 00:12 AM (CMT)
"Question Re: "Migraine Cocktail" at E.R."
I just read Sailing Muffin's post about being given a "migraine cocktail" at the E.R. (Lots of different meds, administered via IV, I assume).

This is what I wish MY E.R. would give me! I don't care whether or not it has narcotics; all I care about is ENDING this marathon migraine.

Whenever I've gone to the E.R. (always for long lasting status migraines) I'm just given an IM shot of morphine or Dilaudid. (I was recently at the E.R., they gave me Dilaudid, and it only helped for 4 hours).

Even IF the E.R. doc is NICE (and we all know there's no guarantee of that!) I'm just a little bit too intimidated to start ordering the doctor what HE should give me.

Even if I printed out Sailing's post (which listed the IV meds) and handed it to an E.R. doctor, would they go along with that?

Probably not, I'm guessing. If it goes against their "usual" way of treating migraines, E.R. docs don't seem to be very flexible.

E.R. docs always seem to be very CERTAIN that whatever they give is going to end a migraine, in my experience. And I really can't imagine saying, "No, doctor. Actually, I need this, this and this, etc." (Even if it involves NO narcotics. I STILL feel VERY awkward about telling a doctor what to give me.)

My neuro is currently on vacation, so HE can't order up anything for me.

It is so much work just for me to arrange a RIDE to the E.R.! Then, to not even get (permanent)relief is disappointing beyond measure.

Does anyone go to the E.R. and get the IV fluids and "cocktail" automatically (WITHOUT prior instructions from a neuro)? I'd really like to TRY the "cocktail", because who knows? It just MIGHT work.

Thanks for any feedback. And (unfortunately) I don't have anyone to "advocate" for me, so it's all up to me.

And of course, when one is in THIS level of pain, it can be very difficult to have much of a "conversation" about ANYTHING---much less give ORDERS to an E.R. doctor. It's TERRIBLE to be all alone in this----I wouldn't wish it on ANYONE.

Thanks for any feedback or advice! Best wishes to you all!

Thanks,
Brenda

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 Table of contents

RE: Question Re: , sailing muffin, Sep-16-07, (1)
RE: Question Re: , loaconstrictor, Sep-16-07, (2)
RE: Question Re: , decaty07, Sep-16-07, (3)
RE: Question Re: , Brenda14, Sep-16-07, (4)
RE: Question Re: , Brenda14, Sep-16-07, (5)
RE: Question Re: , sailing muffin, Sep-16-07, (6)
RE: Question Re: , loaconstrictor, Sep-16-07, (7)
Migraine Cocktail, headhurts35, Sep-18-07, (8)
RE: Question Re: , LTAYLOR, Sep-18-07, (9)
RE: Question Re: , VickiG, Sep-20-07, (10)

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sailing muffin Click to EMail sailing muffinClick to view user profileClick to check IP address of the poster Sep-16-07, 03:37 PM (CMT)
1. "RE: Question Re: "
Hi,

I have heard of "migraine cocktails" before. The first one I had was at a different hospital, and had different things in it. I agree that it might be worth looking into something similar.

I am surprised to hear that they just give you the shot of pain medication. Even when that is what I needed, it was almost always given with phenergan or another anti-nausea drug- or at least benedryl.

When I was living in Virginia, my neuro there gave IVs in his office, because he said it saved a lot of troublel. I had a bad one, so he had me come in for a few days and we finally hit the right cocktail for me. The best consists of IV Depakan, Benedryl, Phenergan, and morphine or diaudid. If it is bad enough to send me to the ER though, I will usually ask about adding some decadron as well, cause that seems to make it last longer.

Anway, as you read in the other post- here is what I got on Thursday: "Migraine Cocktail"- Decadron, Benedryl 50mg, Reglan, Toradol, and a liter of fluids. After that, I was given IV Depakan 500mg and 5mgs Morphine.

I think the "migraine cocktail" varies from place to place. This is the second time I have had that one though. It does sem to work. I think the other meds help to knock me out though and that the sleep helps as well.

Next time you see your dr, you might want to relate the fact that you got only limited relief from the ER and see if he has any ideas. If nothing else, he can write it out a prescription pad so you will have it at the ER.

I know it is hard to go to the ER and hard to ask someone to go with you. When I was in undergrad, I used to say, "Can you please take me to the hospital? I'll buy you dinner later!" It worked on college students.

It sounds like you definiely need a lettr from your neuro when it gets that bad. Also, you might see if there is anything he could let you have at home that might keep you out of the ER.

I hope this helps. Let me know if I can do anything else.

Pain free days,
sailingm

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loaconstrictor Click to EMail loaconstrictorClick to view user profileClick to check IP address of the poster Sep-16-07, 04:24 PM (CMT)
2. "RE: Question Re: "
LAST EDITED ON Sep-16-07 AT 04:25 PM (CMT)

Sailing~

Your Cocktail is almost identical to what I get, except I need Phenergan instead of Reglan because I interact poorly.

Second round they move to IV magnesium and Depakon, then they hit the narcotics in the third round, if needed, I believe.

My ER won't do pain meds for migraine in the first round without a Neuro calling in auth or having standing orders on file, and that's fine for me - the coctail works better, anyway.... it breaks it, and the results last....!

I usually get sent home with a 5 day supply of steroids and a course of nausea meds, too.

~Liz

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decaty07 Click to EMail decaty07Click to check IP address of the poster Sep-16-07, 05:50 PM (CMT)
3. "RE: Question Re: "
I went to the ER today and boy am I loopy and yucky feeling even though they gave me zofran.. They got an iv started after 5 sticks they started out with zofran and 2mgs of dilauded then 15 min later she brought in 2 more mgs of dilauded.. when that didnt do the trick they gave me 4 of morphine on top of it and my bp was still 152/100 and im still in horrid pain as i type this they said they will more than likely admit me tomarrow for pain control which means dilauded or morphine every hour for 2 days then weanning me down to oral pain meds whatever that is boy this sucks ill tell you that im just feeling yucky plain and simple.

Sara

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Brenda14 Click to EMail Brenda14Click to check IP address of the poster Sep-16-07, 06:36 PM (CMT)
4. "RE: Question Re: "
Thanks, Sailing, Liz, Sara, everyone!

Sailing: I guess I should specify: On most occasions they seem to give me the IM morphine ALONE. But when I recently went to E.R. and they gave me Dilaudid, they DID give me Phenergen along with it. Either way, it doesn't seem to make any difference.

And thanks for relating how difficult it can be getting a ride to the E.R.! I feel so guilty asking a friend to give up his or her time. I'd LOVE to buy my friend dinner in return, but I never seem to get well enough to go out (at least not for several months!).

Anyway, my MAIN QUESTION is: If I go to the E.R. with a list of IV meds, is there any chance in this world that I'll actually GET this?

I know, there's no way you guys or anyone else could really know the answer to THAT question! Perhaps someone who works in an E.R. might know.

My other QUESTION is very similar: Is it okay to give orders to an E.R. doc as to which meds to give me? I'm SO intimidated...

Any advice is greatly appreciated! Good luck to you all!

Thanks,
Brenda

My main question to everyone is

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Brenda14 Click to EMail Brenda14Click to check IP address of the poster Sep-16-07, 06:38 PM (CMT)
5. "RE: Question Re: "
No, there's no other "main question" there at the end! Something just went wacky and I don't know how to edit!

Brenda

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sailing muffin Click to EMail sailing muffinClick to view user profileClick to check IP address of the poster Sep-16-07, 07:38 PM (CMT)
6. "RE: Question Re: "

Hi,

I usually try to get a letter from my dr stating that I am a patient and what meds i take for the ER. I have also had them write out what to give me just in case I have to go to the ER. It has never been a problem. Most of the ER drs accepted it and felt better because it showed that I was a legitimate patient. One wrote it on a prescription pad and the other in letter form, but I never had a problem in the ER.

It would not hurt to ask.

Pain free days,
sailingm


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loaconstrictor Click to EMail loaconstrictorClick to view user profileClick to check IP address of the poster Sep-16-07, 09:20 PM (CMT)
7. "RE: Question Re: "
I don't ever give doctors "orders"... but I don't ever feel shy about telling them what works and what doesn't.

A cocktail like what I usually get doesn't get any resistance when requested - there's no narcotic component to it, so the docs are more than happy to oblige. When I request IV magnesium, I do get some push back from certain docs, but my Neuro explained to me that some docs have had patients have bad SEs from IV mag, so they shy away from it, which may be why I get push back.

If I wanted something stronger, my Neuro is very much in the loop on my treatment, and I know he would back it (as long as I presented a solid case to him), so I'd simply call him first and request that e call orders ahead. Other members have written letters from their docs that seem to work, but my Neuro has had problems with those in our area because the ERs want items with current dates - I'd need a letter from that day, which would require an office visit, THEN an ER trip. Makes no sense.

However, the combo of decadron, phenergan, toradol, benedryl, and fluids works better for me than ANY single shot of narcotic has worked, hands down. Also, I had good luck using oxygen at an ER visit once, as well.... my Neuro cautioned me though that unlike cluster headaches, Migraines will develop a tolerance to oxygen treatments. Pleh.

Anyway, good luck to you....

~Liz

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headhurts35 Click to EMail headhurts35Click to view user profileClick to check IP address of the poster Sep-18-07, 09:50 AM (CMT)
8. "Migraine Cocktail"
My Migraine cocktail is always the same. I have it listed in my file. They start me with IV fluid, benedryl, phenegen & Torodol.
This usually works for me. Sometimes if I've gone through a bag of fluid and haven't gone to the bathroom they will hook me up to more fluid. Good Luck finding your right combo Bonnie
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LTAYLOR Click to EMail LTAYLORClick to view user profileClick to check IP address of the poster Sep-18-07, 09:32 PM (CMT)
9. "RE: Question Re: "
My docs always ask me what works. Even though I don't go more than a few times a year the staff has not changed much and they know me by now. I guess it just saves time looking up the info.

It really depends on how long and how severe the migraine is but it ranges from Fluids, Morphine & Phenergan to those plus ativan, zofran, and benadryl. And then repeated or changed doses if it is super duper bad but I try not to let it get to that point any more. I get yelled at by my ER docs for letting it get so bad before coming in. I know how lucky I am and I wish everyone had this type of help available to them. Peace, L

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VickiG Click to EMail VickiGClick to view user profileClick to check IP address of the poster Sep-20-07, 04:31 PM (CMT)
10. "RE: Question Re: "
I think Liz hit on the point I was going to make. My experience has been that the people in the ER are much happier giving a medicine or combination of medicines that is not a narcotic.

So if you were to print out what people get when they go to the ER and show it to the doctor, you might just ask, "Do you think this would work for me? It seems to work for some other people I know?", it might work. Make it seem very clear that you are asking the advice of the knowledgable doctor, not telling him or her what to give you.

But since they are willing to give you a narcotic in the first place, I would think they would be willing to try something that doesn't include a narcotic and hold back the narcotic for later if the first round doesn't work. Or maybe even add it in with the first round.

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