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If you end up in the emergency room here in North America, and you’re diagnosed with migraine, there’s a very good chance you’ll end up with an injection. That injection is usually something called Demerol, or meperidine hydrochloride. But is that the best way to go?
Of course, Demerol for migraine is nothing new. Basically, it’s prescribed for the pain (usually headache pain). Meperidine is a powerful, fast-acting opiod (narcotic) drug.
Though Demerol may help with the pain, there are problems. It doesn’t tend to last as long as some drugs, there are issues with toxicity, and concerns about dependence. Is Demerol really the best drug to take in an emergency situation?
Though it’s being used less and less in many countries around the world, it’s still prescribed for migraine in the emergency room. A study over the summer set out to find out what other options might be better.
This was a meta-study - a review of information on the use of drugs for migraine in emergency (11 clinical trials were studied in all). The study found that many of the alternative drugs already used were more effective (or similarly effective) than Demerol at killing the headache pain itself (for example, a DHE (dihydroergotamine mesylate or Migranal) injection). (overview here)
Surely there are many options for dealing with advanced migraine symptoms, far beyond DHE and Meperidine. I hope more studies are done to find the best, fastest treatment for someone who so urgently needs it.
There may not be much we can do in the meantime. However, if you have ended up in emergency before, it would be a good idea to take a note of what worked for you (I remember being in emergency and going through a lot before finding real help!). You could make the information part of an emergency card or medicine log that you carry around and can pull out at the hospital (after all, you don’t want to try to explain it in the middle of an attack!). Remember, what worked well for someone else may not work well for you - these studies are simply looking for what is generally most effective.
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Heather 09.22.08 at 12:48 pm
Demerol usually doesn’t work for me so I ask for Stadol. The ER knows me and my migraines so they are good about listening to me. I also get Phenergan with the Stadol. Demerol usually would make me a bit sleepy but didn’t do anything for the pain and everyone knows it is very hard to sleep during a migraine.
Sandy 09.22.08 at 3:32 pm
I went to urgent care with a 2 day migraine that I could not get rid of and they gave me a shot of demerol. You can feel the drug almost immediately and it worked great. It makes you very sleepy and you cannot drive for awhile. I would definitely take it again. I am very thankful for demerol.
P.S. If possible bring someone with you so can get a ride home.
LIZ BRATCHER CARLEY 09.22.08 at 4:23 pm
Hi James…oooo I h.ave to say I am so happy you did an article on this.
I used to use demerol and I was always in a rebound loop.
I had changed neurologists and he is one of the leading neurologsits in the country for migrianes. I was told NEVER TO USE DEMEROL BECAUSE OF IT’S TOXIC SIDE EFFECT AND IT STAYS IN THE BODY FAR TO LONG!
The drug that I see most specialist use is Dilaudid. I use this for my migrianes and it does not put me in a migraine loop as I call it.
There have been studies on this and Dilaudid was the one with less rebound and it is not nearly as toxic. The other name for Dilaudid is HYDROMORPHONE.
Moriphine is also not as good as Dilaudid, where moriphine will often not get rid of the migraine totally and it comes back.
Dilaudid is one of the strongest narcotics out on the market so it is only to be used when we have those horrible migraines, the ones that are 7 out of 10 or higher.This would be used when you need to go the ER for relief!
(REMEMBER THIS IS NOT MEDICAL ADVISE YOU MUST SPEAK TO YOUR DOCTOR)
James as a matter a fact I live in Southern CA and I don’t know of an ER or urgent care that still has demerol, they have all made the switch to dilaudid.
I am so happy you brought this to light. So many who are migraineurs and are not in the health care field do not get the information as fast as doctors and such.
Just and FYI for Dilaudid, when you get it in the ER you have to ask for an anti-nausea because this medication is STRONG and it makes you very nauseas. But if you are given phenergane with it, or something of that nature it will get rid of the nausea and then he dialudid will do its work on stopping your horrible pain.
Thank you James for speaking abou this…so many do not know that there is something out there to take away those 9 out of 10 migraines.
I hope you are having a migraine free day today!
Liz
http://www.migrainecommunity.blogspot.com
LIZ BRATCHER CARLEY 09.23.08 at 3:30 am
sANDY,
I understand what you are saying. But as we know meds work differently in all!
But dilaudid will give you the same ’sleep’ affect! Which is so nice with a migraine uuuhhh!
The reason I am not for demerol is the toxicity. It stays in the body. If you use it once a year….well then that is your choice and the er. But when I first used demerol I DID NOT WANT TO CHANGE AT ALL!!!! I WAS AFRAID THE OTHER WOULD NOT WORK (my hubby is a doc would tell me to take the dilauded, i didn’t even believe him), finally I tried the dilaudid and it was different.
Just a thought
liz
James 09.23.08 at 10:24 pm
I’m glad to hear that, in your experience, Demerol is being used less. I’m not going to knock it if it works, but if 9/10 times something else works better, we shouldn’t just fall back on tradition!
There really are a lot of options. What emergency rooms need to know is what works best for most people.
What you need to know, if possible, is what works best for you.
MaxJerz 09.29.08 at 2:56 pm
Thought I would post this list of IV meds used for Migraine treatment, if you haven’t seen in before:
http://www.healthcentral.com/migraine/treatment-161484-5.html
Be well,
MJ
James 09.30.08 at 9:51 am
Thanks, MJ!
A little background for everyone else. This links to a study on IV meds given in a certain clinic when the migraine attacks and/or headaches were particularly unresponsive to treatment. A wide variety of meds were used, none of them Demerol, but all given through IV.
Almost all were “successfully” treated, most having at least a 50% reduction of symptoms, some able to return to normal life.
It’s good to see investigation being done on a wide variety of treatments via IV.
ERp 10.02.08 at 2:28 pm
As an ER physician, I have virtually stopped giving Demerol all together for any condition. There are several reasons. First, it is very short acting. Second, it has toxic metabolites. Third, it is about as addictive as it gets. Fourth, the people that get it often go into a delirious state for an hour or two afterwards. Fifth, I have accidentally OD’d several people on it - I gave the “usual” dose of 50 or 75mg and in each case they almost stopped breathingI I had to reverse them with Narcan. Sixth, there are better drugs out there - injectable Imitrex, Reglan, Decadron, Depakote, and even Morphine (which is safer, easier to titrate, and less often abused). Finally, it is a drug of choice for drug seekers who exaggerate or fake symptoms. You get the ole’ “The doctor gave me something that begins with D - yeah, that is what I want”. Some hospitals have completely removed Demerol from the formulary and they have noticed a huge drop in visits by the repeat offenders.
I just posted on a rare Migraine complication on my blog if you are interested.
http://www.erstories.net
James 10.02.08 at 3:05 pm
Thanks, ERp, it’s good to hear from someone on the “inside” of this issue. It’s not an easy topic, but I do always hope we never get “stuck” on certain kinds of treatment, because there likely are other options on the way.
Garry 10.08.08 at 4:53 am
As a D.O. in emergency medicine for aquarter of a century it had gotten to the point where even the word “Demerol” began to make me angry. I think you have to spend some time working in the E.R. to fully understand why. At the hospital where I have worked for the last 4 years it is not even on the formulary. At first this elicited attitudes of absolute disbelief on the part of some patients. “How can that be, some people need it”. For me it is the end of what used to be a small but frustrating part of working in the E.R. Thank god it is gone from my present facility.
James 10.13.08 at 10:56 pm
Thanks, Gary. I can imagine it was frustrating! Again, if there’s something that does the job better, great. Then again, I would hate to see emergency get rid of a drug just because some … maybe even most … people abuse it, if it’s still a help to some.
Barbara 11.15.08 at 7:12 pm
That’s an interesting theory, but by the time I am at the point of suicide from a status migraine I have used far more triptan/DHE type drugs than are safe. I have a 4 day “suicide danger limit” at which I can no longer tolerate the level 8 headache. It is only at that point where I am willing to ride in a bumpy car with bright lights to a bright noisy emergency room which could possibly be staffed by physicians like the one who posted about drug seekers.
Migraneurs are some of the most easy people to differentiate from drug addicts in my humble opinion, and some of the most dreadfully treated. Addicts tend to be thin with bad skin, teeth, and hair, bad veins, (though our veins do shirk with dehydration), and they simply act different than a sick person.
The instant the er physician has established the patient can’t tolerate further ergots/triptans, and established migraine history via patient and neurologist an IV should be started (assuming status h/a) an anti-emetic, then enough narcotic and I could care less what letter it starts with “doctor”, then corticosteroid if the sufferers’ migraine typically returns.
Personally I think anyone who claims a comment on headache should be a lifelong sufferer or at least have lived with a parent who was a lifelong sufferer of debilitating migraine. Otherwise, you just don’t have a clue.
James 11.17.08 at 1:52 pm
Thanks for the note, Barbara. I certainly agree that people who have dealt with migraine for many years (as you and I have) have a perspective that no one else has. I would be careful about shutting out other people from the conversation, though. Other perspectives are important - we just have to realize that every other perspective has its limitations. Doctors can see things patients don’t - and vice versa.
From what I’ve heard, I do agree with you that many in emergency rooms could do a lot better differentiating between drug seekers and migraineurs. Let’s face it - it’s a very scary thing to be on the way to the emergency room, in incredible agony, knowing that you may get someone who doesn’t understand or care. At the very place where you should be getting the best care.
I’m so sorry you’ve had such a challenge - challenges I’m sure I could never understand. But do remember, there is hope. There is hope that better solutions can be found for you. Hope that research today will bring even more solutions tomorrow. There is also hope that you can live a valuable, worthwhile life in the midst of pain.
For me, my hope comes from all these things, but my ultimate hope comes from God Himself.
I hope other visitors will read your post and remember the challenges migraineurs face. We need to find ways to make ER a solution, not the shop of horrors it often is. I say this with due respect for many, many ER workers who are compassionate and skilled, and who are doing a great job. Sadly it’s not always that way.