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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I have found that Demerol doesn;t work for headaches, as a person who has suffered with chronic pancreatities, confirmed by specialists, Demerol works for organ pain, never helps bone pain or headaches. I recently had my first migraine ( i hope my last ) and i had Demerol, never touches any form of a headache. Its best to try other meds first or even a little heat at the neck sometimes its arthritis. I have had to take Demerol daily for 16 years now..i have been strict and stable with dosages. I highly recommend not giving iv Demerol to people, as it gives you a rush, that is what becomes addictive to people, there is no rush in pill form..
I think it is important not to make overly broad and often inaccurate statements about any specific drug and it’s efficacy in severe status migraine. Demerol and other IV narcotics are not the first choice to break a dangerous status migraine in many ER’s. However, narcotics together with the migraine cocktail currently used can be very effective in reducing the nightmarish pain of a 4 day migraine. It may not be correct for a person who has experienced a single migraine in a lifetime to demonize medications used on occasion by other sufferers. Neither Demerol or any other narcotic drug given in an IV gives a “rush” to those of us in that kind of pain. It sometimes simply relieves the pain slightly while the Decadron, Pherergan, and Benedryl start to work.
I am on disability for severe, frequent migraines for over 2 decades. After years of testing for triggers, none were found. Over the years, I went through numerous trials with medications to find out what did or did not work for me. Whenever I went to the ER for treatment, I was given a Demerol injection. Beta blockers and other “preventive” measures have not worked. I am having a terrible time now because after having found a combination of medicines that gave me the best results, my insurance (Medicare & Medigap) will no longer cover those medications. Those two medications combined cost under $500 a month maximum for the insurance company. The only medication they will cover now, costs $1500 a month. I used it for the first time today, and I am very upset about being forced to abandon what worked for these results. It took over an hour for there to be an improvement in my pain, and then it put me to sleep. I did not want to sleep long, because I knew if that happened I wouldn’t be able to get to sleep at night. I wound up sleeping through both alarms I’d set and slept straight through for 5 hours. Now it is nearly midnight and I cannot fall asleep,and have to be up at 7 AM for work. I have battled with doctors, pharmacy, insurance more than once over the years and now to the point of emotional/mental exhaustion. I am trying to re-enter the workforce and I simply can NOT use a medication that is going to put me to sleep! I have also tried alternative methods such as chiropractic, herbals, etc., but the insurance covers none of these either. I do not know what else to do or try.
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