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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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.
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.
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
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
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.
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
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.
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
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.
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.
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.
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.
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.
Demoral with vist—something to stop the vomiting is the only thing that works on my migraines. ER’s have used tobradol and many other drugs but they do not kill the migrain. The only pill that helps a migrain is zomig 5 and it usually takes 2 of them to work. 15 of them a month costs a minimum of $363.00 per month. I cannot afford. When hedache gets bad my blood pressure shoots up 150/110 and higher. I am trying a beta blocker blood pressure medication to help.
It does help some but with the stress that I am having at age 61 taking care of 84 yr. old mother–I am nuts half the time with worry and what to do next. I wish we lived in Washington where they now allow a person to die in peace. My mother wants to die, and I kept her alive with open heart surgery when Dr.s said last year to let her go. I love her very much. My brother who is 10 years younger than me will do nothing to help take care of mom. It would be OK, if she would live with me and my husband, but she won’t and the old 85 year old Dr. that she was going to gave her permission to be at home alone, to take care of herself. It is a constant fight to keep track of what she is doing next. She made me her POA long ago which at that time was good. I did not relize that science has made our bodies die before our selves. Her body is crumbling andthey keep putting on bandades, she has in writing the request to be left to die, it is hard. I feel like I am killing her. And yet I have been told by my Dr.s that this stress is killing me. In the last 2 years I have gotten very very old and my own life with my husband has suffered greatly. My husband has been very good, he helps me with everything. My husband and I were the oonly ones to take care of my dad who died in2006 also. He died in a nursing home eventually. But it was real bad. Nursing homes in Central IL. let people die in their own excrement so they can take their homes and what ever the patient has worked for all their lives. Without the stress their have been times that I can go 4 or 5 months without a migrain. But now my husband is getting them too. Don’t ever think when you reach 55 or 60 that you will be in you”GOLDEN YEARS” it never happens. I did not know demoral stayed in my body, till I had to have a test on my colon and stomach and they gave me demoral to keep me under–I had NO PAIN BUT I WATCHED THE OPERATION ON TV AND TRIED TO TALK WHILE THEY HAD A TUBE IN MY STOMACH. The Dr. that I went to for this did not know about my headaches. But there is a question that I have, does Demoral effect the heart as I have angina and must take nitroglycerin at times. Thankyou
Thanks for the comment, Patsy.
I assume you’re talking about Vistaril for the nausea? Just clarifying for other visitors.
Thanks for sharing so openly. You’ve brought up a number of issues that are so important, so hard to talk about, and yet so important to talk about. I’m so sorry you’re in such a difficult part of life.
You’re right – as we get older our bodies do “crumble”. It’s not an easy decision when it comes to prolonging life. I do believe there is hope for those in their later years, and for you too who are younger. I’m encouraged that you are actively pursuing treatment for yourself. That is not an easy thing to keep on doing – so your courage is noteworthy.
I don’t think Demerol has a direct effect on the heart. However, it can cause blood pressure changes, so I would talk to your doctor about that.
James,
It is amazing that I stumbled across this post. I know ER docs don’t like Demerol and it seems like I am running into them more these days. For years, I got Demerol and Phenergan for my migraine pain. It worked great. It usually took 100-150mg dose, but it worked. I liked the sedation because chances were I had gotten no sleep the night before. Also, by the time I hit the ER, I am not a good candidate for more triptans or DHE.
I had a neurologist who gave Depakote IV (1gram) in his office. That worked also. That was fine if I happened to have an appointment that day. But the choice of driving less than 5 minutes to the ER or 45 minutes across town was an easy one. The ER won every time. I have received Depakote IV at the ER, but for some reason, it was not effective.
Just recently I have either been in a facility that didn’t stock Demerol and I received Reglan and Benedryl IV. I can’t say whether it worked because by the time they gave it to me, the head pain was gone.
Just last Saturday, I ran into a dr who wouldn’t give Demerol. I received Dilaudid (2mg) and Phenergan (??mg). The vertigo was worse that from Demerol; the pain returned within 3 hours, and the nausea was worse than before. My DH suggested a return visit, but I decided to wait it out.
Thanks for the comment, Debbie. It certainly isn’t easy trying (or being forced to try!) new things. I hope you can at least find some doctors that have done their homework and know what to offer instead that has a good chance of succeeding!
You medical people kill me with your “rid the ER of Demerol” arguments. I have suffered with migraines for nearly 20 years and have had all the latest and greatest drugs to combat migraine. The only effective “rescue” drug that
works for me is Demerol. I have had many of the alternatives. Morphine, Reglan, Hydromorphone, Stadol, etc,etc. They either don’t work for me or let a rebound occur. It’s pretty easy to weed out the abusers if you are a good doc. Otherwise, SUFFER a migraine and then go to an ER w/o something that works for you!!!!!
Troy,
Thanks for your comments. In defence of some of the others who have posted, I think the motive behind removing Demerol is not bad – they’re concerned about it effects and convinced that other treatments will work just as well.
Of course, that’s the question – will other treatments work as well? And it’s not easy to answer. As someone who has been in ER with a severe migraine, I agree that we should be careful not to get rid of what works!
But I hope no one who has commented has to have a migraine in order to be convinced.
I am so glad I’ve found this. I was trying to found out more about Stadol that my son used to be given in the ER. He told me it was now in a nasal spray form that would work faster than oral medication if you could get your doctor to prescribe it; I just have been given to understand it is very hard to get that done; do you have any ideas about that? he is now under the care of a neurologist who wants to schedule him for another MRI; he had one done about 5 years ago which is what led to him being diagnosed with the migraines; I believe he was being given the Stadol before when he was going to the ER and “just” being given an injection without anything being done to find out what was actually wrong with him. Then he began to be flagged as one of those “drug seekers” who was just wanting something so then was not even able to get anything; in a way I’m glad because that’s what led to him going to the ER that did the original MRI and told him then he needed to go to a neurologist; the only problem was that he didn’t have the money because he could hardly work because of the migraines (no insurance either); however, thanks to that same hospital; in their clinic they adopted a policy of adhering to the same guidelines as the hospital and began to let you see their doctors at no cost if need be so at least now he is guaranteed 6 months of treatment to try to get to the root of these migraines and treat them. I’m wondering now if they really actually stopped because of the studies saying that Stadol is actually addictive; I’m also wondering if that did contribute to him actually becoming a “drug seeker”; treat the problem by making a druggie then blame them for being one? anyway, I don’t think that is why he wants the Stadol; it’s just that it did work for the migraines – maybe the good stuff is just all addictive.
On 4-24-99 I was beaten unconcious arresting a suspect (DUI and on Cocaine) and hit 4 times in the left emple.After 1 1/2 yrs later I started to get severe migranes that have now occured sometimes to every 3 – 4 months. I was admitted to local hospital and have been to Johns Hopkins,MD and Penn State Hershey Medical Center,PA for advise and possible treatements or remedies.Mophine , Dilaudid , Regalin,Toradol. Percocet , Vicoden , and may other pain meds don’t have any effect on me at all.
I am given Demerol 100 mg IV every 2 hours for the pain that is above an 8 on scale.I am no addict at all and have no side effects after they start reducing the amount from 100 mg to 75 mg , then down to 40 mg. Now all the local hospitals have stopped using Demerol and I have looked to Jefferson Medical,Philadelphia for further help.I use steriods , Depakote , Neurontin , Vicoprfen , Cymbalata , and other meds now along with hot showers , heat pads and anything that can reduce the pain. Imitrex and Stadol put me respitory arrest and they have tried Botox injections , other meds,Maxault,Zonogram ,and Methadone and Neubane. Excuse for any spelling of meds.
Some things work and wish they would not make everyone suffer for others mistakes by misuse of drugs.I’ve been a cop for 35 yrs and know that drug use is bad and what it does but if I soon can’t control this I have to retire.
Everyone has different nero receptors and the right meds that work should be used on individual basis. If anyone else has any ideas I am open for suggestions. Also Johns Hopkins did recommend an natural medication call Migravert but it did not work either but is total natural.
By the way now all hospitals in my area no longer use Demerol at all!
Jeff, I so empathize with your recurring migraines. I can’t imagine how you do your job in that pain. I am an ex-Atlanta cop, and my husband is still there in his 35th year.
One natural remedy that worked for my chronic severe frequent migraines (at least for a year or so) was the brand name Petadolex, it is the herb buttterbur. It takes about a month to kick in, it probably won’t help you permanently but for the time it helped me, my HA’s reduced in frequency, and intensity. It’s sort of expensive, if you look online you can get a 3 pack for $75 or so.
It is terrible to be treated as an addict, and those post-trauma can be even more complicated than plain old inherited migraines. You may have mentioned, but have you tried Lyrica? It has been helpful for some. My neurologist still insists Imitrex injections are the “gold standard” for an acute migraine, but I know that doesn’t work for everyone, and other health issues prevent using triptans in some people.
I am glad you appear to be near Philly, you have access to the best docs in the business there, and hopefully with your health coverage you can get to resources others can’t get to. To stay somewhat on topic, Demerol use even by IV several times per year isn’t going to create or support an addict. To me this fear of narcotics in pain situations is a tragedy and a media creation. Acute pain must be addressed, Demerol and other narcotics are tools for that. Even if you must depend on a narcotic eventually, to improve the quality of your life, that is different from addiction.
Look at The Robbins (might be Robins) Headache clinic website, it has numerous resources and suggestions. Also, I know you must have considered it but with 35 years in you could take your pension with a decent benefit and just work EJ’s if you need the money. It would put you in a position to work around you migraines. Good Luck.
To Troy and anybody else,
I understand you stating the ” END DEMEROL” in the ER’s. I have had migraines since I was 8 yrs old. In the 1960’s they knew nothing about it. I am now in my 50’s and they still don’t know anything. I was reading all the blogs about Duiladid, the Triptams, Morphine and everything else ER’s want to give instead of Demerol / Phenergan. I am one of those persons with mutiple heart surguries since my teens. The other meds they have tried on me were worse than the migraines. Everyone who has had one will understand. To hurt for 3 to 5 days then go to the ER and have to wait 6 hrs while people who came in after you seems almost criminal. I happened on this sight looking for a pain mgmt doctor. This lets me know I am not the only one out there.
I have been to every pain mgmt west of the Mississippi, and still no help.
hope to hear from someone,
Bye the novel notionalist
I went to the ER for the first time last Friday. Fortunately, it only took about an hour before they had me hooked up to an IV. They gave me morphine, which helped with took the migraine down to a tolerable level (tolerable being relative, of course). Afterwards, I itched from the morphine for almost 24 hours. They gave me benadryl in my IV as well for the itching, but it wore off long before the itching stopped. I’m curious if there are any of the other meds that don’t have the itching problem (I know not everyone gets it). I can’t take oxycontin for the same reason. It’s really quite unbearable, and kept me up for almost 20 hours after the ER trip, and I slept fitfully after that. Hopefully, I”ll never have to go again, but the headaches seem to be on the upswing right now, so I want to be prepared. Anyone else have this problem and a solution?
What about the Imitrex , Treximent , Stadol or others. I have had severeve migranes from a head tramua in 99 and now have found that the pain meds are possibly causing the rebound headache migranes.Thomas Jefferson Headache Center,Philadelphia,PA has said this is common problem. Covering the problem with pain meds and not treating the problem.They now have me on Topamax 150 mg and headches are less and not as severe.
I had been to John Hopkins,MD and Penn St Med Centers,PA before finding the possible solution. Good luck.
Hi everyone,
I’ve just come back from a 6 wk. hiatus being around my son seeing his migraines in action; they were so bad the head nurse at the hospital (where we were trying to deal with my 84 yr old mom’s hip surgery) was scared to death, especially since his neurologist had sent him for an angiogram after his MRI seemed to show aneurysms (turned out not to be), that he was going to burst a blood vessel. That same neurologist turned out to be a problem; his nurse finally wanted to talk to him when we called for more Trexamet – again – bad move when you’re in the middle of a migraine – he’s out of his head – and when you have things in your head that shouldn’t be there in the first place they come out at a time like that – suffice it to say he discharged him as a patient – said he was taking too much of the medication – it’s not like it’s a narcotic – by law they would have to treat him if he went to the ER bu not otherwise and he was actually trying to get real help not just a band-aid so back to his primary who when he told her how much and often said it actually sounded more like cluster headaches (so not sure if still need to be here but read on) so put him on oxygen therapy but when went to get it the lady there said she’d had them and went to – hang on – a chiropractor for 3 months and has never had another one. So we found Healthsource – a chain – he was put on a 4 wk. treatment plan and the change has been tremendous. It’s expensive in a sense but much less so than continuing to pay for medication. As far as that, he couldn’t do that but we got him on plans with the manufacturers that allow him to get his meds for free. Check into it! The chiro we paid for but many insurances do cover or they would probably work out a payment plan for you. Worth seeing about!
I have been to urgent care at my HMO about 8 times in the past 6 months for multi-day migraines that refuse to be contained by my regimen of proactive or abortive meds. I’ve found that what works is a combination of Stadol, Toradol, and Phenergan. It has to be all three, as there is some combinatory effect. Of course, by then I’ve taken 3-6 Maxalts over a 2-3 day period, so perhaps I need all four. [sigh] When is someone going to concentrate on a cure?
Wouldn’t it be lovely! You and me Susan. Unfortunately migraine operates somewhat like epilepsy, and as we know that is only “controllable” not curable. Preventatives as we have them now do not work for every sufferer. I think this is the secret: If you are identified as a migraine sufferer early in life (due to maternal migraine, and migraine in childhood) preventatives have a much better possibility of working. My 15 yr old daughter had success on her first try with Topamax at 75 mg per day. It has reduced her migraine frequency by at least half. She takes Advil perhaps once per week, Maxalt maybe every other month.On the other hand, my mother suffered migraine which had her hospitalized for weeks at a time throughout her life and no preventative or combination was the slightest bit helpful. The same situation exists with me. By the time you have experienced so many status migraines, your threshold is so low, that the preventatives don’t work. So, you are left with going to urgent care for whatever they will give you for relief. Its very unfair for providers to undertreat this debilitating condition. Any of you sufferers (especially women) with children who are showing frequent migraine indicators should get to a neurologist ASAP to discuss getting the child on preventatives early! It might prevent the 40-50 years of migraine and all these ER visits.
This is an excerpt of one of your posts.
“On the other hand, my mother suffered migraine which had her hospitalized for weeks at a time throughout her life and no preventative or combination was the slightest bit helpful. The same situation exists with me. By the time you have experienced so many status migraines, your threshold is so low, that the preventatives don’t work. So, you are left with going to urgent care for whatever they will give you for relief.”
I was wondering what the term “status migraine” means and what you meant about your threshold being low and preventatives don’t work.
I’ve had migraine since age 7 (possibly longer) but wasn’t diagnosed until my 20’s. My doctor at the time in Toronto prescribed narcotic painkillers. Later, my Vancouver Dr also prescribed narcotics. I didn’t even know about preventatives until I moved to a very small remote town in the FAR north when I was in my 30’s. I feel so lucky because I didn’t expect terrific doctors in such a town. This doctor told me about preventatives. I didn’t have much success but tried everything (maybe 20 different types of migraine preventatives… nothing worked). He did a ton of research for me and told me about everything new that came along. A couple of years ago in my mid 40’s I decided to try preventatives again. I had some luck with Nadolol. It reduced my attacks from 20 – 25 days a month down to 3 – 5… Awesome. Unfortunately it stopped working after about 18 months. I’m not working now so I try to tough it out and use demerol again when I can’t deal with the pain any longer. Sadly my old doctor is trying to retire but the woman who is taking his place is almost as good. They both really listen and I know they care. In major metropolises I couldn’t get a decent doctor but have lucked out twice “north of 60″.
Anyway… I was wondering if the reason I haven’t had much success with preventatives was because I didn’t try them until I’d had migraine for over 25 years?
Hey Mary,
I’m not a healthcare professional, just a life-long migraine sufferer from a family of hereditary migraine sufferers. That being said, I have a level of expertise based on personal experience and nonstop research into the disease we share. “Status migraine” (short for status migrainous) is a migraine lasting longer than 72 hours. Those are usually the migraines that make the docs pay attention because by then the sufferer is so dehydrated, plus there is some evidence that the risk of stroke increases after days of migraine.
I do not know for a medical certainty that using preventatives early (once diagnosis of migraine is made) prevents severe, lifelong pain. I do know that in older people who have had severe regular migraine,it usually takes many tries or combinations of preventatives to achieve headache improvement. Frequently, as with your try at Nadalol, the medicine will reduce frequency or intensity for some brief time, then poop out.
A threshold, refers to the amount of stimulus or “trigger” a sufferer can tolerate before symptoms appear. For example, a person with epilepsy left untreated will have increasing seizures. Each seizure lowers his threshold and enables more seizures. Assuming he then is treated successfully with Dilantin or Neurontin, or whatever before he has had dozens of seizures, his seizures are less likely to happen.
With us, I believe that if all those years of migraines could have been avoided (by early preventative medications) that our migraines wouldn’t have reached these levels of pain, frequency, and duration.
It’s not anybody’s fault as far as prevention goes; prevention wasn’t really even a mainstay of treatment until pretty recently. In the 1970’s prevention consisted of either Inderal or amytriptaline. Neither of those worked for people in my family, so it was a continual battle against the existing headache.
I really recommend following Teri Roberts information on migraine, as well as information cited at the Robbins headache clinic website. It will give you lots of information on migraine, new preventatives, theories, medications for acute attacks, etc. I mentioned in an earlier post, but butterbur (which is herbal) worked for me as a preventative for a while and it had no side effects.
You are certainly not “out of luck” regarding prevention even after decades of migraine. Older sufferers do find things that are effective; I just believe the sooner one gets on a preventative, the easier these things are to control somewhat. My minister was in her 60’s and her first try at Neurontin helped her tremendously. So, you never know!
Hi, “status migraine” is a migraine that pounds continuosly without any break regardless of any meds you take. The only way tom stop it is an injection strong enough to put you to sleep. When you wake it will still be there but not as bad. You need to take your home meds every 4 to 6 hrs without missing a dose until it stops. this could take a couple of days. I hope this answers your question.
write back if you need any more info.
Bye, the novel notionalist
I have been a life long sufferer of migraines. I remember being a small child and needed to be placed in baths of ice. I have been facing ignorance from doctors all my life. I have a reaction to maxeran every time i go to the hospital and usually by then my migraine has lasted for days and i cannot deal with it, so off i go to the er. I have explained every time that it makes me have a panic attack. I rip out my iv and run from the hospital every time. I cannot explain it really and despite telling them they give it to me anyways, what i have read says that it can interact with my drugs for depression and insomnia. Is this true. What can i do from keeping them from getting it.
My doctor wants to take me off the only medication that works, maxalt.
How can i tell her that nothing else works.
She is a new doctor and actually said that it may be psychological I feel desperate and scared. I have stopped going to the hospitals. please help if you can.
Kelly
Kelly,
Is your doctor a “regular” doctor or a specialist? If possible, you need to be seen every few months by a neurologist or neurosurgeon. They understand better; It may not help, but it sure couldn’t hurt. There are a whole host of preventive meds that you can try before ending up in the ER with a migraine and panic attack. I’m on several prevention meds that at least keep the migraines down to a tolerable level, so I don’t have to face those bright lights and multi-hour waits at the ER.
Demerol doesn’t last long, it also makes a lot of people itch. If you have a REAL Pain Issue here is the BEST Believe me I know pain medicine since I had a cervical fusion in 2000 and as we speak have a prescription for Injectable Pain medicine. Dilaudid is simply the best, taken with Phenergan it s one of the best.I take Nubain everyday, Nubain and phenergan are used in a lot of ER’s for Migraines. Morphine works for some but Morphine usually doesn’t work for SEVERE pain. Any pian Medicine Works better with an Anti Emetic, Like Phenergan,Compazine,Tigan,Vistiril,Personally I like Phenergan best and it is getting hard to get in an ER because, A Woman lost her Arm from some IDIOT giving it to her Un-diluted. If you have severe pain do research on what works best for you, Example, Nubain is NOT a Controlled substance in most states,it doesn’t make you high or loaded like Dilaudid or Demerol. I done research and took it to my Personal DR. I told him it had reallt helped me, He came back into the room and ask if Ineeded syringes. It has almost eliminated my trips to the ER, I feel so fortunate to finally having an MD listen to me and help.
Just a word about Compazine — some people (turns out I am one) have a *horrible* reaction to Compazine called akathesia. It is defined as “an almost indescribable sense of terror and doom” along with intense restlessness and discomfort. Some people are mis-diagnosed as being psychotic when they come into the ER that way, thank goodness the nurses recognized that my reaction was a result of the Compazine they had given me. I have no idea whether all anti-emetics cause this reaction, but it was the most horrible experience of my life. So I would ask specifically about the properties of the various choices.
I have migraines for 29 yrs and I’ve tried meds from anti-depressants to anti pshcotics. I have migraines at least 5-7 times a month and the only thing I take at this point is Vicodin. I have a “pain contract” with the hospital, I can go twice a month for shots for my migraines. Found out I’m allergic to most everything they have. I was in the medical field until I had to go on SSDisability at 41, for migraines. The “cocktail” they give me now is Stadol, Promethazine(generic Phenagrin), and Benadryl. The benadryl is for the side affect of the Stadol. Demerol worked tons better for me than anything. I had a migraine for 31 days, so the docs said. I just tried Dilaudid and had an allergic reaction to it while in the ER.
Sometimes it’s ok to fall back on the old meds, Demerol made me sleep after nights of staying up, never a “hangover” but then the day after I get a shot, I take it very easy. The reason the ERs quit giving Demerol is because if they don’t know you, they can’t tell you have a migraine and allot of people went to get a “high”, messing it up for people like me. Also, if something else is causing your migraine, they like to use Demerol as a first med for surgery. The anestologists are the ones that did the study on residual meds in the system, which are the ones who use it the most. As far as the residual affect, lots of clear fluids can clean Demerol out of your system just as quick as any other pain med, usually 72-84 hrs. So now I’m stuck getting a drug that I have a reaction to and I even need benadryl a couple of days after I get the shot. I’m ready to go to the pain clinic(again) and see if I am a candiate for the electronic stimulation implant. I’ve missed to much of my life due to all of these doctor’s wanting to try different things on me, toxifing my body. I’ve even had surgery, and that didn’t work. Botox just made me look younger, which was a good side affect, but didn’t do anything for my head. I’m at the end of the road basically, if anyone has heard of anything other then prescription or over the counter meds, I would love hear about it.
Just my situation!
I had Dilaudid the last time I was in the hospital. It made my headache much WORSE, and I couldn’t get anyone to pay attention to give me something else instead. When I was finally released, I asked my neurologist (who wasn’t on call that weekend) to note in my chart not to give me Dilaudid anymore. It’s bad enough to end up in the hospital, but then to have to stay there in pain is just unbelievable.
I’ve used Demerol 100mg IM injections for migraine for 5 years now. Originally I would go to the ER, but once our insurance changed and they deemed a visit to ER as only ‘not breathing’ or ‘bleeding to death’ as the only qualifiying events, my physician and I had to come to new delivery system. The injections are carpuject and you simply use an injector to give shot. I personally was allowed up to 30 injections per month. I have a headache everyday… just never know if it will go down path of migraine or chronic daily headache. The Demerol is used for only HA of 7 or above; migraine specific. I also take Depakote ER, Topamax (400mg daily), propranolol 80mg. Zomig 5 mg is my rescue med however due to crappy insurance. (H). I’m only 3 tablets per MONTH. that’s right, 3 in 31 days. so, my Demerol becomes rescue. I always try to get rid of HA by using 3 ASA and 1 APAP to start. Sometimes it works… my quality of life sucks, i’ve missed a great deal of my children’s life due to try and sleep off a headache. Wish the manufacturers and Doc’s thought about that sometime… I can no longer work a full-time job, and i drive seldom. I’m lucky to get 10 shots now a month. This allows me to work thru some headaches and determine which ones are just not tolerable. I want my life, just not like this! Keep Demerol available for those of us who truly benefit from it and get it from a licensed practioner. Getting it from a pharmacy makes me feel like a criminal, they treat you like less of a person, at least it’s not Oxy and i keep it all for me! let those judging eyes burn a hole in someone else!
good luck to all of us who suffer. God loves us more than anyone!
I was just in the ER on Friday and the hospital I usually go to in Overland Park, KS does not give Demoral, Toroidal, Stadol, or any of the usual pain meds anymore. They are now giving just Compazine with benadryl. I was a skeptic at first but after suffering with a migraine for many days i was willing to try anything and it worked.
I went to our hospital’s urgent care two days ago with a horrible migraine. The PA offered me Dilaudid. I told her that the last time I was in the hospital for migraines, they gave me Dilaudid, and it made my headache much worse. She said she would check on what else they could use. After awhile, a man came in to give me shots–”pain medicine,” Zofran (for nausea), and Toredol (helps boost the pain medicine). The nausea subsided. The headache, oddly enough, moved from my left eye to my right, and only went from a 9 to an 8. When I got my discharge papers (from yet a third person), I asked what pain medicine I had received. They gave me Dilaudid. I ended up being out another day from work because it didn’t kill the headache. Isn’t that kind of malpractice, to give someone a drug they specified did not work for them?
Here where I live in Canada when I go to the ER the usually give me IV Maxeran and if that doesn’t work then they follow that with IV Stemetil. Both need to be run at a very slow drip rate to avoid side effects but usually the Maxeran is most effective. Occasionally they will run it a second time if needed.They also have a protical for migraine sufferers. Usually within 15 Min after you arrive in the ER you are hooked up to the IV – you may have to go back out to the waiting area with it but atleast your getting treated.
In Canada, I have had maxeran with 2 ibprofren and 2 tylenol(please i could do this at home!) the maxeran made me very sick. I have had a migraine now for 4 days. Tylenol 3 and extra strenght liquid motrin not workng-made me very itchy-i threw up the $20 imitrix, i just tried eating now to see if that helps and having some coke-these are menstrual migraines…i feel like i have been shot in the head-i feel suicidal from the pain. I am reluctant to go to ER because it has never helped in the past. I am thinking demerol may help…again don’t know if they will give it to me at ER…they treat you like a drug addict-I really don’t think i can stand to wait 4-5 hours in the ER and not get any demerol…i will hopefully hang in there until tomorrow and maybe I can get in to my doctor and get some demerol…I cannot take this anymore…why isn’t there more help for people with this disablling condition?
I have had migraines for 30 years, been to all kinds of neuroligists, even The Midwest Neurological Institute where I had 3 neurologists at the same time. We figured out that my trigger is the weather. Mainly low pressure systems or extreme quick weather changes, also a 25-45 degree change in the weather which happens in the spring and fall seasons more than any other. I have been through sleep studies(I have sleep apnea but the machine made no diffrence in my migraines), have had botox injections, as as the institute concluded, “I’ve had everything in the closet for migraines.” I was in the health field so I know the different drugs that can be used and have tried everything even in the ER. By the way, you should only go to one ER for your migraines so they get to know you, your specific problems, and what does and does not work. Then, you won’t be judged quickly as a “drug seeker”. Docs cannot really tell if a person does have a headache/migraine and for a while, people went to the ER to get Demerol for the “high.” I did check out the residual effects the doctors are claiming now that Demerol has but the other pain meds have the same if not worse effects in the information I have found. Again, that is just me and I am not a doctor. I have had a liver problem before so I do research meds often for new studies. I am allergic to Morphine, thank God I was in the hospital when I got the injection. My allergies include DHE45, this so called new migraine med, made me VERY ill. I am allergic to Codiene, Newbain, Tordol, Vicodin, and Diloded. I have a verbal pain contract with the hospital since I do have to go a couple of time a month to get migraines broke that I cannot at home. I was getting Stadol, along with a large dose of Benedryl because of the side effects it gave me. The doctor that owns the company that contracts for the ER, I am on a first name basis with, came into my room the last time I was there and we discussed everything that I have had, so now I am back to Demerol with Phernagan(sp?) for nausea, and it also has a good side effect that for some reason does help migraines without boosting the effect of Demerol. Through my many different trials of meds, I am to be on pain killers and muscle relaxers daily. I do not take them daily anymore though, it is to hard on your organs and you build up such a tolorance to any kind of pain meds that when you do go to the ER, sometimes it does not help. I have transformed migraines, which basically means I have a head ache every day and if I get over stimulated wether it be positive or negative, it can turn into a migraine. On the onset of a migraine, I do take the pain pills, muscle relaxers, and one sinus pill(ask your doc about the sinus pill first!). I learned of the sinus pill from the Mayo Clinic when my sister went there.
I live in Missouri and as the old saying goes, “If you don’t like the weather here, wait 15 minutes and it will change.” Germany has studied weather associated with migraines for 60 years and the EDA and docs in North America are finally taking notice that it is very much a problem for some, this is why journaling migraines is important. Write down little notes about the time of day, everything you ingested that day and the day before, what you were doing when it came on, where you were at the time of onset, and the weather.
Anyway Demerol, not used often,such as a couple of times a month as I do, we have found is much more productive and less harmful to my system.
Talk to your ER doc, most of them will tell you that they don’t use it in the ER. For someone that is basically allergic to everything but Demerol, then Demerol is used.
I also save my discharge papers, and I ask the nurse or doctor I want what they gave me and the amounts hand written on them because I do save them. Also, keep them in one place that way if you need to go to the hospital and need something different, you have proof in hand that you have tried what they wanted you to, and you can tell them why you need something else.
Good Luck!