Demerol for Migraine in the Emergency room

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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70 comments… add one

  • wanda Feb 15, 2012

    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..

  • Barbara Byrd Feb 16, 2012

    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.

  • V Apr 22, 2012

    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.

  • cleve Sep 6, 2012

    it is said that people have insurance and when you need it, they cant come through for you, i know how it is having migraines and it is a pain you cant sleep eat your constantly vomiting. can’t stand noises or bright light nor movement. demerol is a good drug but everyone is diffrent thats why we have somay drugs out there. now for me benadryl doesnt work dhe makes me sick and i vomite all the time steroid will just mask the symptoms it didnt do anything and i still go to the emergency room. now at my dr office they dont carry demerol nor toradol so i have to go to the ER SO THATS A BIGGER BILL I HAVE TO PAY SO WHAT GOOD IS IT TO GO TO THE DR. AND MOST ER THINK THAT YOU ARE SEEKING DRUGS BECAUSE YOU ARE IN PAIN WHERE IS THE JUSTICE OR THE COMPASSION

  • Wanda Sep 7, 2012

    Cleve, I feel for you.. I have been adamant with my family doctor, I didn’t want to be treated thru an ER, they tend to see it one way and that’s gets frustrating and very costly. I mean do u have a family doctor that will give let’s say a monthly dosage, u stay within the allowed time, for usage. I had an advantage here in Canada , being we don’t pay for ers or doctors, it’s cheaper on the system to have a family doctor to treat me! I recently found out that people can have my condition and never get fixed, to dangerous with the pancreas , now I am taking my self off meds due to liver issues, so be careful, it’s been 22 years for me.. Hang in there, keep reading..

  • Jacquie Sep 9, 2012

    After trying three migraine preventatives with no good result and finding myself in a 12-14 day rebound situation on a regular basis I can tell you that Demerol is the ONLY thing to break the cycle for me. Every clinic and urgent care within a 25 mile radius of me has stopped having it on their premises due to security and liability issues. This means the ER and a huge co-pay if I want to find any relief and needless to say I put it off as long as possible. It seems like people who suffer this disease are not taken seriously by the medical profession. I know we certainly aren’t by the insurance companies.

  • Wanda Sep 10, 2012

    Hi Jacquie,
    So sorry to here that, bad enough to have these issues, never mind the judgement from staff. I used to have a nurse say when I was in the hospital with idiopathic pancreatitis . ” I don’t believe your pain is that high” your cheeks are too red. Your going to be an addict if u keep taking this??I am like what nursing school did u come from? When u become my doctor, then will talk she gave me my med by iv, I went home for a visit I had to come back early because my pain was sever. Only to have my neighbor say, “Wanda that nurse, cut our pain meds in half” I was floored, but it made sense. We demanded the head nurse look at our charts, sure enough, she DECIDED we didn’t need our pain meds. We all signed a letter telling head nurse that we did NOT want her as our nurse… Never had her again.. It’s tough with judgement as many r healthy and have never experienced SERIOUS pain. Plus they get cold, in different, it’s sad.. I hope things get better and u can find something that works for u!

  • DOC mcmakin Nov 14, 2012

    I have found nubane to work if things get that bad no next day hangovers and works fast,

  • Shelli Nov 15, 2012

    Demerol worked great for me…killed the migraine everytime. Unfortionately the doctors had issues with it. Treated me like a druggie. I was allowed to have it three times a month. And I never asked for more than that and one doctor actually tried sending me to detox!! Some of the doctors would not give it to me inspite of the fact I had a pain contract for it. Now my hospital does not carry demerol at all. Totally dropped it. I now get dilauded. The docs still fuss over giving it to me…but not as much as they did over the demerol. Dilaudid does not work quite as well…..it helps…but not the same. But I guess you take what ever help you can get.

  • Jeff O'Donnell Nov 16, 2012

    I had headaches when younger but then got 4 blows to left temple. About a year later migranes would not release and was hospitalized
    Demerol was the only mef that would stop pain. Nothing else either worked or put me in seizure or respatory arrest. Imitrex and Stadol put me in arrest. Morphime, Codiene, Dilauded, Nubane,Vicodin,ethadone

  • Jeff O'Donnell Nov 16, 2012

    They didnt work. So hospitals ate Demerol free and found hot showers and heat pads help.Pheigran and Benadryl combination work but last Dr said too many red flags. So Im lost!

  • Wanda Nov 17, 2012

    Jeff I have had a whopper for a week, nothing is taking it away, heat lessons it a bit..

  • Lisa Nov 18, 2012

    Wanda, If you have been taking Demerol daily for such a long time, your body has adjusted to your dosage and that is maybe why it does not work for you. Or it simply isn’t the medication that you need. For me, I’m an older woman who has had chronic migraines since I was in my teens. For years I suffered with them, going with the heat pads and all that stuff. Never took the pain away, always just a matter of waiting in a dark room, not being able to sleep and the pain would last for at least 24 hours, sometimes for days on end. Now about 20 years ago, I started trying different meds for my pain. I still try other things but my body is so touchy about most meds for migraines that I have horrible side effects from most migraine medications. I had never tried Demerol all that time. Finally, my doctor decided to give it a try. With that and Vistaril (calms the stomach) I am finally able to get relief. It’s been a good 10 years now that I have been given this. My Dr. agreed on a pain contract for 3 doses (injections) per month, that’s it, no more than that! That’s not a lot when you consider that I get 4-6 headaches a month as opposed to the 20 days of the month that I used to get the headaches. Now the ERs in our area are no longer using demerol. So, I’m back to more suffering if my Dr. is not available or is on vacation. I won’t go anywhere else anymore because it’s useless. And I am not a druggie, because I still suffer. I do take some meds for high blood pressure, Cholesterol and things like that, those are necessary. My triggers are always stress. So there are some people out there, like myself that the druggie people have ruined Demerol for. Those of us with true Migraines who Demerol works for, have to go back to suffering. Makes me so angry, not at the doctors, but at the false patients!

  • Wanda Nov 18, 2012

    Lisa, sorry to hear that. Due to chronic Pancreatites I have been on Demerol for that pain. It’s definitely working for that, It does suck to have such brutal headaches. I have been going threw menopause, and recently been suffering thru my worst bout of a headaches ever. Using heat and trying to keep still. I don’t understand why doctors feel such fear prescribing meds, after all they r doctors! I recently learned that absorption is difficult for us with CP, so that and tolerance may be effecting me. I have nothing against it, it’s kept me sane from my CP pain. I hope some how Lisa u can get the meds you need..
    Take care

  • Theresa Dec 13, 2013

    I’m 47.and hadrssince 17. I 1rst tried chrio, little good. Then went to drs, neruo’s.bone & joint Ive been waiting for the neuro to call getme I tey botox sonce Aug. Ive called many times telling them how bad it is. They don’t seemto care. I went er last after having it straight since Mon. Since askin what worked, and I told the demeol w/phenergan, I was Then told they don’t give that. Mentioned dulid. I explained had that while admitted on cardio floor and it didn’t work. Gabe it anyway waited. ..I was worse and a hemiplegix migraine came on. The dr came In & wanted me to try compazine. I expressed my fear of trying another med that I wasnt sure if id have side effects. Again I wanted an explainatiom if its about what’s safe for me then why not give what had been safe sonce my teens instead of risking a new med wnd possible reactions. No answet! After I came & read all of the riskS, side effects and whom shouldn’t take it, then I was really pissed. Im planning on calling the risk manager next , get an appt and go over all of this. This is absurd and makes no common sens. I was told sheet dulild was given& didn’t work that it works for other patients! I corrected her that eBay works for onemaynot workfor another.and if a med doesn’t cause one patient a reaction doesn’t mean it may not on another. . good grief, we have a bunch of idiots our medical field

  • Jeff ODonnell Dec 14, 2013

    Although Drs and hospitals don’t want to give Demerol I have continued to be treated like a lab rat and nothing works. When I get a status migrane I’m home with heat , showers and Vicophrofin for 2 -3 weeks. Workers Comp still fighting the case and headaches are 2 – 3 a week and are manageable. However when one locks in it’s pure hell and hospitals are useless. Last time in August /11 Neurologist was advised of my reactions to Triptipans and gave me DHE-45 and roommate called after having seizure that I don’t remember. I’ve been everywhere from John Hopkins, Hershey Medical to Thomas Jefferson any many others. Don’t know what to try further.,

  • Nancy Dec 16, 2013

    Try medical marijuama it works for all pain without side effects. Good luck 26 yr in pain and migraines till last year with the program. Still bad days but living not crying everyday.

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