Treatment Protocols: How They Make ER Visits Easier

Yesterday, +Migraine Again posted an article that I wrote about how my migraine treatment protocol makes trips to the ER easier.  I wanted to share that article with my readers who don't follow me on Facebook or Twitter.  I hope that this opens up a conversation between you and your doctor about creating a protocol that would help you receive the best care when treating your severe pain in an emergency room or urgent care setting.  You can read the article and get more information about when to go to the emergency room with a Migraine.

How My Migraine Treatment Protocol Makes ER Visits Easier  

You can also read my original draft below.

Most migraineurs have had to deal with the unpleasantness of the emergency room.  When prescribed abortive and/or rescue medications fail to get rid of the migraine, many of us wind up in our local ER’s or urgent care centers (When Should You Go to the ER with a Migraine?).  Instead of going and getting taken care of like we expect to be, many migraineurs face judgment from the medical staff and are often treated as drug-seekers.  Some of us may end up going to the ER or urgent care a couple of times in one month if a migraine episode will not ease up for more than a day or two.  That does not mean that we are looking for a high.  I have failed to meet any migraineur who enjoys how painkillers and narcotics feel.  All one in that much pain is looking for is relief.

Due to this common treatment, a lot of us choose to tough it out at home instead of dealing with the glares, questions, and inadequate treatment.  For migraineurs like myself who are allergic to or cannot tolerate triptans and most anti-inflammatories, opiates are our only option.  In my experience, most doctors frown upon administering any form of opiate or narcotic and if they do, will only give you one dose. And that is only if the Toradol, Phenergan or Zofran for nausea, and possibly Benadryl you were given first didn’t work at all.  It is an all too frustrating situation to be in when you are bombarded with severe pain, nausea, and horrible photo- and phonophobia.

I can’t count how many times I have suffered in silence at home because that was less of a burden than dealing with how I may be treated in the ER or urgent care.  When I would go, I would be given the bare minimum and sent home still in pain.  It wasn’t until I began seeing posts in support groups about migraineurs having a treatment protocol from their neurologist or headache specialist that I actually considered having one.  My neurologist of over ten years never mentioned having one and I figured that with one, I may get the actual care I need.  Back in December, I was in my ER waiting room for six hours waiting to be seen.  The lights, sounds and smells were keeping my migraine at a 10 on the pain scale.  All I could do was just sit there and cry.  It was ridiculous how my pain was not seen as emergent or important enough.

There was a light at the end of that long, dreary wait when I was seen by a compassionate doctor who offered up some new things to try.  I typically would just get IV toradol, phenergan, and one (or two if I’m lucky) dose of dilaudid.  She added IV magnesium, Benadryl, and a steroid (Decadron) to my traditional cocktail of medications.  My migraine was raging so it took four doses of dilaudid to bring it down to my baseline of a 2 on the pain scale.  Once I got home I immediately faxed my doctor my ER visit summary with what I was given and asked that he type up a treatment protocol with those specific medications and doses for whenever I need to go to the ER or urgent care.  While I was at it, I also had him type up a protocol for needing inpatient care in order to break a status migrainous with the use of DHE infusion (which usually takes from 2-4 days).

I keep all of my protocols, medications, and visit history
in my binder.  This book of information allows me to get
the treatment I need right away.

Now that I have my treatment protocols, I am no longer questioned or treated inadequately.  I keep a binder that has my protocols, list of medications and allergies, past visit summaries, and upcoming appointments.  It goes with me every time I go to my local urgent care, who has the same capabilities as an ER with a much cheaper copay.  I just hand the doctor my protocol and with no questions asked, I’m given exactly what is on that sheet of paper.  It is such a wonderful feeling knowing that I am in charge of my care.  There is never a time when you do not have to advocate for yourself.  If you know what works and what doesn’t when you have to go to the ER, have your doctor put together a treatment protocol for you.  It makes a world of difference in how well your migraine is treated in those situations.  If it’s coming from the horse’s mouth, who are they to question it, right?