The local ER experience

who-says-migraine-is-the-8th-most-disabling-disease-in-the-world

On a local site they were complaining about the hospital and most of the complaints were invalid. Mine was not, but that is a side note. The one real complaint I have I didn’t mention because people wouldn’t get it. Because they have no idea how serious migraines can be.

I never go to the ER for a migraine unless it is a status migraine. An acute migraine that has lasted more than three days. Often I go on day 5. And I stopped even doing this long ago.

Here is what the treatment generally is:

Approximately 40% of all migraine attacks do not respond to a given triptan or any other substance. If all else fails, an intractable migraine attack (status migrainosus), that is, an attack lasting longer than 72 hours, should be addressed in an urgent care or emergency department. In rare cases, patients may need to be hospitalized for a short period and may need to be treated with intravenous valproate or dihydroergotamine (intravenously/subcutaneously/intramuscularly) for a few days Medscape

Here is a typical guideline

Or this treatment

The last time I went recently the doctor said we don’t see you often here for migraines and I said no and didn’t explain. But there are reasons. He treated me with morphine because I cannot take toradol anymore. By the way, the One doctor who Didn’t give me the stink eye because I can no longer take NSAIDs by the way. The nurse hooking me up for hydration literally said to me ‘we hydrate because sometimes a migraine can be caused by not enough fluids’. I wanted to tell her it just might… might… be the vomiting, lack of eating, and diarrhea that is to blame after five days of migraine straight. Maybe. Maybe that is why they do that. Just a thought.

Anyway, when I used to go for a status migraine I know for a fact they had no idea what a status migraine was. They always treated with toradol and nothing else. Sometimes with something for nausea, but not always. Sometimes hydrate you, but not always. And they didn’t particularly care if it didn’t work, which it just didn’t. So I stopped going because migraines are low on the list so it is always hours and hours in a very migraine adverse environment, for a treatment that does not work, to leave with a migraine anyway. No real point to it.

Then one day I had a status migraine to which I pushed through like always. Sick. Sleep deprived. On day five I woke up with a numb hand. Permanently numb and over time it spread over that hand. Until the whole hand was numb and had a sharp prickle sensation on it. Turns out it was nerve damage. One neuro says from the status migraine. Another says from a stroke in my sleep caused by the status migraine, causing the nerve damage. Either way, nerve damage. But would it have mattered? No. I would have went to the ER, gotten toradol after a 6 hour wait and left with the migraine and still had the nerve damage. Because they didn’t abort it. Because they don’t know how or care to know how. Or care that I leave that way. It is just a migraine after all. They just need the bed.

So that doctor wonders why I do not go? It never helps. I know I should. Stroke risk. Apparently nerve damage. Heart attack risk. Coma. Death. All higher risks when a migraine like that persists. But I gave up on them. People tell me, I should go to a different ER. Way out of my way and maybe, just maybe the treatment will be better. But to the people who say not to complain about that ER? Don’t even go there. I had one doctor ask Me if one of my symptoms was a migraine aura. Me. If he didn’t even know that, then I can guarantee you he didn’t know what a status migraine was. He gave me two Percocet’s. For a status migraine. Yeah, that did not work oddly enough. Because I knew that wouldn’t work I took one, drove home, and took the other praying for sleep. It failed.

The doctor who gave me morphine, and hydration and a boat-ton of anti nausea meds, well it sort of handled my nausea and it knocked the pain down to a 4… which by the way is so very low that I was one happy camper when I left. I consider him ranked one of the best damn doctors I have ever seen there. At least he had some good bedside manners and didn’t treat me horribly just because I can’t tolerate toradol. Right up there with the fellow who actually did know what a status migraine was and gave me DHE.

So I don’t go to the ER here for status migraines. When I am working, I get them quite frequently and they are a serious problem. But, I do nothing but suffer with them, because there is nothing to do with them apparently but that.

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