Require migraine treatment advice

Currently suffer from chronic migraines. Change of seasons is worst. Suffer approx 20+ headaches / month. If take meds in time...I.e. Feel headache coming on, so will take Maxalt....if no success will take another and finally if migraine still does not dissipate will have no choice ,but, to head up to hospital ER for good shot of Toradol, which, more often than not will nip migraine in the bud. That is until the next one.

My problem is ; if awakened in middle of night or meds have no effect, headache will grow exponentially and even treatment at hospital is ineffective. I can tell you the pain in my head when this situation occurs is literally unbearable. No traditional Migraine treatments at hospital will work either; only treatment I can say is helpful is good shot of Morphine w/ gravol, which, does not cure headache, but allows terrible pain to be somewhat bearable. After 20 min or so, will be sent home to basically rest and let migraine run it's course.

This is where I have dilemna. I would say 60-70 % of time, if I personally know physician, the doctor will administer this treatment and as I said...am sent home to basically sleep and let headache run it's course. The other portion of time, I will run into a physician that seems totally disinterested in my past history/treatment. Will advise me that Morphine is not  accepted migraine treatment and will try several acccepted migraine treatments that simply do alleviate my condition. I try, in vain, to explain my history, but, doctor is almost seemingly emphatic to my input. I may add that after administering each treatment (unsuccessfully), I must wait approx 30-45 min to see if medicine is successful. All the while, I am in complete disarray.

Finally after few hours, physician will somewhat "give in" and administer Morphine. My last 2 visits, however, the amount of pain reliever administerd was not enough to disturb a mouse and episode continues.

My question is , how can I go about convincing Hospital ER doctors that when my headache reaches certain point, is basically untreatable....only option that works in my circumstance is treatment I have mentioned. They tell me morphine can be addictive. I tell them I realize that but I have CMH and am going to get another headache again regardless. I tell them other physicians have administered medication I know works. Doctors that have no interest in this treatment; my words fall on deaf ears.

I just don't know where to turn because my past 2 headaches were among worst I've endured and am quite worried about the next one (I.e. Will I run into right or wrong physician at hospital). I already take Botox every 90 days, but , pain specialist has advised me they most likely require more Botox treatment ( is very expensive - my plan covers every 90 days). I have also had success with occipital nerve blocks, but, live in northern region of province. Can only be administered if qualified professional happens to be working in ER.

I guess my hope is that I would like to be administered treatment that actually has some relief ( realize morphine is not an accepted treatment for migraines, but helps me in my unique circumstance), would not liked to be looked on as if some type "drug addict" looking for "fix" - this could not be further from truth and I resent the innuendo. Just want terrible pain to end, be sent home to " sleep it off" so to speak and be treated with respect.

Have already filed complaint with Ministry of Health, but, am awaiting answers. Does anyone have suggestion or advice that might help me ? Very, very much appreciated. Might add , have already had my family physician inform hospital ER of my condition and treatment, but, seems to have fallen on deaf ears. Thanks again.

Unfortunately the drug seekers out there have created a really bad situation for those of us with serious pain problems who really do them on occasion for migraines and other chronic pain problems. I have heard as many as 50% of those turning up at ERs may fall into this category. You can see how that would predispose them not to believe someone whose pain they cannot see.

So how to get the right treatment? Some people have found success with getting a written letter from your physician, providing the diagnosis and recommended treatment, along with a list drugs that have been tried and do not work for you. Some ER docs will give that a little more weight. If you go to the the same ER, it may also be possible to get your doctor ( or a doctor on staff there) to put into your file the recommended treatment, along with a record of what does not work for you.

Personally I never go to ER for migraine because I have heard so many horror stories and if I'm that bad off, I can't move anyway. And I certainly can't communicate or or make reasonable decisions about going. So I am lucky that my doctor has prescribed Oxycodone for me, which at least makes it bearable. But they are making it very difficult for physicians to prescribe that here ( due to all the drug abusers), so I'm constantly worried I will have problems in future.

Good luck!

I understand what you're saying. What perplexes me ( as I've discussed with my wife) is that if you were happen to go to hospital ER with broken leg or kidney stone perhaps ( as I've done), the hospital seems intent on making patient comfortable (I.e pain relief) before addressing problem.

With migraine attack, which I can attest to as being one of most painful experiences i've ever been thru, the hospital,seems more intent on eliminating headache ( for which there is no cure) without regard to extreme amount of pain I am experiencing. Just don't get it, but, thanks for advice....will be definitely attempting to get this accomplished

Well, I completed what my intentions were. Filed a complaint with the HospitaI go to for treatment as well as Ministry of Health - Provincial Ombudsman. Both indicated would be looking into matter and get back to me

T. In another twist of fate, I incurred accident at home where I was entering my wife's vehicle....slipped and really banged side of my head against vehicle. Ended up with huge "goose egg" on side of my head as well as searing pain. Once again, went to Hospital E.R. For treatment. Explained that pain emanating from side of my head was intolerable ( similar to bad migraine attack) as thought may have incurred concussion. Thankfully, tests proved negative, but, head was still pounding.

. Doctor administered ineffective treatment (Toradol) and when I communicated to him that this medication was not working, he suggested pain from hitting car door with head should not be that bad and basically nothing he could do. I was so frustrated by this that literally almost got off hospital bed and put his lights out.

How the heck does he know level pain I am in. Dr. also suggested I have low pain threshold and I responded with "don' t give hoot about pain threshold; only know amount of pain I am experiencing" ( exact situation as severed migraine) and want to be back to normal as quickly as possible.Could not believe I was released when reason I went to Hospital in first place was to try and have this pain alleviated.

At this point I am so steamed and frustrated. Honestly do not know where to turn. Any suggestions would be greatly welcomed.

Hello, Glo
I am so sorry that you suffer from such bad M (migraine), but you have came to the right place for information and advice. Unfortunately I was not able to read you post, because like many other M sufferers I am not able to read big block of text.

You are likely to get much better response if you divide your post into smaller paragraphs, so we can read them.

You can do it by going to Edit at the top your post and splitting the text so more people can read it.

MiniI

Thank you for dividing the text to make it easier to read, Glo.
Unfortunately at the moment, like you I am suffering from an extremely painful episode of M, due to violent weather changes here in UK. and computer screen (any light) makes it so much worse, so I cannot write much more at the moment.

I am so sorry about lack of understanding about the pain levels - such a common problem.

My experience is that sometimes an injury that should not be that bad (eg dropping a can on my foot) starts the chain that leads to a migraine (which is that bad). It's as if your body has a positive feedback loop that escalates the pain signal instead if it diminishing over time like it supposed to.

If the doctor treating you had any understanding of migraines, he would know that. I recommend skipping the hospital you go to and try to find a chronic pain specialist or neurologist who undestands migraines. So many doctors really do not.

It's amazing that the urgent care/emergency room doesn't have the records from previous treatments. I imagine they actually do, but the doctor on call just doesn't bother to consult them, as he "knows how" to treat migraine.

Of course, they are always worried about drug seekers. It's too bad that only opioids treat your pain, you'd have a much easier time if some other treatment worked.  With me, none of the standard treatments work either,  but a moderate dose of IV NSAIDs will abort most of mine, so the few times I've ended up at the ER they have no problem following my advice.

All I can think of is to have your primary doctor right a short, no more than 2-3 paragraphs (since the doctor on call will only glance at it), letter about your condition, its lack of response to standard treatments and a statement you are not a drug seeker, that you only use morphine on rare occasions when your migraines get out of control (maybe listing when you have used morphine in the last year). Along with his contact. This might reassure the doctors on call that you are not an addict or drug seeker.

Would your primary prescription give you a prescription for a few tablets of morphine, assuming you can swallow oral medication when you have a migraine this bad? I know with me, my stomach stops working and meds just sit in my stomach and never get absorbed. But if you can handle oral medication, the couple of tabs might get you by until your can see your primary physician again and help you avoid the ER.

I totally understand where you are coming from as I am in the same boat you are.

Have had chronic migraine for 22 years and when it gets out of control the ER is the only option.

The MD that I was with for 13 years, would give me a signed letter once a year stating my diagnosis, what treatment he was giving me, and that when my migraine got out of control, what and how much to give me.

Most of the time it worked like a charm.  

But there will always be those ER doctors that aren't going to administer a narcotic period.

It was certainly worth having though because like I said most of the time it worked because it took the total responsibility off them.

My MD retired 3 years ago and I have been in Pain Management ever since.

The PM Doctor got so frustrated by the way I was treated at our hospital ER that he now sends me to one an hour away from home where he has spoken to the ER and I have no problems anymore.

I only have to go maybe 3 times a year now because PM Doctor gives me the same med in pill form that I used to get a shot of and that usually works.

When a patient has documentation of an illness that causes pain flares I just don't understand their reluctance to give the meds that work.

I too have been put thru their "protocol" treatments for migraine and either they don't work at all or cause me terrible side effects.

One thing that frustrated my MD and now my PM Doctor is that I only go when it is BAD and my bp will be like 180/110.

On more than one occasion an ER doctor has offered me meds to get my bp down.  Like that is going to solve the underlying problem!

I would try the letter if I were you.

Cindy

About BP - mine does the same thing during a migraine, so that the few times I've gone to an ER they think I must be in severe pain and offer me pain drugs.

But in my case, the high BP is a sign of the migraine, not due to pain.

The last time I was in the doctor's office with a moderate migraine with just some pain at the back of my head but a lot of nausea and photophobia and so on ( I was actually there for my flu shot, not the migraine) and it hit 200/120, which scared me a bit. But it quickly went down again over an hour. Normally I have "normal" BP.

I looked up a study of migraine and high BP in several 100 migraine patients and the study did not find any correlation.

My migraine develops before my BP goes up, so I'm not getting symptoms directly from the high BP but getting the high BP from the migraine, I think.

Does anyone get high BP during a migraine even when they are not in severe pain.

Hi,

I'm so sorry that you are having such a rough time. Here are my thoughts.

1. Definitely get a letter from your neuro stating that you are his patient and what treatment works best for you. This will certainly smooth out some problems at the ER. ER doctors will take it seriously and it may eliminate some of the drug seeker or lets throw everything else at it before going with what works mentality.

You mentioned Toradol shots. My neuro has actually prescribed some for home use. If I have a bad one, I simply give myself a shot of Toradol and a shot of Phenergan and that helps a great deal. This might be a good option for you and it would allow you to save the ER for the ones that only respond to morphine. One other thing, can you take oral morphine? If you can, it is possible that you could try this and hopefully avoid the ER.

About 10 years ago, my neuro decided to change tactics. Instead of continuing to look at preventatives, we had to start focusing on what would keep me out of the ER and allow me to have a better quality of life. this led to starting long-acting pain meds, an occipital nerve stimulator, and learning how to cope with this.

I know you mentioned that the bad ones creep up on you while you sleep. I know some migraine preventatives are also sedatives. Could you add something like this in at night? I take Zanaflex, but there are plenty of meds that could help.

Hang in there.

Pain free days,
sailing