What Will This Summary Cover
This summary will cover:
- Medicines to treat severe migraines in the ER
- What researchers have found about how well the medicines work
- Possible side effects of the medicines
- Things to talk about with the ER doctor
Note: This summary does not cover what researchers found about treating migraines at home or ways to prevent migraines. It only covers what researchers found about treating migraines in the ER.
Where Does The Information Come From
Researchers reviewed studies on medicines to treat migraines in the ER. These studies were published through January 2012. The researchers were funded by the Agency for Healthcare Research and Quality , a Federal Government research agency.
The researchers wrote a report on what they found, and this summary is based on that report. The report was reviewed by doctors, researchers, other experts, and the public. You can read the report at www.effectivehealthcare.ahrq.gov/migraine-emergency.cfm.
What Should I Do When A Migraine Begins
Work with your doctor to come up with a plan for managing your migraines. Keeping a list of home treatment methods that have worked for you in the past also can help. When symptoms begin:
- If you take migraine medicine, take it right away.
- Drink fluids, if you don’t have nausea during your migraine.
- Lie down and rest in a dark, quiet room, if that is practical.
Some people find the following useful:
- A cold cloth on your head
- Rubbing or applying pressure to the spot where you feel pain
- Massage or other relaxation exercises
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You Sit And Sit And It’s Not A Migraine
We all know that triage rules apply, and Migraine isn’t a life-threatening condition like a gunshot wound. That doesn’t make the long wait any easier.
“I get ushered from one waiting room to the next with more people in each one. The final one is set up as a cubicle style and they talk to you like you’re an addict.” Jeannette G.
“Last time I went to the ER, I was charged $500 to sit on a bed in a hallway.” Anna K.
“I HATE BEING IN THE ER with a migraine especially. No one ever seemed to observe the no perfume/scents rule. The fluorescent lights are horrible. The noise is extra, extra noisy.” -Laura M.
“I’m sensitive to light, sound, smell and none of the injections I get ever help so why in the world would I go to the loudest, brightest, smelliest place there is just to sit and be ignored for hours to maybe get meds that don’t even help?” -Barbara D.
You Have To Prove Your Pain And That You’re Not A Drug Addict
The abuse of and addiction to opioids such as heroin, morphine, and prescription pain relievers is a serious global problem that’s escalating annually. ERs are trained to screen us all the same: hmmm, could you be one of the 36 million opioid abusers worldwide?
That complicates the problem of Migraine as an invisible illness for which there’s no scan or blood test to easily prove your diagnosis. The stigma continues.
“They think you are there because you are a “druggie”, ask you a million and one questions that you can’t answer because of the migraine fog.” Jaselle H.
“They assumed I was a drug addict because I was in my mid-twenties and writhing in pain with “no discernible reason”. Then I got an IV and froze for a few hours before going home.” Lorenzo T.
“I’m allergic to normal migraine meds and when I told them that, the doctor stormed out, came back with a syringe, gave it to the nurse and told me that he’d give me Demerol this time to help get rid of the headache but that I’d better never come back again because he was never giving me that med again. He said if I wanted it, I’d have to get it from someone else. It was the first and only time I’d gone to the ER for a migraine. I was so insulted and demeaned, I would never go back again. I couldn’t believe it.” Andi S.
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Trigger: Lack Of Food Or Sleep
It’s important for people prone to migraine headaches to have a regular pattern of meals and sleep. Low blood sugar from skipping meals can trigger a migraine. Eating too much sugar also can cause a spike, then a “crash” in blood sugar. Drink water throughout the day to avoid dehydration and sleep at least six to eight hours a night.
Preventive Medications And Treatments
Especially for tough-to-manage, chronic migraine cases , doctors may prescribe medications to prevent the onset of attacks. These abortive drugs include:
- Beta-blockers:Drugs of this class, like Tenormin and Inderal LA , lower blood pressure and have been shown to help with migraines.
- Tricyclic antidepressants: Elavil and Pamelor , among others, are a type of antidepressant that can also help with pain.
- Antiepileptic drugs: Medications to prevent seizures, antiepileptic drugs, like Depakote and Topamax , are also prescribed for migraine.
- Calcium channel-blockers:Verapamil may be prescribed. This class of drugs is typically used for high blood pressure and other cardiac issues.
- Calcitonin gene-related peptides : A newer class for migraine prevention, drugs of this type include Vyepti and Ajovy .
Another option for difficult, chronic migraines are Botox injections. Using a toxin made by the botulinum bacteria to essentially numb pain messaging, shots are delivered to specific areas on your forehead, sides, back of the head, and/or neck. The effects, however, only last about three months, so multiple appointments are necessary.
When migraines are known to be associated with the menstrual cycle, hormone therapy may be attempted.
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What Are The Side Effects Of Nsaids
NSAIDs can cause problems with your stomach and gut.6 These problems include constipation, diarrhea, gas, bloating, nausea, or pain. More serious complications include bleeding or stomach ulcer, or kidney problems. Signs of these complications include changes in stool or urine and weight gain, among others.
People with certain health conditions should not take NSAIDs. For example, people with certain heart problems should not take non-aspirin NSAIDs.
Even though these drugs are available without a prescription, it is a good idea to talk to your doctor about taking them. If you are taking several medications, it is important to know which of them are NSAIDs.
These are not all the possible side effects of NSAIDs. Patients should talk to their doctor about what to expect with treatment with NSAIDs.
When Nothing Else Works
Having a plan for managing your migraine attacks at home is important. But if your migraine attacks sometimes leave you wondering if you should head to the emergency room, youre not alone. In fact, according to the Migraine Research Foundation, every 10 seconds someone in the U.S. goes to the emergency room complaining of head pain.
If you decide to visit the emergency room, the care team may be able to treat your symptoms with medications for pain and nausea. These medications are usually given as an IV while you rest in the emergency room. Having an IV can also help with dehydration, which may also be contributing to your migraine attack. Though these treatments can stop symptoms and help your migraine go away, they unfortunately dont usually do much to prevent future attacks.
If you experience a migraine that is noticeably different from your usual migraines, you should call your healthcare provider or go to the emergency room right away. You should also see a provider if you have an unusually severe headache or a headache that lasts longer than 72 hours. Other reasons to get medical help include loss of vision, fainting, or uncontrollable vomiting. Headaches can sometimes be a symptom of other serious health conditions. In rare cases, migraine pain lasting longer than 72 hours called status migrainosus may sometimes require hospitalization.
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What Other Information Should I Know
Keep all appointments with your doctor. Your blood pressure should be checked regularly.
You should keep a headache diary by writing down when you have headaches and when you use sumatriptan injection.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.
It is important for you to keep a written list of all of the prescription and nonprescription medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
What Are The Symptoms Of A Migraine
Individual migraines are moderate to severe in intensity, often characterized by a throbbing or pounding feeling. Although they are frequently one-sided, they may occur anywhere on the head, neck and face or all over. At their worst, they are typically associated with sensitivity to light, noise and/or smells. Nausea is one of the most common symptoms and it worsens with activity, which often results in patient disability. In many respects, migraines are much like alcohol-related hangovers.
Migraine pain can be felt in the face, where it may be mistaken for sinus headache or in the neck, where it may be mistaken for arthritis or muscle spasm. Complicating the diagnosis of migraine is that the headaches may be accompanied by other “sinus like” symptoms, including watering eyes, nasal congestion and a sense of facial pressure. Most patients who think they have sinus headache in fact have migraines.
In up to 25 percent of patients, the migraine headache pain may be preceded by an aura, a temporary neurological syndrome that slowly progresses and then typically resolves just as the pain begins. While the most common type of migraine aura involves visual disturbances , many people experience numbness, confusion, trouble speaking, vertigo and other strokelike neurological symptoms. Some patients may experience auras without headaches.
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Treating Migraine Headaches: Some Drugs Should Rarely Be Used
Migraine attacks can last for hoursor even days. They can cause intense pain, nausea and vomiting. They can make you sensitive to light or noise and they can affect your life and work.
To treat migraines, you may be given a prescription for an opioid or a barbiturate called butalbital. These are pain medicines. But you should think twice about using these drugs for migraine. Heres why:
These drugs can make headaches worse.
Using too much pain medicine can lead to a condition called medication overuse headache . Two kinds of pain medicine are more likely to cause MOH:
- Drugs containing opioidssuch as codeine , morphine , Hycodan or oxycodone .
- Drugs containing butalbital .
They are not as effective as other migraine drugs.
There are other drugs that can reduce the number of migraines you have and how severe they arebetter than opioids and butalbital. Even in the emergency roomwhere people with severe migraines often ask for opioidsbetter drugs are available, including triptans.
They have risks.
Opioids and butalbital can cause serious withdrawal symptoms if you stop taking them suddenly. People who use high doses for a long time may need to be in the hospital in order to stop using them.
Opioids, even at low doses, can make you feel sleepy or dizzy. Other side effects include constipation and nausea. Using them for a long time can lower your sex drive and cause depression and sleep problems.
Which drugs are good for migraines?
Limit the use of all pain medicines.
What Are Rebound Migraines
Women who use acute pain-relief medicine more than two or three times a week or more than 10 days out of the month can set off a cycle called rebound. As each dose of medicine wears off, the pain comes back, leading the patient to take even more. This overuse causes your medicine to stop helping your pain and actually start causing headaches. Rebound headaches can occur with both over-the-counter and prescription pain-relief medicines. They can also occur whether you take them for headache or for another type of pain. Talk to your doctor if you’re caught in a rebound cycle.
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Take Steps To Tackle Work
The pressures of an increasingly demanding work culture can result in significant work-related stress for many employees. Depending on the nature of your work this may be consistent or vary across months, years or even throughout your working life. Stress can have a detrimental effect on sleep, eating habits and general wellbeing which can all be potential trigger factors for migraine attacks. Clear demands, clarity of role and objectives, regular supervision and support through change should all be adopted into management systems to effectively deal with stress in the workplace.
Many employers have additional offerings in place to promote staff wellbeing. These can range from flexible working policies, employee assistant programs, gym memberships and mentoring programs. Familiarise yourself with your companys policies on managing stress at work and what you are entitled to in your workplace. If you feel that you have specific needs as a person with migraine then you can discuss this with your employer.
The Health and Safety Executive has a body of excellent information and resources on work-related stress, including the Management Standards for work-related stress which helps employers to support their workforce. Visit their website for more information.
When To Call 911
Get emergency help in the following cases:
- Your headache is more painful and extensive than any in the past.
- The onset of the headache is much more rapid than usual.
- Youre experiencing problems speaking and having sudden vision problems.
- You have numbness, weakness, or issues with movement and/or balance.
In addition, the following cases may not constitute an emergency but warrant a call to the doctor:
- The general pattern of your headaches has changed.
- Treatments and/or medications are no longer effective.
- Your medications are causing side effects.
- Youve started taking birth control.
- You need pain medications three or more days a week.
- Your head pain gets worse when you lie down.
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Whyyy Is This Happening
Vestibular migraine attacks are one of the most common causes of ringing in your ears. This tinnitus + migraine combo affects about 1 to 3 percent of the population. Vestibular migraine is also responsible for up to 30 percent of reported episodes of dizziness.
Scientists still havent unearthed the exact link between migraine and tinnitus. But there are a few possible reasons you may hear ringing in your ears during a migraine attack.
How To Avoid Migraines At Work
More important than treating migraines once they come on is avoiding episodes to begin with, says Diamond. That means taking steps to adjust your work routine and office environment as much as possible in order to mitigate the specific factors that prompt episodes.
Ultimately lifestyle plays a role, and so we talk about the migraine brain being more irritable, says Diamond. It doesnt like change. Establishing solid routines and sticking to them can be an important factor in avoiding migraines, she says. That means waking up and going to sleep at a regular time every night, staying hydrated, keeping daytime naps relatively short and not skipping meals.
Some people who experience migraines may want to avoid fluorescent lighting, as bright light can trigger their headaches. So can strong odors for some patientsso if a colleague uses strong-smelling perfume or aftershave that triggers your symptoms, that might call for a respectful conversation between co-workers.
You might not be able to change everything about your work environment to avoid migraines, but its important to adjust what you can control to make episodes less likely to occur.
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What Is The Best Thing To Do For A Migraine
If you get migraines, you can ease the pain immediately by simple measures that include:
- Resting with your eyes closed in a dark, quiet room
- Putting an ice pack on your forehead
- Hydrating yourself by drinking plenty of liquids
You can talk with your doctor and try complementary or alternative treatments along with other medications. These include:
- Biofeedback: This method helps to identify stressful situations that could trigger migraines. By modifying your bodyâs reaction to stress, you can prevent migraine attacks.
- Cognitive behavioral therapy : A specialist can teach you changes peopleâs attitudes and their behavior.
- Progressive muscle relaxation : A therapist will teach how to tighten and relax your body muscles to relieve the stress that triggers your migraine.
What Can Cause A Migraine
Doctors are not sure what exactly causes migraines. But, many things can trigger a migraine. Different people have different triggers, which can include:
- Stress or anxiety
- Changes in hormones
- Bright lights, loud sounds, and strong smells
- Certain foods, such as chocolate, cheese, salty foods, or processed foods
- Food additives such as MSG or aspartame
- Not getting enough to eat
- Not getting enough sleep
- Some medicines
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Preventative Medication And Therapies
If you experience frequent migraines, your GP might discuss preventative medication options with you.
It is important to note that preventatives for migraines are not pain medication, but help to reduce the number of migraines. They take time to work, so the minimum time period required may be three to six months. Contact your GP or specialist for further information. All of these treatments have their advantages and disadvantages and some of the medications might not be suitable for everybody.
You might find that this medication reduces the frequency and severity of your attacks but does not stop them completely. You will need to continue your other migraine treatments when you experience an attack.
National Institute for Health and Care Excellence recommends that GPs and specialists should consider the following drugs and therapies if they think you might benefit from preventative treatment:
Beta blocking drugs
These drugs are traditionally used to treat angina and high blood pressure. It has been found that certain beta-blockers prevent migraine attacks. Beta-blockers are unsuitable for people with certain conditions.
This drug is typically prescribed for the treatment of epilepsy but has also been found to help reduce the frequency of migraines. Again, it is not suitable for everyone. In particular, women who are pregnant or thinking about getting pregnant should be advised of the associated side effects.
Botulinum toxin type A