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Posts Tagged ‘status migrainous’

Avoiding the ER

February 16th, 2009

I narrowly averted an Emergency Room visit yesterday. I’m not really sure if I should be saying that proudly or with embarrassment.  The fact is that I have never yet been to the Emergency Room for a Migraine.  It had never occurred to me until I began studying up on Migraine a few years ago that it was even an option. I don’t know why – I just figured, it was pain, you just put up with it.  Since then I’m happy to say that although my Migraines are frequent, they have not often been severe and they don’t often last more than 24 hours.  I have had half a dozen Migraines where I was within an hour or so of deciding to go for emergency care, but the pain abated, the Migraine resolved, and I averted it.

When should you go for emergency care? If you have a Migraine that continues for 72 hours without a 4 hour break in pain while awake, you are in status migrainous, a dangerous condition which carries an increased risk of stroke. Before you hit that 72 hour mark, seek emergency care to break the Migraine.  However, my headache specialist has told me that if my usual abortives are not effective on a Migraine, if my pain levels are unusually high, or if the pattern is out of the ordinary for me, I should not hesitate to seek emergency care.  What you want in the emergency room is probably not narcotics, which are generally not very effective for treating Migraines anyway, what you want is one of several intravenous treatments which will actually break the Migraine cycle. Here is a list of recommended IV treatments at My Migraine Connection.

I woke Friday morning with a severe Migraine. After 2 doses of Imitrex it subsided somewhat, the pain went from about a level 7 to a level 4 and I thought it was resolving.  I still had pain when I went to bed but thought it would fully resolve while I slept.  I woke Saturday morning with pain at about a level 2.  This could still be a Migraine in the process of resolving.  It grew a little worse throughout the day and I gave myself another Imitrex injection in the afternoon. Again, this knocked the pain level back enough that I thought it was probably resolving. Yesterday when I awoke the pain was severe, around a level 8, and pounding.  I took another Imitrex injection, and a reglan, an anti-nausea medication.  Around 10 I took an oxycodone – a narcotic I have as a rescue medication.  A few hours later I took the last Imitrex injection I am allowed for the week.  At this point, the Migraine was almost 60 hours old.  If it did not respond to that last Imitrex, I was bound for the ER.  The combination of the oxycodone and the Imitrex put me to sleep, and when I woke up a few hours later the pain was down to about a 2, the pounding had stopped, and it felt like I was on the mend.  So I did not go.  Today my head feels a little sore, as if it was bruised, but I am not sensitive to light or sound and I believe I have moved on to the post-drome phase.

Did I make the right choice? I don’t know. I’d be more confident talking about this if I didn’t feel deeply reluctant, even fearful, about going to the Emergency Room.  I’m not sure why.  Yes, I’ve heard horror stories about Migraineurs being turned away and mistreated as drug seekers. I’m prepared to go in with my list of IV meds and my assertive husband and tell them I don’t want narcotics, I want something that will break the Migraine. I will also go to the ER at the hospital where my headache specialist practices, where they will call the neurologist on call who will have access to specific instructions about what to give me. I have been treated in several Emergency Rooms for several things and yes, had my life saved there. I do have some life-threatening medication allergies – maybe that’s what makes me nervous. Maybe it’s the old perfectionist’s reluctance to let anyone else be in charge – especially when my life is on the line!

I feel like I was saved by the bell, yet again. I hope that if I had felt no relief from those two meds in the early afternoon yesterday I would have gone off the ER. I believe I would have – Danny was prepared to take me, and I don’t think he would have let me off the hook at that point.  One of these days I’m going to have to get it over with and do it.  Please tell me about your ER experiences!

– Megan

Tags: emergency room, emergency treatment for Migraine, iv treatment for Migraine, severe Migraine attack, status migrainous
Posted in Communicating, Medicine, Musings | Comments (10)

Taking Care of Myself

May 23rd, 2008

That’s what I’m doing today.  It’s 5:00 and I think I’ve missed status migrainous by about 4 hours.  Status migrainous is a condition where a migraine has continued for 72 hours without a 4 hour complete break in 
pain while awake.  It is a serious condition which carries an increased risk of stroke due to long-term dilation of the blood vessels around the brain.  I am lying in bed with my fingers crossed because my migraine seems to have finally broken after about 68 hours. 

The pain started Tuesday evening and has varied from about a level 2 on a 1 – 10 scale to about a level 8 or 8.5.  It has varied from itchy nagging pain all over my head to furious pounding pain in both temples.  It has been a particularly sneaky persistent presence, sending me strange nightmares.  I have woken up two mornings in a row with the sense of something awful sitting on top of my brain, waiting to pounce.  I have used 4 doses of Imitrex on it.  Finally today, after all of today in bed, most of yesterday, and half the day before; and after 4 expensive, befuddling and nauseating doses of Imitrex, I think the pain is gone.  I’m afraid to move in case it’s just asleep and I wake it up again.  For many of you, this will sound quite familiar.

Nearly all of my plans for the last few days have gone out the window.  What have I accomplished?  I did have an important business conversation with my husband.  I did gather up a list of all the homework my son has missed while he’s been out of school with the flu.  I did wash a few dishes here and there.  I did about 20% of the business work I had on the agenda for the last few days.  I helped my daughter find her uniform for work.  I’m about to be really ambitious and dig up some pretty pictures to illustrate this post.  Other than that, I have been taking care of myself.

What does that look like?  Today, and the past few days, it has looked like sleeping late, staying in bed in my pajamas for much of the day.  Today it involved not even taking a shower so as to keep my head quiet.  Anyone who knows me will tell you how much I hate not taking a shower!  It has looked like saying no to even talking to my family when the pain level was high.  It has looked like keeping track of how long this migraine has gone on, diarying about it, and calling the doctor for help.   I spoke to the nurse this afternoon and now have a plan in place for what to do if the migraine doesn’t break, or recurs, over this holiday weekend.  I’m happy to say the Emergency Room is not the first line of defense in the plan!

I went on the My Migraine Connection forum to connect with my buddies over there and gripe about this long migraine.  One of my friends told me she was proud of me for taking care of myself.  It was a revelation to me, a welcome one, to realize that I have been doing that – taking care of myself! 

After 30+ years of migraines, coaching others to accept their disease and build the best life they can around it, I still struggle with acceptance.  After basing my self care on meditation and relaxation exercises and building my life around my illnesses, I still fight tooth and nail.  I didn’t take an Imitrex Tuesday night because I wasn’t positive it was a migraine.  Maybe I could have prevented the following days of pain if I
hadn’t been in denial then.  Regret is pointless.  Great thanks to Gret for reminding me of what I am accomplishing today.  I am taking care of myself.  The shower will still be there tomorrow.  Chances are, so will the dirty dishes.  And the newsletter I owe to you, my subscribers.  And the garden beds to weed.

Wherever you are, whatever you’re doing tonight, remember to take care of yourselves.  I hope for all of us a pain-free tomorrow.

– Megan

Tags: imitrex, Migraine pain, self care, status migrainous
Posted in Managing | Comments (2)