GREAT article from ER doc perspective on migraines.........interesting

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Regular Member

Date Joined Nov 2006
Total Posts : 81
   Posted 12/15/2006 8:16 PM (GMT -6)   
Hey all:
This article is in a e publication that our buddies, ER docs, read and use.  Enjoy!
26 y/o female
IBS dx 1996, Crohns Diagnosed after extreme flare in Feb. 2006, Emergency Appendectomy Memorial Day 2006 MEDS: Prednisone, Imuran, Lomotil, Darvocet, Phenegren, Reglan, Digestive Advantage, and way too many vitamins   
Migraines Dx 1990, MEDS: Neurontin 900 mg, Prozac. As needed: DHE, Reglan, Phenegren, Maxalt, Amerge, plus all the pain meds (Dialudid, Nubain, Stadol) Allergic to Imitrex

Veteran Member

Date Joined Oct 2006
Total Posts : 902
   Posted 12/16/2006 12:33 AM (GMT -6)   
Good article. Thank you for the link.

This is interesting:

Opioid analgesics. In an emergency department setting, opioid treatment for migraine should be avoided. Recent findings suggest that patients presenting with acute episodic migraine may develop chronic migraine after receiving parenteral opioids. This was found to be particularly problematic for patients who had been opioid-naive prior to treatment.

I used to get migraines once in a while and now I have them nearly everyday. I wonder if a trip to the ER is responsible????

How come none of my Doctors have suggested this? I have had a 20 year history of migraine and spent the last year on State Disability for it. I'm not better off than when I filed and now I'm back to work - with migraines.


Some headache specialists are allowing migraineurs who occasionally fail abortive therapy to use olanzapine 10 mg as a rescue drug. Patients are instructed to use the olanzapine only if their headache worsens after taking two doses of the same triptan within 24 hours.

Olanzapine will induce a six- to eight-hour period of sleep, after which the patient will awaken pain free. This therapy is an excellent option for patients who travel frequently and wish to avoid treatment for acute migraine.

Other procedurally oriented treatments, including botulinum toxin A injection, trigger point injection, occipital nerve block, and sphenopalatine ganglion block, have been used to treat migraine as well. These are considered second- or third-line therapies that can be tried when other treatments have failed. They can also be used in combination with other treatments if a patient has a specific migraine trigger. A complete discussion of these treatments, however, is beyond the scope of this article, as is the topic of migraine prevention.
"God grant me the serenity to accept the things I cannot change, to change the things I can and the wisdom to know the difference. Amen."
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Regular Member

Date Joined Nov 2006
Total Posts : 94
   Posted 12/17/2006 6:09 PM (GMT -6)   

Thanks for the article. I was reading recently about Transformed Migraine--could that have anything to do with the reasoning behind Opiod treatments or maybe just the possibility of rebounding and the patient not being pain free a short time later?
I'm not sure if this type of migraine would apply to you, I've done some researching on it, and it sounds like it starts out as episodic migraines and then transforms into a chronic daily h/a (mild) with severe migraine attacks. It sounds like certain types of pain medications/amount may play a role in...Just thought pass along since I saw your post...

Take Care!

Post Edited (mommyto3) : 12/17/2006 4:18:11 PM (GMT-7)

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