Hey Guys,
I'm just coming off a wicked two day migraine, and I'm so pissed off I can't stand it. I've had migraines for over thirty years (I'm 40), and during that time, I've been on or tried virtually every medication used for migraines. I'm currently taking 200mg Topamax as a preventative, Stadol Nasal Spray as an abortive, and whatever I can get my doctor to prescribe for pain management(sometimes Lortab) if she's in the right mood. I get no relief from any pain medication other than something narcotic at this point. This has been the case for a long time. I've been averaging having to get a pain shot (nubain/phenergan) from my doctor's office every 8-10 days, but I have to use the Stadol NS a lot more frequently.
Well, Friday I started fighting off a migraine with the Stadol NS in the afternoon. It kept trying to come back (weather front moving in) all evening and by 3am, I had a full blown migraine. I got my mom to drive me the the doctor's office when they opened at 7:30. The doctor on duty was actually just a nurse practioner, but he's a wimp. He looked through my chart, and I've seen him before for the same problem. He decided I was having a rebound headache (NOT!), and would only give me a shot of Toradol or Ultram. Well, Toradol does nothing for me, and Ultram doesn't work because I take Effexor. I explained this in detail, but got nowhere. That was all he was willing to do. My other choice was to leave and he would refund my appointment charge. Gee, what a guy.
So, off to the ER I went. Of course, it took three hours to get seen by the doctor (but he was HOT!!! 
) We had a nice little discussion about my migraines, symptoms, medication history and so forth, and I promptly got a shot of 10mg of morphine and 25mg of phenergan. Unfortunately, it took so long to get some relief, I ended up having to get a second shot of the same thing, which took care of the migraine nicely. He also gave me a prescription for a few percocet, for after the morphine wore off. Good thing, cuz I felt like a horse had kicked me in the back of the head.
) We had a nice little discussion about my migraines, symptoms, medication history and so forth, and I promptly got a shot of 10mg of morphine and 25mg of phenergan. Unfortunately, it took so long to get some relief, I ended up having to get a second shot of the same thing, which took care of the migraine nicely. He also gave me a prescription for a few percocet, for after the morphine wore off. Good thing, cuz I felt like a horse had kicked me in the back of the head.It is amazing to me how wide spread the medical profession is on pain management. At the ER, I've been given everything from Nubain to Dilaudid. Some doctors will prescribe narcotic medication for later and some won't. I am having the worst time finding decent pain management. Even the pain clinic here won't prescribe medication to keep me comfortable. Unless my doctor is at the office, I guess I'm stuck going to the ER when I need a shot. Doesn't seem like a great plan to me, but oh well. If I could just find a good neurologist.
Thanks for letting me vent.
Leigh Ann 
"The weather is here, I wish you were beautiful."
) was he did not think I should settle for pain meds and try someone who could work on preventing them. He admitted he did not have much experience with controlling migraines and I respected him a great deal for that. He sent me to 5 or 6 neurologists. The first one pretty much "dropped" me after he found out I did not have a tumor he could operate on. He wanted to settle for pain meds so I moved on. It seems every neuro I went to was ready to give up after a couple of medication trys. My new family doctor (who continues to prescribe pain meds) sent me to a neuro he went to med school with. What a fiasco! He wanted to try a couple of different treatments (which involved painful injections) and I was willing to try anything. The pain clinic decided they could no longer prescribe narcotics so my family doc. continues to. No one told me that the insurance was covering only a small portion of the treatment costs and I did not get a statement from the insurance company until the treatments were finished. Now I owe the doctor so much money they won't let me go back until I get the balance paid down. I used to go in for the nubain/phenergan shots but they quit helping. The family doc switched to demerol/phenergan but they quit helping. Now I pretty much rely on the ER as well and if I am luckly I get a doc that will give me morphine, only about half of the ER docs will. I am to the point that morphine is the only thing that works.
) not all of us ER docs have a God complex. Formulating a care plan with your primary care physician and/or neurologist will provide guidance for the emergency physician when you present with a migraine. Speaking as someone who has been there, it is great to have background information and a plan in black and white -- something to do that will actually help the patient I am seeing. I was never one of those "weenie" doctors afraid to give narcotics. Quite the contrary -- I took pain relief very seriously and the nurses called me "the morphine queen"...So having a care plan on file in the emergency department could be very helpful for you. I would definitely look into it. If you have such a plan an emergency physician would have a hard time explaining why s/he did not follow it. Hope this is helpful.