Yesterday. At work. right on time @ 2:00 pm. Holy Eff is my response to the rest of the day and my ordeal with a new hospital.

I left work and went to Silverton Hospital in Silverton, Oregon because their emergency room will always get you into triage and to a doctor within 20 mins whereas if I went to the emergency room in my city (Salem), I would be waiting 3+ hours. 

I digress; doctor saw me, I described the pain I've been having, (i brought my headache journal and told him i've been keeping track) and explained the attack I was currently in during the discussion. My eye was leaking, nose running, it felt like satan was sucking on my eyeball. It was grand.....

So he asked me what I thought and I said I thought I might be suffering from Cluster Headaches but maybe SUNCT or Paroxysmal Hemicrania. He agreed saying he also thought it was Cluster Headaches. So he asked me if I wanted pills which I immediately declined. He suggested injection and I agreed, thinking I was gonna get Imitrex (since it was the only injectable I could think of at the time).

Doctor left, saying he'd put the order in. Nurse came back about 20 mins later with the shot....excuse me, the 2 shots.

Shot #1:
Diphenhydramine Hydrochloride: 12.5mg IM

Shot #2:
A cocktail of:
Phenergan (Promethazine Hydrochloride) - 25mg
Dilaudid (Hydromorphone Hydrochloride) - 3mg

I was in so much pain, that I couldn't think far enough to ask in depth what these would do. But the nurse and doctor said that the Dilaudid is 5.5x(ish) stronger than morphine and that it would stop the headache and break the cycle.

Well I know full well that they gave me a very heavy narcotic, and I KNOW narcotics don't work, but now I have additional info about treatments used and their failure rates to present to my GP this Friday.

I spent nearly all night, waiting for the dizziness to wear off and for my energy to come back. I didn't feel drained like how a CH attack drains me; I felt drained in all the wrong kinds of way. I kept feeling like I was out of breath, it took too much energy to formulate full sentences and pretty much anything but laying down was too much work for me. It was a not ok feeling.

I just wanted to vent. I'm sitting here with another HA and just biding time until Friday. Thanks guys/gals. I'm glad you're all here.

Oh man I clicked with trembling mouse finger when I saw the title of this topic - that sounds like a helluva lousy day you had, Harp.  :(

I sure hope you can get some relief with high liter flow O2 aborts and/or clusterbuster prevents, and PRONTO. :o

Hi NeurologicHarpoon

Just get this in your mind...
No matter HOW bad it is, it wont kill ya!
Then, it s all downhill from there!
We are here to help!

Respect

Gary

This is an old article but the script is still the same! How sad. But, in their defense, we are such a minority group in medicine that they can't know everything about all that walks in the door.

But you see why we bang the bell on seeing a headache specialist......
====
Treatment of Primary Headache in the Emergency Department


Harvey J. Blumenthal, MD; Michael A. Weisz, MD, FACP; Karen M. Kelly; Renae L. Mayer, MD; Jeffrey Blonsky, MS4
Headache 43(10):1026-1031, 2003. © 2003 Blackwell Publishing

Posted 01/06/2004
Abstract and Case History
Abstract
Background: Each year many patients present to an emergency department for treatment of acute primary headache. We investigated the diagnosis and clinical outcome of patients treated for primary headache in the emergency department.
Methods: Patients treated for acute primary headache in the emergency department completed a questionnaire related to their headache symptoms, response to treatment, and ability to return to normal function. These responses were compared to the treating physicians' observations of the patient's condition at the time of discharge from the emergency department.
Results: Based on the questionnaire, 95% of the 57 respondents met International Headache Society diagnostic criteria for migraine. Emergency department physicians, however, diagnosed only 32% of the respondents with migraine, while 59% were diagnosed as having "cephalgia" or "headache NOS" (not otherwise specified). All patients previously had taken nonprescription medication, and 49% had never taken a triptan. In the emergency department, only 7% of the patients received a drug "specific" for migraine (ie, a triptan or dihydroergotamine). Sixty-five percent of the patients were treated with a "migraine cocktail" comprised of a variable mixture of a nonsteroidal anti-inflammatory agent, a dopamine antagonist, and/or an antihistamine; 24% were treated with opioids. All 57 patients reported that after discharge they had to rest or sleep and were unable to return to normal function. Sixty percent of patients still had headache 24 hours after discharge from the emergency department.
CONCLUSION: THE OVERWHELMING MAJORITY OF PATIENTS WHO PRESENT TO AN EMERGENCY DEPARTMENT WITH ACUTE PRIMARY HEADACHE HAVE MIGRAINE, BUT THE MAJORITY OF PATIENTS RECEIVE A LESS SPECIFIC DIAGNOSIS AND A TREATMENT THAT IS CORRESPONDINGLY NONSPECIFIC.

My only trip to the ER was a 4 hour KIP 10, and I was experienced with the Beast. At the end of 4 hours, I ended up on a table screaming for O2 while the ER doc decided I needed to be strapped down and given a nasal canula. The horror continued until my own neuro showed up around 6AM. After that, I asked for a scrip to take with me if I needed to go to the ER ever again. It was for highest flow O2, freedom of movement, and DHE IV. She also briefed the ER staff on what to expect if another clusterhead came in. Haven't had a repeat since I've been on my O2 regimen as presecribed by Batch, and 400mgs/day of verpamil. Thank God. By the way, you do have a good prevent/abortive plan in the works, right? Blessings. lance

Hey NH in Salem,

Sounds like a bummer and sorry you had such a rough time, but at least you got a diagnosis... 

Unfortunately none of the meds you were given in the ER will do much to stop a CH or end a cycle.  Powerful opiates/analgesics only dull the pain.  They do nothing to the actual CH or triggering mechanism and only leave you in worse shape when they wear off.

Take another look at the following link and take a copy along for your next appointment:

START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGE

Having a good oxygen therapy system makes a world of difference living with CH.

Take care,

V/R, Batch