After my first complex migraine on June 16th, after receiving Botox on June 17th, and after 6 days of trying Benadryl, Zofran, Cambia, Ibuprofen, and Prednisone, I decided it was time to go to the Hospital. I know many migraine patients go to the ER for a number of reasons, whether it to break a migraine/headache cycle, to abort a really bad migraine, etc. However, I had never been to the hospital for my migraines or headaches, so I did not
know what to expect. My mom, who also has migraines and is a nurse, explained to me what they might try and what to expect. I really did believe that one ER visit and I would be all better, I was wrong. If you have not been to the hospital for migraines, this blog post might help you understand what might happen. Obviously, not every hospital has the same headache protocol and treats each patient different, but this was my experience.
I went to the emergency room on June 23, 2018, which was a Saturday. Upon arrival, they went through all the normal intake things, like vitals, medications I am on, blood work, etc. I began with just an IV Saline drip until the doctor on call was consulted. I was grateful to have my regular neurologist in the hospital that day, so she stopped down in the ER to check on me and give her opinion. So the hospital I went to had a “triple cocktail” headache protocol routine they follow. This consisted of Benadryl, Reglan, and Toradol. There is generally suppose to be a waiting period between when the Benadryl is given and when the Reglan is given, but because I was in the ER that time was cut in half. Five minutes after the nurse pushed the Reglan I began to have a reaction. I felt like I was crawling out of my skin, I could not lay still, I jumped over the bed rail, tried to pull my IV out and run. That reaction is known as a dystonic reaction or extrapyramidal symptoms. More Benadryl was given to reverse the reaction, and it did. After about an hour of waiting for the Toradol to do its thing, I was still in pain. The next course of action was to try IV Solu Medrol, in case it was to work better than the oral Prednisone I had been doing for the past three days, but again I was still in pain. After that, my neurologist recommended that we try DHE, which is a success for many migraine patients, and I wish it worked, but nope… another allergic reaction. This time I started having really bad chest pain and my throat was tight; it was not a fun experience. I had an MRI done, but it did not show anything, which I did not expect it to. However, I did use a few choice words with the Doctor for ordering a loud MRI for a migraine patient. I was then admitted to the hospital because there was nothing left to do in the ER.
When I got to the neurology floor, I had a nurse come in and explain that they were going to try to do the “triple cocktail” protocol again, except this time with the appropriate amount of time between each of the medications given. However, I still had a reaction to Reglan and was given Cogentin. We tried DHE again the next morning, but the same thing I had chest pain. I spent the next 3 days in the hospital trying different steroids, anti-inflammatories, and a bunch of other medications. They decided to send me home, in the same amount of pain that I came in with, because there was not much else they could do.
When I got home, my neurologist called and asked me to get my D-dimer blood levels checked, and they were slightly elevated. She asked me to come back into the ER for an MRI with contrast to check for blood clots, so June 29th I was back in the ER. However, the Doctor on call ordered a CT with contrast rather than an MRI that was I would not have to go through that horrible noisy experience again. Thank goodness. But still the CT showed nothing, and I was admitted back into the hospital. This time we tried magnesium drip, a 3-day steroid drip, Zyprexa, Phenobarbital, and at one point Ativan which I had a reaction to as well. This was when the conversation started about sending me to a city hospital for further treatment. They talked about Thomas Jefferson University Hospital for Ketamine infusions or Methodist Hospital for Lidocaine infusions. They were able to get me a bed at the Headache Unit at Methodist Hospital for Lidocaine infusions, so on July 3rd, I was transferred there. I am someone who loves to read medical research, but I was in so much pain that I could not read or understand what was being put into my body, which frustrated me. It was not the best experience, but it is part of the journey and something to share. Like I said each hospital handles Headache patient differently, but this was my experience. My next posts will share what it was like at Methodist hospital as well as Jefferson, which I think many people will find helpful.
New Medications Mentioned:
- Prednisone: Steroid- “provides relief for inflamed areas of the body” https://www.mayoclinic.org/drugs-supplements/prednisone-oral-route/description/drg-2007526
- Reglan: (metoclopramide) GERD “increases muscle contraction in the upper digestive tract.” Can also be used to help with nausea https://www.drugs.com/reglan.html
- Toradol: (ketoralac) NSAID “works by reducing hormones that cause inflammation and pain in the body” https://www.drugs.com/search.php?searchterm=Toradol&a=1
- Solu Medrol: Steroid- ” prevents the release of substances in the body that cause inflammation” https://www.drugs.com/mtm/solu-medrol-injection.html
- DHE: (dihydroergotamine) Ergot Alkaloids- “Works by narrowing the blood vessels around the brain and affects blood flow patterns that are associated with certain types of headaches. DHE 45 is used to treat a migraine or cluster headache attack” https://www.drugs.com/mtm/d-h-e-45-injection.html
- Cogentin: (Benztropine) “reduces the effects of certain chemicals in the body that may be unbalanced as a result of disease, drug therapy, or other causes.” https://www.drugs.com/mtm/benztropine.html
- Zyprexa: (Olanzapine) most commonly used to treat psychiatric disorders, but can also help with migraine headaches
- Ativan: (lorazepam): Benzodiazepines “affects chemicals in the brain that may be unbalanced in people with anxiety” https://www.drugs.com/ativan.html
- Phenobarbital: Barbiturate https://medlineplus.gov/druginfo/meds/a682007.html