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        New Message Board Archives >> Medications, Treatments, Therapies 2004 >> ER--not the place for primary CH care
        
(Message started by: Bob_Johnson on Jan 15^th, 2004, 10:39am)

Title: ER--not the place for primary CH care
Post by Bob_Johnson on Jan 15^th, 2004, 10:39am

Yet another report showing why we must find a doc with knowledge & skill in treating Cluster--if at all possible.
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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

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.

Title: Re: ER--not the place for primary CH care
Post by Tiannia on Jan 15^th, 2004, 3:43pm

WTF - Sixty-five percent of the patients were treated with a "migraine cocktail"

I've never heard of one of those and I spent many many times in the er with my mom for her migraine for as far back as I can remember.

Tia

Title: Re: ER--not the place for primary CH care
Post by chronic_chic on Jan 15^th, 2004, 4:14pm

My guess is....study done at a hospital with a headache center attached. ER's there tend to treat headaches with migraine cocktails instead of painkillers.

Based on being an ER employee, I wouldn't recommend ER as best place for headache treatment unless headache is not a primary headache (aka....symptom of stroke, heart attack, aneurysm, tumor..etc) In those cases...get thee to an ER quickly!

Some people find relief at ERs, but for the most part they are noisy, overcrowded, very bright lights and strong sensory things going on, and the wait is very long if you're not coming in with an "emergency."

I asked James (my boyfriend) if he's ever had a cluster patient come into the ER where we work at (he's been there a lot longer), and he said he's never had one. Lots of headaches...migraines and other, but never a CHer...he asked how would you know. I gave him a brief description...and he said, "wow...no never had one of them come in." Guess the CHers don't frequent our ER too much!

I would always go if you feel it's necessary...Just don't make it your place of primary headache care!

Just some ER thoughts from an ER employee...

~Lizzie :)

Title: Re: ER--not the place for primary CH care
Post by Prense on Jan 15^th, 2004, 5:30pm

I have been seen very rapidly during all ER visits. They want to treat with narcs though. No thanks. Since my last ER visit, I have been prescribed imitrex, and I have never had to visit an ER again. Oddly, every ER carries triptans and dihydroergotamine. Neither of those were ever offered to me...

Chris

Title: Re: ER--not the place for primary CH care
Post by t_h_b on Jan 15^th, 2004, 6:21pm

The ER is not the best place for ANY primary care!

Title: Re: ER--not the place for primary CH care
Post by chronic_chic on Jan 15^th, 2004, 9:56pm

Here is a link to another headache website....There are forms to print here that your MD can fill out requesting what type of medications you should receive upon visiting the ER for care.

http://headaches.about.com/cs/advocacy/a/emerg_forms.htm

Hope this helps someone!

~Lizzie