Had another very bad attack today. I wished I was able to get to the phone and dial 911. Afterwards though, I thought to myself, what in the world would they have done? It seems like nothing helps this cluster f* stuff. So I guess you just try what you have on hand and wish for the best?

They can give you high flow O2, imitrex or DHE IV treatment (which is very effective).

And when those 3 don't work, they give you enough narcotics to sedate you.

The ER was actually how I was introduced to DHE, and it has been a lifesaver from time to time throughout the years.

I the beginning i use to go to ER everytime until i learned how to partial deal with them! get some O2 and have some imitrex shots... that will help for the pain

We spent last Tuesday night in ER from 1 - 4:30 a.m.  (Thanks to insurance not providing us with imitrex shots, instead they get to pay for an ER visit..figure the logic in that)  3rd time in 20 yrs.  Unfortunately most ER docs are not well versed in CH.  I called on our way in, talked with ER nurse, gave her my hubby's history, (they could look it up in the system), who is doc is (small town, well known doc), what meds he's on, and to please have ready 100% oxygen at a 15 or higher flow w/ full mask and an imitrex shot, and not to expect us to go thru the insurance bs process right away because he was in excruciating pain.  We got there and were put in a room and waited, and waited, and waited and they weren't even busy!   Could not get the nurse to understand the urgency, (even though one look at my hubby would bring most people to tears) could not get the doc in there, and then they expect him to give his whole life history while dealing with his pain.  Now, I understand they have a protocol and process to go through and must rule out other issues (and if you're a healthcare provider God love ya! I have a few in my family and I educate THEM on CH)  But at the very least they could have given him oxygen.  One hour later he finally got his shot..an hour after than the doc comes back to check on him (we can't leave til he does) and he says "that shot worked that fast?"  He had no clue because I watched him leave the first time and go out to the desk and start sifting through a book (probably looking up the definition of cluster headaches).  I'm sure he's a very fine doc and probably saves many lives and would have been Johnny on the spot were it a trauma victim or heart attack but unfortunately for all of us the medical community as a whole has no clue the suffering that goes on during a CH attack. 

We're all at war with this damn beast so find a knowledgable doc who will arm you with an arsenol of prevention and aborts.  Cause when the sun goes down and it's scary at night we sometimes feel we're all alone, and sometimes we are, left to fight each battle every night....until you come here and know you're not alone.  I'm a newbie to the board too but the embrace, encouragement, advice, and outpouring of support gets us through.   Good luck and God bless you....peace and wellness to all!

Great post hiswife and I am sorry for what you had to go through in the ER.  You took the words right out of my mouth in your post...

The question:
What can they do for you at the ER?

The answer:
Make you WAIT WAIT WAIT and WAIT some more. 

God bless all medical staff for the work they do, but sometimes when someone like a CHer is in EXCRUCIATING PAIN they either aren't versed in CH treatment or are too damn slow to act.  All it would take is to get the history (which you do on intake anyway) and order a Nurse to give O2 or a shot, that friggin simple, not to mention it would free up an ER bed/room faster for someone who may need it urgently. 

I have been to a non-busy ER where they've made us wait for hours and have often wondered if it's a money thing...the longer you are there the more money the hospital makes.

Thank you everybody for the input. I used to go to the ER for a shot of dilaudid and it would take the pain completely away. This cycle, I go to the ER, get the shot and the pain comes back. I haven't been since I've learned about CH, but was just really curious as to what they would do for you because conventional medicine doesn't work (or so I've been told).

Is there anything that they can do RIGHT at the ER to help? Sometimes I feel this might be my only option and I kinda dream that if the pain gets much worse, I can always fall back on an ER visit. Without that, I feel pretty hopeless.

Ok, I'm joking.  But if you really want to get admitted fast!

Just tell them that while he was having his attack he got electrocuted, you will get right in!  And that I'm not joking
about.

I was once, and burnt my fingers like hell.  So, went in for
the burns, nurse at triage asked me how I burnt my fingers.
I said, Oh I was just shocked with 110v for a little while.
Front of the line!  So, what ever it is, work in a shock.

:D  Your in like flint!

Peace,

Boski

I will remember the shock thing and look up maybe some possible stuff that goes along with being shocked. Yup, I don't care if you have a gun shot wound to the butt, I'm getting some kind of treatment FAST and before YOU! (lol, but not really). Thank you for all the ideas and support.

Kathleen

The ER can do alot--only if they know how/what to do.
If migaine is so poorly recognized, you can only imagine how problematic is the response to Cluster!
=================
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.

==========
From Headache
Less Is Not More: Underutilization of Headache Medications in a University Hospital Emergency Department
Posted 10/11/2007

Madhavi X. Gupta, MD; Stephen D. Silberstein, MD; William B. Young, MD; Mary Hopkins, RN; Bernard L. Lopez, MD; Gregory P. Samsa, PhD

Abstract
Objective: To gain knowledge of episodic headache patients who seek care at an urban university emergency department (ED), to evaluate the care they receive and to examine the impact of the ED on these headache patients.
Background: In the United States, 1% of all ED visits are for the chief complaint of headache. The ED has a significant role in the identification and treatment of primary headache sufferers.
Methods: Patients who presented to the ED with a chief complaint of headache were prospectively administered a patient survey, the PRIME-MD Patient Health Questionnaire, and MIDAS. Inclusion criteria: any patient 18 years or older with a nontraumatic headache of less than 1 month in duration. The patients included had episodic headache. Exclusion criteria: any patient with a history of a lumbar puncture or epidural procedure in the previous 7 days or those with chronic daily headache. Patients who met criteria were asked questions about headache type, health care utilization, satisfaction, co-morbid illnesses, and demographics. A neurologist independently reviewed the ED chart.
Results: A total of 219 of 364 patients were eligible and consented. The median age was 34. Most (147, 67.1%) were women; 104 (47.5%) were diagnosed with migraine or probable migraine by chart review; 36% did not have enough information for a neurologist to code a diagnosis. Relatively few headache-specific medications were used 24 hours prior to ED arrival. Only 5% of patients were on headache-preventive medication. Patients commonly received neuroleptics (dopamine antagonists 98 [67.5%]) or opioids (93 [64.1%]) in the ED; however, 74 (33.8%) subjects received neither medication nor IV fluids. Upon leaving the ED, 21.8% were pain free and 89 (40.6%) patients were asked to follow-up with a physician. A total of 137 (62.6%) patients had no documented discharge medications. One person received a prescription for a preventive medication. Sixty-four percent of those who returned the diary reported that the headache returned within 24 hours of leaving the ED.

CONCLUSIONS: MIGRAINE ICHD-2 CRITERIA ARE UNDERUSED, AND PATIENTS ARE UNDERTREATED IN THE ED. MANY PATIENTS LEAVE WITHOUT A DISCHARGE DIAGNOSIS, OUTPATIENT MEDICATIONS, OR INSTRUCTIONS. ED PHYSICIANS COULD HELP IDENTIFY THE MIGRAINEURS AND CHANNEL THEM TOWARD APPROPRIATE OUTPATIENT TREATMENT.

JMO, ER is a waste of time,the members here know more about this than any Doc I know.JMO If you have not had a cluster headache you dont know jack about this and are cluless as to the pain.. you guys have halped me more in a few weeks than doctors have in ten years.

Quote:

If you have not had a cluster headache you dont know jack about this and are cluless as to the pain..

Gonna strongly disagree with you here. I know a good handful of people who have never experienced the personal joy of a CH attack, but know intense pain and also know exactly what we need.

Brew wrote on Sep 3^rd, 2010 at 11:10am:

Quote: If you have not had a cluster headache you dont know jack about this and are cluless as to the pain.. Gonna strongly disagree with you here. I know a good handful of people who have never experienced the personal joy of a CH attack, but know intense pain and also know exactly what we need.

I have never talked to anyone who has the slighest idea of what this pain is like unless they have been there. And nobody knows what we need becuse we are all diffirent in what helps us.Broken arm, put it in a cast,bad tooth, pull it,cancer, chemo. Cluster headach ????? who knows we dont even know what it is for sure. :)

Maybe I know more people than you.

Brew wrote on Sep 3^rd, 2010 at 12:13pm:

Maybe I know more people than you.

Could be?????

Sorry for the hijack, kdeen

My hubby used to beg me to go to the ER because he DID understand the pain I was in and hated seeing me that way.  I never would go due to the treatment I'd recieved previously when I went for maigraines.  Hospital is a 20 minute min drive, plus wait time......nah...I'd rather stay at home and deal with the pain myself.  By the time the Dr would see me, the ch would be over anyway. 

midwestbeth wrote on Sep 3^rd, 2010 at 12:26pm:

My hubby used to beg me to go to the ER because he DID understand the pain I was in and hated seeing me that way.  I never would go due to the treatment I'd recieved previously when I went for maigraines.  Hospital is a 20 minute min drive, plus wait time......nah...I'd rather stay at home and deal with the pain myself.  By the time the Dr would see me, the ch would be over anyway.

Exactly,then you talk to some youg resident that cant even spell "CH"

Great idea, Marc.  It is kinda hard to educate when you're in the middle of an 7+ ch.

It's never a good idea to go to the hospital in the late summer/early fall anyway.  Too many new residents mucking things up.

mikstudie wrote on Sep 3^rd, 2010 at 11:59am:

Brew wrote on Sep 3rd, 2010 at 11:10am: Quote: If you have not had a cluster headache you dont know jack about this and are cluless as to the pain.. Gonna strongly disagree with you here. I know a good handful of people who have never experienced the personal joy of a CH attack, but know intense pain and also know exactly what we need. I have never talked to anyone who has the slighest idea of what this pain is like unless they have been there. And nobody knows what we need becuse we are all diffirent in what helps us.Broken arm, put it in a cast,bad tooth, pull it,cancer, chemo. Cluster headach ????? who knows we dont even know what it is for sure. :)

Short hijack here and then back to our regularly scheduled programming.

Pat,
Give your husband a hug and a kiss from me.

mikstudie,
I can probably discuss treatments and the headaches better than most doctors ever will.

'darlin~supporter for over 25 years.