OK, Ill bite.  Why do people go to the ER with cluster attacks?  For this question I am assuming that you are already diagnosed and certain, and you are in the middle of a cluster attack.

By the time you are well into the attack, get driven to the ER and wait in line because you are not bleeding, isn't it over?  What do they give you to make it better?

This piggy backs off of another thread and I know people have done it.  What were your experiences?  Is there a threshold where we go to the ER and something good happens there for us?  I haven't gone and my gut feeling is it is a waste of time (don't throw rotten tomatoes at me) but I am curious. (Smile faced guy says let 'ol Shaggy know how your trip to the ER was).

--Shaggy

For several years before we discovered psychedelics, Michael was chronic but still had his ups and downs during what was really a constant attack. Some of the more violent periods - and many times those came several times daily - were so frightening and Michael was so out of control with the pain elevating till he was blacking out every few minutes, that we elected to take him to the ER. We live a solid hour from the nearest hospital and there were times when we made the trip 2 or 3 times per week. One time he blacked out 6 times on the way. The spectacle of him screaming, writhing and hitting everything in sight in the waiting room, even while being moved around in a wheel chair and trying to answer questions from a nurse, finally getting a bed and waiting sometimes as much as 1/2 hour before getting a shot, was worth it to get him out of the pain.

I think Bonkers and Bob nailed it. Until you actually understand the whole CH process, it looks and feels like an out of control train wreck. The ER is the only thing that presents a possible solution...even more so to the poor supporters like Bonkers....who have to stand by helpless and just watch.

So unless there is a pre-designated path.....as with Brew and his program......the ER is just a last desperate shot to make the damned thing stop.

Joe's 2 cents.

I think that it would make sense if you get caught without your best abortives.  Maybe traveling, maybe just out, or there are some people who have said they respond to pain meds.

Otherwise I'm not sure (outside of being told to go by your doc)

The only time my son was put into a coma, they used an anesthetic that they called "white night." Both his Neuro and I gave consent for the procedure. He had already been put into restraints, but remained completely out of control. They kept him in a coma  for 5 days but when they brought him out of it, the HA was gone and he remained relatively PF for a few days. Seems to me a little extreme, looking back on it.

In 22yrs of CH, I've been to the ER twice for them. 1st in '05 after 5 hours sleep in 4 days then getting hit with a Kip-10. After it was over I was left with a "afterburn" @ Kip-8 that wouldn't quit.

I told the Nurse I needed a shot of DHE because it worked at an inpatient program I was in. Well they had to try everything but, including a shot of Dilaudid, "it's 7 times stronger than Morphine." Then Lidocaine up the nose, then Imitrex.

Finally 13 hours later I was given the DHE shot and fell asleep 5min later. 10min later I was awakened and escorted to the Phsyc ward because I told them CH is know as suicide headaches. Swore I'd never gp back.

In '08 a similar situation, but this time I told the Dr no narcotics. "Well what do you want?" DHE, in 20min I was given the shot then monitored while I slept for 2hrs.

Do I recommend the ER? NO NO NO!

Don

I think it was first Imitrex and oxygen, then

WOW! Sounds like you actually had a fairly knowledgeable ER!

Joe

When mine started, many years ago, no one knew what a CH  was.  My G.P. put me on Sansert, having diagnosed me with  histamine headaches.  I was given Tylenol 3 (with codiene) for pain, but an upset stomach was the only effect.

I usually went from 0 to Kip 8 or 9 with each headache.  When, on occasion,  I hit 10, I simply felt that I could not stand it another second. 

Of course, someone drove me there and as this usually happened in the wee hours of the morning, I didn't have a long wait in the waiting room, but by the time the doc got around to me, the headache was about to quit without his/her help.

So, when I did go to the ER, it was out of pure desperation and lack of clear thinking.  Just .....please, somebody help me!

If it's bad for migraine folks you can only imagine the picture for us!
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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.

George: the issue is that docs are still not receiving the training that WE need--and it's not their fault. ER docs receive excellent training in those areas of medicine which they will see most frequently and which reprsent the greatest danger to the patient. Still, the bottom line is--they don't know enough about headache to be, broadly speaking, effective.
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Medical education in headache
Posted 9/26/07, MEDSCAPE   

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Abstract statements from a study of headache education in medical programs. Second para. specific to neurological residency training. Gives good idea of why it's difficult to find a sharp doc.
=========================
"Objective. To explore the extent of headache education received by medical students and residents.
Background. Headache is a common, often severe, and sometimes disabling problem. However, 49% of sufferers do not seek professional treatment -- of those who do, only 28% are very satisfied. One possible reason is limited education of physicians about headache.
Methods. Surveys were sent to all allopathic and osteopathic medical schools, 200 family medicine residencies, and all 126 neurology residencies. Information requested included the amount and perceived adequacy of headache education and any plans to increase headache education.
Results. Response rates were 35% to 40%. MEDICAL SCHOOL LECTURE HOURS RANGED FROM 0 (4%) TO >5 (24%) WITH 92% HAVING NO PLANS FOR AN INCREASE IN HEADACHE EDUCATION. FAMILY MEDICINE RESIDENCY LECTURE HOURS RANGED FROM 1-3 (30%) TO >5 (34%) AND CASE PRESENTATIONS FROM 1-5 (23%) TO >5 (41%), WITH 88% OF PROGRAM DIRECTORS HAVING NO PLANS FOR INCREASE. NEUROLOGY RESIDENCY LECTURE HOURS RANGED FROM 1-3 (11%) TO >5 (64%) AND CASE PRESENTATIONS FROM 1-5 (23%) TO >10 (57%), WITH 80% HAVING NO PLANS FOR INCREASE.
Conclusion. Undergraduate medical education in headache is limited. Despite medical schools perceiving their training as adequate, both neurology and family practice residency program directors believe entering residents are inadequately prepared in headache upon entering the program."

"Neurology Residency Programs
Neurology residency program lecture hours varied from 1 to 3 hours (11%) to >5 hours (64%) (Figure 2). The number of case presentations ranged from 1-5 (23%) to >10 (57%) (Figure 6). Forty-two (95%) of program directors believed that their headache education was adequate (Figure 4). Interestingly, 20% of neurology programs indicated plans to increase training in headache management. Similar to the family practice programs, 68% of the program directors believed that new residents had inadequate knowledge about headaches upon entering the program while only 11% of the program directors believed that their residents were well informed about headache."