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?

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

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

Great post 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.

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.

  Your in like flint!

Peace,

Boski

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.

Quote:

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.

Maybe I know more people than you.

Sorry for the hijack, kdeen

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



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