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Chronic Headache & Migraine Summit

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01 August 2017

Urgent Care - It's A Gamble Every Time


The last thing I need when I go to urgent care is to be treated as a potential drug seeker.  I have a genetic neurological disease which has no cure.  Sometimes, my medications do not stop a migraine attack and I need a more aggressive form of treatment to break it.  As a person living with migraine, I do not need to have unnecessary anxiety each and every time I step foot in an urgent care center or emergency room.

Yesterday was not a good day.  I have been dealing with a migraine attack for about a week.  My prescribed pain medications can only be taken for three days.  After that I pretty much have to suffer through it for at least 5-7 days before taking them again to avoid rebound headaches.  I resort to homeopathic remedies such as ginger tea, plenty of ice packs, essential oils, rest and dark rooms.

My head pain was at a nine for over twelve hours.  The nausea was terrible causing me to vomit and have diarrhea.  I was having dizzy spells and was extremely lightheaded.  I knew that a trip to urgent care was needed.  In a perfect world, that wouldn't cause me to feel any certain type of way.  But as a migraine patient, that is nowhere near the case.

I avoid going to urgent care mostly due to the anxiety it causes.  I have to roll the dice every time I go.  Is it worth the chance of getting a doctor who will not want to treat me? Most people would probably say that it isn't and I totally agree. This is something that the majority of the world does not understand when it comes to migraine.  We risk getting under-treated or not treated at all when we are in legitimate and debilitating pain.

In June, I took a trip to urgent care after a long and stress-inducing day in D.C.  I had just finished being a part of a panel on Capitol Hill to discuss migraine and it caused a major let-down migraine.  As usual, my anxiety was super high as I worried if I would get a compassionate doctor who will follow my protocol.  As soon as the doctor walked into the room I knew he wasn't that guy.  He gave off a vibe that told me that he wanted to do as little as possible to treat me.

After telling him the medications that I have at home, which includes oral toradol, he wanted to only give me a toradol injection.  I handed him my protocol and he took it almost unwillingly.  He obviously did not feel comfortable with it but after some hesitation, he ordered the medications.  Thankfully, I always have very nice and compassionate nurses at my urgent care so they soften the blow a lot.

Part of my protocol is receiving dilaudid.  My neurologist prescribes 1 mg of dilaudid, up to four doses, to break my migraine.  Two doses does the job in combination with the other medications I receive.  That particular day, my pain was at an eight.  After the first dose of dilaudid, my pain only went down to a seven.  The doctor did not want to give me another dose and sent me home with my pain barely reduced saying that my medications at home will be able to help me.

Obviously they were not able to otherwise I wouldn't have even come here.  I was so over it that I didn't argue or push the fact that I am still in severe pain.  I just went home.  I knew he wasn't going to budge on his decision and I have to pick and choose my battles wisely. Why must I even have to deal with this? It's preposterous.

Back to yesterday.  I was in tears before getting to urgent care.  I was in bad shape.  With my Migraine Hat on, migraine binder, and bottle of water in tow, my husband drove me to my appointment.  My anxiety meter was pretty elevated.  I'm never fully relaxed going.  I know it may not work out in my favor.  I get there and the nurse takes my vitals.  As usual, my blood pressure is super high due to my raised anxiety and level of head pain.  After the second try it went down considerably.

The nurses always make it a nicer visit.  They treat me kindly every single time.  It's the doctor I am most concerned with.  I was told the doctor would be in shortly.  Apparently that means 40 minutes.  That is way too much time for my anxiety to spiral out of control. I am super anxious waiting to see which doctor will walk through the door.  The one who will follow my protocol and not be judgmental or the one who barely wants to help me.

Imagine if someone with severe asthma was treated in the same way.  They go to the emergency room because their asthma pumps aren't working to help them breathe and need a breathing treatment.  The last thing they need to worry about is whether or not they will be treated as a drug seeker. They are having difficulty breathing.  Why should they have to prove that they are not "faking it" in order to get treatment because they are addicted to the nebulizer?  Sounds ridiculous doesn't it?  That's pretty much life with migraine in a nutshell.

After my agonizing wait, the doctor finally came in and I got a good vibe from her.  She was very open about my protocol and placed the orders quickly.  I lucked out this time.  No judgment or questions about whether I am doing enough to manage my migraine.  I could finally relax and allow the treatment to do it's job.  But why should I even have to endure such uncertainty at all?

I need all medical professionals to understand that when we decide to get treatment for a severe migraine attack, we really need it.  We are not looking for a fix.  We just want to feel better after going through days of unrelenting pain, lack of sleep, and exhaustion.  Why is that so hard to grasp?  To the doctors and nurses who find it more important to judge us, ask us condescending questions, and to doubt us - you need to really educate yourself on the realness of our disease.  The last thing that I want to contend with after throwing up and crying in pain is your bad attitude.

Even though yesterday worked out, it did not diminish the fact that I had to deal with the possibility that it wouldn't.  It's a crazy situation that people with migraine have to put up with.  Some don't even go seek treatment anymore because it's just not worth the anxiety and anguish. There have been plenty of times where I felt like walking out because the mental anguish was just too much to deal with on top of my physical ailments.

Things need to get better in urgent care and emergency room settings.  It would be nice not having these concerns and anxiety when I need my pain treated. The sad part is, I know it will be like this for a long time.  It makes me so angry that I and others have to deal with this at all.  As long as migraine isn't taken seriously and is seen as just a headache, we will have to endure this type of treatment from medical professionals uneducated in headache disorders.

I will have to continue to advocate for my care relentlessly in all situations.  Even in ones where I can barely speak because the pain is so great.  I will continue to speak honestly about the many obstacles we have to overcome.  It is my hope that we will never have to endure these things in the future.

3 comments :

  1. As a another living with chronic migraine, I have experienced everything you shared and agree with all your points. Well said. I'm just worried that not only is our treatment limited due to restrictions on opiates and perceptions of drug seeking, but recent studies like the one showing compazine was more effective than hyrdomorphone in treating acute attacks in the ER. As a researcher, I always worry that doctors and hospitals will make sweeping (policy) decisions based on single studies that get a lot of attention because of the current context. We can't expect one treatment to work for all of us. I think we just keep doing what we're doing and remind them there are human faces behind the decisions and we're the ones experiencing the resulting pain. Great piece!

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  2. As another chronic migraine sufferer, I feel you. I hate going to emergency, they always treat me like a drug seeker and I've never once NOT had to do a sobriety test.
    In my last attack, I took 3 Oxy's over 12 hours and I knew if I went to the hospital with that information I'd be treated like a druggie. It's such a fickle line.

    I feel for you!

    A - themigrainediarist.wordpress.com

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