Thanks for writing in.
I am a medical specialist with an additional degree in cardiology. I read your mail with diligence.
I empathize with you; obviously, you are suffering from migraine and must be taking medicine(s). I must say without being being judgmental, today two things have gone wrong. One to anticipate and avoid having an episode. Second is failure to go to emergency, when it was indicated or call 911. I shall elaborate.
A: Avoid Factors that precipitate a migraine attack:
You should avoid factors that precipitate a migraine attack (eg, lack of sleep, fatigue, stress, certain foods, use of vasodilators). Use a daily diary to document the headaches. This is an effective and inexpensive tool to follow the course of the disease.
Patients may need to discontinue any medications that exacerbate their headaches. If an oral contraceptive
is suspected to be a trigger, the patient may be advised to modify, change, or discontinue its use for a trial period. Similarly, when hormone replacement therapy
is a suspected trigger, patients should reduce dosages, if possible. If headaches persist, consider discontinuing hormone therapy
When to seek emergency medical care or be transported to ER.
Hospital admission for migraine may be indicated for the following:
•Treatment of severe nausea
, vomiting, and subsequent dehydration (YOU VOMITED 5 TIMES)
•Treatment of severe refractory migraine pain (ie, status migrainosus
from overuse of combination analgesics, ergots, or opioids
Patients should be transported in a way that minimizes visual and auditory stimulation
. Most patients should not receive opiate analgesics until a thorough neurologic examination can be completed by the responsible physician.
While the emergency physician must be able to identify patients with serious headache etiology, note that more than 90% of patients in the ED have migraine, tension, or mixed-type benign headache. Therefore, providing symptomatic relief should be a priority. Rest in a darkened, quiet room is helpful. Some patients find cool compresses to painful areas helpful.
Migraine-specific medications and analgesia are the keys of ED care. Despite contrary evidence, narcotics remain the most frequently administered medication for patients with migraine and for ED patients with headache.
It has been reported that nearly three quarters of ED patients with migraine or other primary headache reported headache recurrence within 48 hours of ED discharge; in this study, naproxen 500 mg and oral sumatriptan 100 mg provided comparable relief of post-ED recurrent migraine.
With Best Wishes
Dr Anil Grover,
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)