Migraine

I was discussing my recent ER visit with my husband. I guess we were kind of de-briefing. And we remembered something that the ER doc said to me. I was admitted to the ER via the phone by my headache specialist who basically told the ER docs what to do via phone conversations for my treatment. However, per typical admittance procedure, the ER docs asked me about my condition and my pain. Actually, it was the resident that did this. She then went to the attending doc to "discuss" before they would go ahead and do what my headache specialist had "ordered."

Well, as the nurse was setting up my IV line, I remember the attending physician coming in and saying, "I just want to make sure this isn't the worst headache you've ever had in your life." I said, "What do you mean?" He said, "Well, it isn't the worst headache in your life. For example, we don't need to do a spinal tap or anything."

Hmm... I'm put in a wierd position here. I believe what he meant was...'it's just a migraine, right?' (Which, I was pretty sure I was having a status migraine. I'd had it for a long time!) And I understand his concern about making sure I'm not having a something more complicated. But, really, how am I supposed to tell by the intensity of my headache?! When he walked out of the room, I said, "I don't think I'd know what 'the worst headache I've had in my life' would be. I've had 'the worst headache I've had in my life' so many times." I've had head pain as a part of migraines where I thought I was going to die & where I wanted to die. I'm just not sure it gets any worse than that. So, how do I know when to answer that question in the affirmative? I certainly don't want any random spinal taps or MRIs when I've had clear ones.

I don't know. I guess I feel there has got to be other signs and symptoms they can be using other than "the worst headache I've had in my life." At least for a migraine sufferer in the middle of a status migraine. I know for the general populous it works. But for me???
Any thoughts?

I don't get it - why was HE the medical professional asking YOU the patient if HE the medical professional needed to do an LP - wouldn't that be up to him again the medical professional to decide if that is the right course of action?

And I think if you are in the ER with a migraine it is always going to be the "worse headache in the world" because if it's bad enough to get me to the ER - then it's pretty darn bad!!!!!!

Hmmm...

I guess my impression of this doc would be to be wary of him. I could well be wrong, buy my first impression was that he might have been trying to determine if you were drug seeking or if you really needed to be in the ER, throwing out the spinal tap idea to "scare you straight" if need be. It could also be that he was just concerned with making sure you got adequate care for your migraine and didn't want to go overboard with tests that might be unnecessary, too. But I'm a bit suspicious, just because of the odd way it all came out.

I believe he was trying to be sure that you weren't presenting with symptoms of stroke, aneurysm, or some kind of infection like meningitis. The headache you get with those conditions is usually a rapid onset and blindingly bad (the "thunderclap" headache). I think he was just trying to be thorough. It's a good idea too considering that migraineurs in status migrainous are at a higher risk of stroke. There are other signs and symptoms of these conditions that doctors assess, but headache is often a crucial one, which is why it gets a lot of attention. I think Teri wrote an article about when "a headache isn't just a headache", but I couldn't find it. I'll keep looking later.

I found this: http://www.neurologyreviews.com/nov00/nr_nov00_headache.html

It's not written by Teri, but Alan Rapoport of the New England Center for Headache is on the Editorial Board for the website.

You may be thinking of Sharon Stone. Teri mentions her in this link:
Migraine and Stroke Risk: What Did the Studies Say?

Sharon Stone had an aneurysm, not just the worst headache ever!

quote:

As we've said before, if you have the worst headache or Migraine of your life, call your doctor or go to the emergency room. Extreme head pain can be a symptom of a stroke. Even though she was suffering from an aneurysm, Sharon Stone said it best, "If you have the worst headache you've ever had, go to the hospital because by the time you get to the hospital, you're as far gone as you wanna be."

Yes, I remember reading this by Teri! I looked all over the other day and couldn't find it. Thanks.

I had the "worst headache of my life" once and after experiencing migraines for 10 years at that point I knew it was wise to go to the ER. I didn't want to go, but felt I had to get it checked out because I know my migraine symptomatology very well, as most of us do. I was checked out thoroughly for a stroke, but only after I had to badger the ER doctor about migraines and educate HIM! We have a great hospital in our community and this doctor was a contract physician not associated with that hospital, employed due to an overload of patients during a busy flu season. Even my husband was so irate, he almost called the hospital to report that doctor. This doctor even had the benefit of electronic medical records, so he could see my extensive history, all my tests, all my neurology consults, visits, etc. (if he bothered to even look).

When I told the ER doctor that it was the "worst headache of my life" and started describing the NEW symptoms I was having, not symptoms I ever had before, he said to me in a very condescending voice something like, "That's what a migraine is!" He then went on to give me the not-so-subtle drug-seeking lecture. I was irate! Needless to say, should I or anyone else I know ever suffer some new and extreme migraine symptoms like that again, no doctor in the world would keep me away from the ER.

Nancy & Migraineur, thanks for all of the information! What great articles. I agree with you that it is extremely important to rule out other conditions. I think that perhaps if I get that question again, I will give the doctor all the information I have about my current pain compared to previous pain.

And I like your point, Eileen. It is not up to me whether or not they decide to do further testing. It is up to medical professional.

Droolie, I hadn’t thought about the drug-seeker thing. Perhaps he was curious if I was a drug seeker. I had come a good distance (over an hour) to be at his ER b/c Dr. Diamond wanted me to go to her hospital. So that could have raised a red flag for him. On the other hand, he was in phone conversation with her about my care & about what meds to give me, so if he had any question about me being a drug seeker, I'm sure she would’ve set him straight.

Marvel, That is terrible that the doc didn’t listen to you!

Kelly

Hei. I knows min case is kinda welld iferents due to other health issues but iw illdescribes to you min worser headache in min life.

Suden knowk to min knees as i grabs min head for it feels like being hits by 2 by 4 fra behinds...

Losing control of urin and other body fluids, wery confuse, in and out consciousness...projectile womiting loss of motor controls.

BP tru roof i no remmbers it esact but the bottom was 150-ish whish is no godt.

To me that was a nine. Equalle only after surgerie to clips aneurysm whhish the pain after that a 9 too.

Min WERY bad migraines i rates a 7 and them wery painfuls.

The abouves headache was min aneurysm doesing a moderate leak and ofcourse it got fix.

I also recent hads another aneurysm clip wit brain surggerie but this one no ever leak or no-ting. We founds it while doesing routines floow up nuclear CAT to looks at min other clipped one.

The doc no knows you so maybe him was making sure it no was the absolute worser migraine in you life. Hard to tells diferences when each migraine is so wery painful but its godt to tries and objective looks at it...is this min worses one?

Wit you being statous migraineous it was godt idea go to ER and maybe a CAT shuld has ben order.

I no sure the doc was seeing if you drugs seking. But it odd for doc ask YOU about tap and such. IN min eyes shuld has spend lil bits time wit you, dids a neuro check, and listen to describes your passt migraines compares to this one. ANy new symptoms tings such as this. Then the DOC desides about tap or a scan.

No sure min words help or no but thunk i shares that wit you.

Hugs,

Solveig

Hello, Sollie! It's so good to see you! Hope you're having a great day!

At my ER, the "worst headache of your life" question seems to be standard procedure. I've been to the ER a few times and they have ALWAYS asked me this question. ALso, my ER docs always manipulate my head and neck forward and backward to see if I have any extreme stiffness there.

One ER doc took time to talk to my sister about this--he explained that he asks the "worst headache" question only to be sure that I am experiencing a "typical" migraine and not something VERY different or unusual for me. He further explained that if ANY of my symptoms were far out of the ordinary, a CAT scan or MRI might be necessary to rule out aneurysm or stroke. He also told us that he moves my head/neck to look for clear signs of meningitis.

I don't even think twice when a doctor asks me the "worst headache" question now...At my ER, this means he's simply trying to decide if he should treat me as a migraine patient or do further (expensive) diagnostic testing.

That's just my experience, of course! But I hope it's helpful!

jenny

Jenny,
Wow! That is so helpful! I read your post with my DH sitting next to me and we both are so grateful! What a great doc.

I appreciated the explination about the head manipulation and meningitis. I've actually heard this before. I remember them doing this when I was hospitalized a couple years ago before they did a lumbar puncture, but totally forgot.

Next time, when I get that question, I'm going to concentrate on answering based on if the pain is similar to my other migraines or different. And if I have different symptoms.

Kelly

Solveig,

Thank you SO much for sharing your experiences! They sounded terrible.

It was really helpful to hear that your pain with your aneurysms was different from your migraine pain. I guess we all should be aware of that when we are having head pain.

It was good to hear that the CAT scans caught your other aneurysm.

Thanks again for sharing!

Kelly

Fredrick sent me to the ER one time. The Dr. did the head scan, then informed me that I was describing a "worst headache" of my life to him. Then he told me if he did not do a spinal tap I could wind up being a vegetable. Then he layed me over one of those little tray tabels and proceeded to do a spinal tap on me. I told him to hurry because I could not set in that position much longer. Then my right leg went numb. When I informed him of the numbness he told me to sit still or it would be very bad for me. REALLY? I so wanted to take a bat and beat him over the head. Wen it was all done they gave me a dose of morphine- I guess. an hour after I left er headache was back. I have had low back pain ever since that spinal tap. My GP said that the spinal tap could not have made my back have pain like it is. But I know it did because I did not have the low back pain before the tap.

The only time I went to the ER I was having a very intense migraine, the worst I'd ever had up until this past year.

I woke up with it and was crying, unable to do anything with myself. My husband had to dress me and carry me to the car. I could only bang my head on whatever surface was in direct line with the appendage in frustration.

All I remember is the ER doc asking me if I'd been diagnosed with migraines and then they did the CAT, then they drugged me up and sent me home when my results came back clear. I remember when I was happily medicated I told the ER doc not to give me a lot of vicodin because I did not want to get hooked. I think he was surprised.

In the past year I've felt some personal resistance to go to the ER when I had the same level migraine...And I had quite a few after the PFO procedure. I made sure my specialist knew, though, and OK'd the meds I was self-medicating with when I was out of triptans (sometimes leftover vicodin does come in handy!). It's not a good line of defense, I know, with headaches banging that badly, but I fear so much being turned away as a drug-seeker after my husband and I put in the struggle to make it there. I don't know what I'd do. I shouldn't waste my fears on "ifs"...And a thunderclap headache certainly would send me to the ER immediately.