Hospitalization for Migraine

Occasionally patients with difficult to treat migraines must be hospitalized to find effective treatment.  If you are a patient who has or may be hospitalized, if may be useful for you to consider how your doctor thinks about hospitalization.

Why patients are hospitalized

The reasons for hospitalization are many but the most common reason is a severe, intractable migraine, persisting for at least a few days, that has been unresponsive to outpatient therapies.  In our office, outpatient therapy may include outpatient intravenous medications over the course of 2 or 3 days.

Another reason for hospitalization is the develoment of severe nausea and vomiting with associated dehydration.  This is treated typically with IV antinauseants as well as IV normal saline infusion.

Patients may also be hospitalized both to treat and to further work up their headaches.  For example, a patient with known migraines whose headache pattern is changing or with new symptoms, might be in need of brain imaging or other evaluations to see if a new cause of headaches has developed. 

The Standard Approach

Your admitting doctor usually has in mind a 1-3 day stay in the hospital, treating you with medications that have a good record of ending severe unrelenting migraine (status migrainosus).  One of the most common medications used for this purpose is dihydroergotamine (DHE), which  is administered intravenously every 8 hours.  The medication acts as a vasoconstrictor (constricting blood vessels in the brain) but also affects the brainstem receptors (5HT1) that are involved with migraine.  Because this medication commonly causes nausea, anti-nausea medications such as phenergan or Reglan are also administered.

Other IV therapies may also be added or substituted.  These are chosen based on what medications a patient has responded to in the past and potential other benefits or side effects.  Examples include IV Benadryl, magnesium sulfate, Depacon, and droperidol.  The anti-nauseants Reglan or phenergan may be included too since they have both anti-nausea and anti-migraine effects.

If DHE is not effective, it may still be useful to explore the use of triptan medications (another class of vasoactive medications) especially subcutaneous injections of sumatriptan.

IV steroids (Solumedrol, Decadron) are powerful anti-inflammatory medications that also may be added to reduce headaches.  These probably work by reducing the inflammation in the brain that is known to occur in migraine.

Narcotic medications are often also included in a patient's treatment.  These include IV Dilaudid, IV Demerol, or IV morphine.  Physicians are often somewhat reluctant to give patients large doses of IV narcotics, given the potential for abuse, dependence, and even respiratory depression.  In addition, once a patient is placed on these medications, if in fact they do not improve, it can be very difficult to reduce the doses.

Other types of treatment

It is important to pay attention to other factors that affect headaches.  Patients usually appreciate private rooms so as to avoid noise.  Insomnia should be treated as well as depression or anxiety.  Some patients have irritation of the nerves in the back of the head (occipital neuralgia) and so may undergo an occipital nerve block while they are hospitalized.  If a patient is not on a migraine preventative medication, maybe they should be - so this needs to be addressed.  If they are on a preventative, perhaps the dose needs to be increased or an alternative can be sought.

Nursing Issues

While it should be that your doctors writes orders and your nurses carry them out, it is often not that simple.  Each shift in the hospital is different, wtih night shift nurses usually having more patients to take care of and therefore being less responsive to your requests.  The time between requesting a medication and getting it may be greater than an hour.  In addition, some nurses begin to resent migraine patients.  They appear often to be too demanding, requesting not only pain medications but that the shades be drawn or that the noise be limited.  Nurses may suspect that a patient is simply 'hooked' on narcotics, and so do everything possible to avoid giving them to the patient.  This can have the effect of greatly increasing a patients pain due to frustration. 

Discharge

Getting out of the hospital can be more difficult than getting in.  A patient with infrequent headaches whose migraine responded well to hospitalization may be able to be discharged on an oral preventative and can keep using their usual home medications (oral triptan, Fioricet, Fiorinal, ibuprofen, etc.).  On the other hand, some patients don't respond to multiple medications given, except to narcotics.  They may be getting temporary relief with the narcotics, but may have no overall dimunition in the headache intensity from one day to the next.  After being hospitalized for a week, it is often unclear how to proceed, the situation becoming frustrating for both the patient and physician.  In addition, insurances may threaten not to continue paying for the hospitalization.  In these cases, there is no easy answer.  Some patient leave the hospital still experiencing significant headaches, using intramuscularly injected narcotics, or self-injecting DHE (or other medications) via a semi-permanent IV.  The hope in these cases is that with use of preventatives and a slow taper, the patient can get off of injectible medications.

Will health insurance pay for the hospitalization?

This is not certain.  In the best circumstance, the admission is pre-authorized through a patient's health insurance, and therefore, the hospitalization will generally be paid for.  If a patient is admitted without pre-authorization, such as directly from an emergency room, then payment varies.  Each health insurer has its own criteria for admission status.  If they feel you do not qualify, they can deny the entire hospitalization, potentially leaving you with a very large bill.  Usually, though the issue is the intensity of hospitalization.  Patients may only qualify for 'observation' status - which means that the insurance company won't pay the entire bill but will pay a portion of it. 

Comments

[viagra overnight]

i like this part of the post:"It is important to pay attention to other factors that affect headaches. Patients usually appreciate private rooms so as to avoid noise. Insomnia should be treated as well as depression or anxiety. Some patients have irritation of the nerves in the back of the head (occipital neuralgia) and so may undergo an occipital nerve block while they are hospitalized. If a patient is not on a migraine preventative medication, maybe they should be - so this needs to be addressed. If they are on a preventative, perhaps the dose needs to be increased or an alternative can be sought." is very good

[Conor]

hey i did everything you said. Thanks
http://www.filecatch.com/trends/sa/22-09-2010.html

[Impotence causes]

Good evening to all readers, my name is Roy, two years ago I received a special treatment for cancer and work out, I like to share this experience mainly to emphasize the importance of treatment in all the different diseases.

thanks!!!

[Cheap viagra]

For me it is a pleasure to comment on a blog like this, to me personally I liked very much reading, I agree with everything they say the above comments, I think if every day items like these appear in the network, I would sit at my computer reading these articles.

[generic viagra]

In most headaches, which hurt the nerves, blood vessels and muscles that cover the head and neck. Sometimes the muscles or blood vessels swell, tighten, or through other changes that stimulate the surrounding nerves or put pressure on them. These nerves send pain messages to the brain, causing headaches.

[coach factory outlet]

Love it, love it, love it!*

[chanel j12 watch replica]

In joyful strains then let us sing

[Supra TK Society]

Patience and application will carry us through.

[Air Jordan 3]

So around the world, America is promoting human liberty, human rights, and human dignity.

[Air Jordans]

I was a shy teenager, glad to have anyone talk to me

[nike shox]

intractable migraine, persisting for at least a few days, that has been unresponsive to outpatient therapies. In our office, outpatient therapy may include outpatient

[UGG Shoes]

*Can't wait! W00t!

[Ugg For Sale]

Am I that easy to forget

Before you lave me sure you"d find

Your want his love much more than mine.

[coach tote bags]

Whether your design project is a new building or a retro fit, Automatic door offers a door to meet

your needs. We only sell and install products that are developed using the latest in

technology and you can be assured that our certified AAADM installers will do the job

right so you can enjoy your Automatic

door for years.
There is currently an overstock on aluminium

[coach tote bags]

"I sought to show the changing balance of planes - from anti-ship torpedo and dive bombers in the early days when the main objective was destroying other ships - to fighter planes, whose main job was to defend against the kamikazes in the final months."

Max, Midway is pretty much the final act of anti-ship carrier warfare, right? If you follow Keegan and Churchill, it's the critical turning point in the Pacfic war - there's a wonderfully readable description of Midway in Keegan's The Price of Admiralty.

[Migraine Medicine]

Great sharing, and I love your post about the migraine Thanks

[buy stuff from China taobao]

That's not his. Steve's is black*_*

[Headaches]

Base on my situation the headache is my main hateful because i can`t do any wonderful things to be done..

[Indianapolis chiropractor - Dr. Steve]

I think people with a migraine should try chiropractic...this is up for discussion?

[Chiropractor Therapy]

Severe headaches is one of the common symptoms of Migraine. It's true that further hospitalization and examination must be done to those who experienced difficulties of treatment in Migraine.

[Headaches Everyday]

Thanks for sharing this informative headache article. The only thing I don't like (although sometimes it cannot be avoided) is the use of narcotics.

[oakley outlet]

@@@@@@@@^%%^$I just love you,but you are going to be other's,my darling,*^&&^&so I have to give up````lp

[Insomnia Treatment]

I agree with the idea insomnia is a state of mind. That leads to recovery coming from a change of focus and mental conditioning rather than a quick resort to drugs . Drugs in the long term can only make insomnia worse. Insomnia Treatment should be about changing routine and behaviour.

[christian louboutin schaussures]

I really do appreciate your feedback. I'm still struggling with the technology but I wish everyone all luck with this competition. I've been pinned down with a sick grandchild and today a very sick daughter - both with gastric flu which afflicts us all at this time of year - so this is the first moment I've had to get to the computer

[Supra Footwear]

So cute! I already like you on FB and also get your posts on Google Reader. :)