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An Excerpt from
Living Well With Migraine Disease and Headaches

Chapter 14: Emergency Care and Pain Management

Anyone with Migraine disease or chronic headaches of any kind should have an emergency plan for times when our regular treatments donít give us relief. We have no way of knowing, let alone controlling, when a headache or Migraine will strike. Simple math tells us theyíre more likely to strike when our doctors are not in their offices. Most doctors arenít in their offices for a full 40-hour week, but letís work with a 40-hour week anyway. A full week is 168 hours. That leaves 128 hours of that week when our doctors are not in their offices for us to call them. Thatís nearly 70% of the time. This is exactly why we must be educated and able to make some treatment decisions for ourselves. Itís also why that backup plan needs to be in place for times when our regular treatments fail us.

We must talk to our doctors in advance about an emergency care plan:

  • Is there an after-hours number to call if we need assistance?

  • What do we do if we have a headache or Migraine and our normal medications donít work?

  • If the doctor doesnít have an after-hours number to call, and our headache or Migraine reaches a point where we need care, is there a particular emergency room they recommend?

  • If we have to go to the emergency room, do they have advice for how to get the best treatment?

One element of a backup plan is called ďrescue meds.Ē Rescue meds are medications to be taken if and when the medications we normally take for our headaches and Migraines donít work. For those of us who use abortives, rescue meds are often pain medications. Sometimes rescue meds are a pain medication along with an antinausea medication. Essentially, if abortives fail, we have to resort to pain management if our headache or Migraine is still manageable enough to handle on our own at home.

If the emergency room is their recommendation for after-hours problems, ask your doctor to complete an Emergency Treatment Request and Information form. Youíll find an example of this form at the end of this chapter, and can print or download one from This form confirms your diagnosis, lists your current preventive and acute medications, and allows your doctor to suggest emergency treatment. In hopes of cutting through the unfortunate suspicions often encountered in ERís by those of us with invisible illnesses, the form also states that we are not substance abusers or ďdrug seekers.Ē Iíll be honest with you. There have been cases where these forms have been extremely helpful. There have also been cases where the ER doctors refused to even look at them. You simply wonít know until you try. Thereís also a second form for us to fill out in advance. It has all the information that the registration clerk will need and saves us having to think about it when our head is pounding.

We need to be prepared for headache and Migraine emergencies in every way possible. Do you live alone? Even if you donít live alone, is someone generally available to take you to the doctor or emergency room if necessary? Plan ahead for this. We have no business driving ourselves under these circumstances. Not only is it unsafe for us and others on the roads, but people who have been in accidents caused by others have ended up in trouble themselves because they were driving after taking pain medications. Medications arenít the only reason for not driving. Pain slows our reflexes and dulls our concentration. There are many reasons not to drive during a headache or Migraine. Be safe first. If there are times when thereís nobody home to help you get to the doctor or emergency room, check the availability of neighbors, friends, and family. If thatís not an option, learn about taxi services in your area. If you have children, know who you can call to watch them. Especially if you have children, it can be helpful to make an emergency event list. This can also be especially helpful if your children are old enough to be able to help you a bit. List phone numbers you may need and things you need to remember to do or take with you:

  • Phone number of someone to take you to the doctor or emergency room.

  • Phone number of someone to watch your children.

  • Reminder to take list of all medications you have taken that day.

  • Reminder to take insurance card with you.

  • Reminder to take doctorís emergency form with you.

  • Anything else you need to remember.

Remember, we can minimize the impact of emergencies by planning ahead and organizing for them. The less we have to do and remember at the time, the less frantic we and everyone around us are likely to be. With everything else taken care of, we can concentrate on getting the medical care we need to get our headache or Migraine attack treated and feel better.

Pain Management:
Even with all the preventives and abortives available to us today, there will be those of us who have times when the appropriate treatment, even if just for a short time, is pain management. While trying to develop an effective preventive regimen, we may need relief. If we use abortives, but limit their use to two or three days a week to avoid rebound, that leaves other days when we may need treatment. For times such as these, our doctors may prescribe various types of medications including prescription pain medications. If youíre taking prescription pain medications, please donít take over-the-counter pain medications also unless you discuss it with your doctor. The prescription medications often contain some of the same ingredients as the OTC medications (acetaminophen, for example), and you could accidentally take too much.

If you take OTC pain medications instead of prescription pain medications, please pay careful attention to and follow the recommended limits on the labels. OTC medications are every bit as potentially dangerous as prescription medications and should be treated accordingly.

Tip: If youíre taking OTC Migraine medications, you may be able to save some money. When the manufacturers of Excedrin Migraine, Advil Migraine, and Motrin Migraine went to the FDA for approval to market their regular products for Migraine disease, they had to make changes in the labeling to indicate the recommended dosage for Migraine. They also made packaging changes and started packaging the same products under two names. The manufacturerís suggested retail prices for the original and Migraine products are the same. However, some stores are charging more for the Migraine products. Also, in the cases of Excedrin and Motrin, there are generic store brands that contain exactly the same ingredients, but sell for lower prices. In other words:
  • Excedrin Migraine = Extra Strength Excedrin = generic store brand
  • Motrin Migraine = Motrin IB = generic store brand
  • Advil Migraine = Advil LiquiGels

Another time when pain medications and pain management can come into play is for that extremely small percentage of people with chronic headaches or chronic Migraine for whom effective preventive regimens arenít found. A good headache and Migraine specialist will work either directly with the patient or with the patient and a pain management specialist to devise a pain management regimen that improves their quality of life and offers at least some pain-free time. Since advancements are made in prevention all the time, itís important that anyone who falls into this category maintain a relationship with their headache and Migraine specialist. We never know when something might come along to change that situation for the better.

All of this has its place in good headache and Migraine management:

Headache and Migraine management should have six parts:

  1. Education

  2. Trigger identification and management: Identifying what brings on your headaches or Migraine attacks and learning how to manage those triggers.

  3. A good preventive regimen.

  4. Appropriate abortives (medications that actually stop a Migraine attack rather than just masking the pain).

  5. An emergency plan and pain management for times when abortives fail.

  6. A strong support system.


© 2005 Teri Robert


 The American Headache and Migraine Association (AHMA)...

a patient-focused, patient-driven organization for patients with Migraine and
other headache disorders and their family, friends, and care partners.
Anyone interested in the concerns or patients with these disorders is welcome to join.

The AHMA exists to EASE the burden of Migraine and other headache disorders through Education, Awareness, Support, and Engagement.


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