If you read the news item below (two posts below) about discrimination against headache sufferers, you will understand why I felt it was imperative that we offer better acute care for our patients. Presently, I offer DHE-45, sumatriptan (Imitrex) and Toradol injections for our acute patients. However, the way it now stands, these patients must schedule (most the time it is a same-day work in) and we do not offer narcotic injections.
In the face of the problem discussed under my discrimination piece, headache sufferers are faced with a real dilemma. Most do not want to go to the ER. Going to the ER is very expensive and honestly, headache sufferers are often poorly understood in those settings and sometimes they feel they are being treated as drug seekers.
We have had several barriers to overcome to improve the situation. First of all, if you are a patient you will notice that our work space is small. I wish that we had a separate acute treatment space and some day, we we can afford it, I hope to expand. The second barrier is that it would create a bureaucratic headache (pun intended) to store narcotics on our premises.
So here is how we are going to solve this problem and offer our established patients better acute care. We will allow walk-ins, but still calling ahead would be better. We aren’t always here as we do work in Bellingham some days. Secondly, besides the treatments mentioned above, I will now offer Dilaudid injections on a case by case basis. I have created an agreement with Medicap pharmacy to keep the Dilaudid. The patient would come by and pick up the script and then go to the pharmacy, return with the drug and we would administer it. If the patient or their family members (and they should have a driver with them anyway) can not go, Medicap would deliver the drug.
All headache specialists agree that there is a place for injectable narcotics in headache treatment. That place is very limited for two reasons. Narcotics do nothing, directly, to reverse a headache. They do “numb” up the head, and sometimes that is what a patient needs so they can go home and literally “sleep off” a bad migraine.
The next limiting factor is that narcotics, when over used, can and will lead to addiction. If having terrible migraines is on an upper tier of Dante’s hell, then having migraines plus narcotic addiction is on a lower (and much worse) tier. So, the combination of oral narcotics and inject-able ones must be limited to avoid this addiction.
Lastly, narcotics are notorious for causing a state of “Medication Overuse Headache” where the headaches get progressively worse over time with the increase use of narcotics.
In summary, if you want to take advantage of this acute care several things must happen first. You must be an established patient who is working on better treatments (such as preventative care). You must have a narcotic contract with us and we will make sure that you are not getting the injections from any other source. Lastly, we will limit the frequency of these injections to avoid the pitfalls mentioned above.
For people in status migraine, we do home infusions with IV medications through a home health care agency. However, if we have the space some day, I would like to do those “in-house” some day as well.
If you have any further questions call Kaaren at 360 588 1460.