What is Migraine Headaches
Migraine is a neurological disease, of which the most common symptom is an intense and disabling episodic headache. Migraine headaches are usually characterized by severe pain on o...
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Dilauded I.V. as ER treatment
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I had to go in to the ER yesterday for treatment of my migraine. I had been in to the base hospital (I am still in the military so Monday to Friday I still have to report to hospital during those times) twice already last week and was given copious amounts of demerol, (sometimes up to 450mg, usually the average dose would be 300mg-350) which in the past had eventually worked. However it was sooooo much of the drug...scary actually. My doctor had told me that she was planning on ordering Dilaudid for treatments but that was six months ago and it still wasn't in to the base pharmacy. I was getting very sick of demerol and finding that it had never really brought my pain down much past a 5/10. Also the next day I felt that terrible demerol hangover....YUCK!!! On top of that the doctors always give lectures on how bad demerol is yadda, yadda, toxic, yadda, yadda but not provide any alternatives...not helpful to someone that has had an intractable migraine for over a week but I digress....
Anyway, I went to an ER and they gave me Dilaudid. What an improvement. It didn't make me feel as "out of it" and crappy as demerol does and it took my pain level down from almost a 10 to a 7 after only 2 mg! Where as demerol was taking nearly 150 mg to even begin to touch the headache. After about another hour I had 2 more mg with toradol, then I had another 2 mg with dexamethasone. I had in the end 6 mg of dilaudid. With the combination of the dilaudid and the dex and toradol I had finally been able to get rid of my migraine. I was very thankful and happy that I was no longer tied to demerol! Now if only the base will get the treatment in.... BTW, I figured out the conversion equivalent between Dilaudid and Demerol and the amount of dilaudid that I had would have equaled about 240mg of demerol....way less then I usually have needed. Plus Dilaudid is NOT associated with toxicity build up that demerol is so in essence it is much safer. I hope that for those of you that have to occasionally end up in the ER for treatment when NOTHING else is working for your migraine are able to access dilaudid. It really did finally get rid of one of the worst episodes of migraine I have had in long, long time. It had been going on for 9 days with pain no less than 8/10. Remember to also get some other strong anti-inflammatory to help bring down the pain and reduce the likely hood of rebound! Posted on 10/15/07, 07:10 pm |
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Thanks for sharing as i am in the same boat in many ways being a cardiac patient high BP and the list goes on why i cant take certain things. So thanks for sharing
Sandi 
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i don't know to much about those drugs, but i have been given morphine (10 mgs) with an anti nausea med in an IV drip and it works well for me.
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I'm glad I could share this info. Morphine has never been that effective for me, however that may be because they have not really tried the correct dosages....they usually try 5mg at a time that doesn't even touch the pain.
Of course as happy as I am to share this I feel I should add a disclaimer.... I know this should go without saying, make sure dilaudid is SAFE for you. It did the trick for me. I also suffer from Chronic Myofascial Pain Syndrome which can set off headaches and also make headaches worse, it can also lengthen the headache cycle. I also have Chronic Daily Headaches that are debated to be possible Transformed Migraines. I have prescriptions for daily pain meds for my other chronic pain. So sometimes for me ER I.V. narcotic intervention is necessary....it may not be for everybody.
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I'm so happy you could find something that got you pain-free! :)
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Ya, dilaudid is what my nueros here only prescribe for my headaches because they say that the incidence of rebound is less with it then other opioids. Also just for people's info, an easy way to convert for morphine to dilaudid is that 10mg morphine equals about 1mg dilaudid. That is not exact, but it can give a rough estimation.
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I found a slightly different calculation for dilaudid compared to morphine. The calculations that I have seen and that my doctor confirmed was that dilaudid is about 5 times more potent than morphine so that would mean that 2mg of dilaudid would be about the same as 10mg of morphine. Those were the conversion numbers I was given.
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You may definitely be right, that is just what they told me in the hospital, I have also seen conversion calculations give different numbers. But those calculators are not very accurate usually.
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I've been given Dilaudid the last time I ended up in the ER. They tried Phenergan and Tramadol injected into my hip but it didn't even touch the pain. So they came back about 30 min later with Dilaudid, and that worked wonderfully. That's the first medication in years that has completely taken all the pain away! I just wish I could get it in pill form.
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I do have dilaudid in pill form. It works well but obviously not nearly as well as I.V. when the headache is out of control. Sometimes thought pain meds are a slippery slope because of tolerance and sometimes rebound. However Dilaudid, in pill form, has been pretty good for me at taking the pain down on non ER days. The problem with having meds for bad headache pain is that I tend to try to deal with an out of control headache for far too long when if I had ER treatment when it first started to get that way, I could have in fact been headache "free" sooner and have it last longer. I have CDH as well so I ALWAYS have some type headache and/or migraine in the background. The trick is to figure which needs hard hitting meds and which ones should just be left alone. Trial and error I guess. I am glad though that I.V. dilaudid with Dex (the dex is really important to ward off the rebounds) seemed to help me more than other meds of the past.
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Ya I have diluadid in pill form also. The thing is that it is metabolized extensively when you take it orally before it hits your blood stream by the liver (first pass metabolism), giving it a very low bioavailability orally. So when you take 4mg orally, that is only has peak plasma levels equal to a little more than 1 mg by IV, plus it takes 45 min to an hour to reach the peak plasma levels. It does work pretty well though. I am just saying that with meds ussually the IV form is far more effective than the pill form, so for a lot of people just because dilaudid IV helped them it doesnt mean the pill will. It does help me though.
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