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Originally Posted by Eagle5US
He is absolutely correct (and backed by the literature) in knowing that triptans are relatively ineffective after the spasm / pain cycle has been initiated. Without getting into the pharmacokinetics of it, a successful initial "migraine pharmacotherapy" consists of Compazine, Phenergan and Benedryl and some add Toradol (the NSAID you probably received) pushed IV. This combination has been shown to have a higher efficacy in relieveing migraine headaches than narcotic therapy as it works on the cause of the HA itself, not the pain receptors associated with it. HA's that are refractory to this coctail and have entered the pain cycle do then need narcotherapy for patient comfort until the HA resolves.
Demerol has a VERY hgh side effect rate, but is dirt cheap and has been around long enough for many folks to be very comfrortable prescribing it. Though I have had tremendous success with it 10 years ago, with the advent of medications such as fentanyl and dilauded, most practioners I have worked with in Emergency Departments and Trauma Centers rarely utilize it today.
Not gospel-only my opinion and the way I practice.
Eagle
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The only side effects, other than the obvious opiate uphoria, were an itchy nose and funny enough, constipation. I remember reading somewhere that in India the children are given small doses of pure opium orally to stave off diareah and the resulting dehydration.
Actually isn't Dilauded a much stronger opiate than Demerol ? I would probably only expect that if I had a more serious injury than a severe migraine. I've had various pain meds for dislocated shoulders for the reduction where I believe I was also alway's given Versid (spelling?) and then woke up an hour later wondering when they were going to reduce the shoulder. Of course by the that time I had been to post reduction X-ray and had a sling and swath on the arm. Funny Bones medication.
I've dislocated both shoulders and one actually had reduced more than 10 times at the ER. I finally got smart and decided to have Cincinnati Sports Medicine due surgery. Since the two surgery's at Womack Army Hospital, Ft. Bragg N.C. and the one here in Cincinnati, neither has dislocated since.
Back to putting drops in the eye.
Thanks for the responses EAGLE.