Dr. Jessica Kiarashi shares insights on what to expect when seeking hospitalization for your migraine
If you have experienced migraine that caused nausea, vomiting or general debilitation in the past, you may have sought out hospitalization for treatment. The uncertainty surrounding seeking inpatient care for migraine treatment can cause those living with migraine a certain degree of anxiety. In fact, according to Dr. Jessica Kiarashi, Chief Resident at the Montefiore Medical Center, it can cause many to avoid seeking help until their pain reaches an unbearable level. To help address this issue, Dr. Kiarashi sat down for a Facebook Live chat hosted by the American Migraine Foundation, where she shared insights on how the inpatient headache treatment process works.
Step 1: Answering Questions
Patients can expect to be asked a series of questions in order to rule out life-threatening issues, like stroke or a brain hemorrhage. They may ask you about when the pain started, or how you would rate it on a scale of 1 to 10. There are also physical exams doctors can do if the migraine is causing you to have trouble speaking.
“If a patient is having what they consider to be the worst headache of their life, which could mean thunderclap headache, we require some brain imaging to make sure there’s no bleeding,” said Kiarashi. “If there are new symptoms present, such as weakness concentrated in one side of the body or trouble speaking, then we have to test for stroke.”
Step 2: Pre-hospitalization Treatments
Once it’s determined that it is indeed an extremely severe migraine, physicians will then move on to some pre-hospitalization treatment options to alleviate pain. “The first thing we try is what we call a migraine cocktail,” said Kiarashi. “It’s a combination of migraine medications administered intravenously. It can usually bring relief in about an hour, but if it doesn’t work, then we’ll move on to valproic acid.” Valproic acid was developed as a treatment for epilepsy, but it can also be used to treat migraine. This treatment is also given intravenously and can work in as little as 10 to 15 minutes.
Step 3: Hospitalization
If the pre-hospitalization treatments are ineffective, then patients are admitted to the hospital for more aggressive treatments. These treatments require hospitalization so that they can monitor for side effects and make sure that you are reacting well to the treatment plan.
“The first treatment my colleagues and I like to try is called DHE, or dihydroergotamine,” said Kiarashi. “It was developed as a treatment for epilepsy but is also effective in treating migraine because it works on similar brain receptors. We require hospitalization for its use because it can cause nausea and requires an IV for administration.”
Skipping the ER
If a patient is sticking to their medication regimen and going regularly to their outpatient visits with consistent follow-up and their migraine is still getting worse, they can also ask their specialist about voluntary hospitalization through elective admission.
“When a patient electively admits themselves into the hospital for their migraine, they bypass the ER wait straight into an available hospital bed,” said Kiarashi. “But this is usually only done if their migraine has gotten consistently worse regardless of treatment over the course of a few weeks. Hospitalization won’t fix or cure their migraine, but it can hopefully bring it back down to a manageable pain level.”
Aside from hosting regular Facebook Lives with leading doctors and health specialists, the American Migraine Foundation maintains a comprehensive resource library full of doctor-sourced fact sheets, toolkits and advice. Download our Emergency Room Treatment Guide for a list of things you need and ways to prepare yourself, or visit AMF’s website to learn more and to find a headache doctor near you.