Opioid hydromorphone (Dilaudid) does not help migraine

Unfortunately, opioid hydromorphone (Dilaudid) is still administered to 25% of patients with an acute migraine visiting an ER. Benjamin Friedman and his colleagues at the Montefiore Medical Center in the Bronx compared the efficacy of 1 mg of intravenous hydromorphone with an intravenous nausea medicine, prochlorperazine (Compazine), 10 mg plus diphenhydramine (Benadryl), 25 mg.
They presented their findings last month at the annual meeting of the American Headache Society. The study was blinded, but a safety monitoring committee stopped it early because the results were so lopsided. Prochlorperazine with diphenhydramine was twice as effective (60%) as hydromorphone (31%) in stopping a migraine and in preventing it from coming back within 48 hours.
So, if you end up in an ER for your migraine, refuse hydromorphone (Dilaudid), meperidine (Demerol), or any other opioid (narcotic) medication. Here is my old post with drugs other than prochlorperazine that are also effective.

  1. Dr. Mauskop says: 12/30/20172:06 pm

    There is no arrogance in my post, only facts. The fact is that for the vast majority of migraine sufferers opioids offer no relief and often make their nausea and other symptoms worse. However, there is a small number of patients for whom an opioid drugs, such as Dilaudid, is the only effective treatment. For those few patients I give a prescription for injectable Dilaudid (hydromorphone) or Demerol (meperidine), so that they do not have to go to an ER wait for hours and deal with suspicious doctors.

  2. Lori says: 12/29/20179:42 pm

    I agree with Greta 100%! I’m 48 and have had migraines since the age of 19. I KNOW that Reglan and Compazine cause akathisia. I KNOW that Toradol doesn’t work. I KNOW that an anti-nausea medication and Benadryl do not work. I have already used rescue medications before coming to the ER. I KNOW that if I’ve gotten to the point that ER is the only solution, only Dilaudid and Phenergan or Zofran are going to work. Still…most times, I’m treated like a drug seeker and subjected to hours of prolonged suffering while the doctor proves to himself (sorry, but it’s always a man) that I was right about what doesn’t work.

    Reading the doctor’s arrogant and uninformed post above makes me so angry! Somebody with a true migraine (with documented history and evidence of regular neurologist treatment) just wants the pain, nausea, and misery to stop, and he/she deserves relief…not additional torture from arrogant physicians who don’t know or don’t care.

    The last time I went to the ER for migraine, they wouldn’t administer Dilaudid until they talked to my neurologist. Fortunately, he was available, but how ridiculous!


  3. Dr. Mauskop says: 10/30/20172:03 pm

    Yes, a small percentage of migraine sufferers respond well to narcotic (opioid) drugs, such as hydromorphone (Dilaudid), meperidine (Demerol), or other. In fact, I have prescribed injectable opioids to some of my patients to save them a trip to an ER. Often, these are women with menstrual migraines who need one shot a month. These are some of the conditions that allow safe prescribing of opioid to migraines patients: the opioid is used not more than once or twice a month, there is no need to escalate the dose over time, there is no personal or family history of drug abuse, the patient comes in for regular visits, and a few other. However, such patients are an exception, which confirms the rule – opioids are not effective drugs for the vast majority of patients. for a shot of
    And, I do experience migraines, although not as severe as yours since I’ve never had to got to an ER.

  4. Greta says: 10/30/20171:28 pm

    You, sir, have never experienced a migraine. After suffering from a headache which relegates one to a dark, cold room with earplugs for days at a time, the presenting patient deserves PAIN RELIEF. In every emergency room that I have entered, there is a sign that states that every patient is entitled to pain relief. Of all of the medications you listed, Toradol is the only medication that provides immediate relief. (In my case, it makes the pain much worse.) Many migraineurs have self administered Imitrex before presenting to the ER, so that is obviously off the table. Your “plan” is exactly what keeps me from getting treated in the ER. If I do go, I am forced to go through your poking and prodding (and more pain and tears) for hours on end before you’ll actually provide me with the small dose of narcotics that I needed in the first place. And do you know what all of your “services” do to my medical bill? It makes it so exorbitant that it takes months upon months to pay off. Just to treat the pain of a common migraine. The pain of a migraineur who has decades of provable migraine history. Is THIS really what you are trying to accomplish with your “plan”? Because if that is the case, you are failing miserably.

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