Prepare for a Procedure
Hospitalization for Headache Treatment
Why do I need to be admitted to the hospital?
Selected patients - typically those with severe medication over-use headaches or those who seem to be "stuck" in a prolonged migraine - may be candidates for inpatient hospital headache treatment. This typically occurs only after all reasonable outpatient treatment options have been exhausted.
The goal is to bring headaches quickly under control with "strong" intravenous medications over three days of medical treatment. The most commonly used drug is dihydroergotamine (DHE), a drug in the ergotamine family, distantly related to triptans (Imitrex-sumatriptan is one such drug). Although DHE can have significant side effects when given intravenously, it is often effective at “breaking” the vicious headache.cycle. In the hospital, it can be given at fairly high and frequent doses when combined with effective nausea medications.
Hospitalization is also an opportunity to “detox” off any over-used short-acting medications including narcotic containing pain-relievers, barbiturates (such as in Fioricet), triptans, or caffeine containing compounds (such as Excedrin). Potential symptoms related to rapid withdrawal can be addressed with other medications and nursing care.
Also, as an inpatient, it is possible to provide IV hydration if needed, and administer other “strong” medications that may have side effects such as sedation if given at home.
Hospitalization also provides the opportunity to adjust outpatient prevention regimen more rapidly than can safely be done as an outpatient.
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How do I prepare?
If it is determined that you are an appropriate candidate for inpatient treatment, our coordinator will contact your insurance company to preauthorize your inpatient stay (rarely, patients are directly admitted from the emergency room or clinic). Basic laboratory work and a baseline EKG are required prior to admission. Other than clearing your calendar for a few days, no special preparations are necessary.
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What can I expect when admitted to the hospital?
On the scheduled admission,day, patients should pick up their registration packet at the Johns Hopkins Bayview Medical Center Neurology Clinic front desk. A simple instructions checklist reviews the admitting process:
- Outpatient lab for blood tests (if you have not had them already)
- Cardiology for a routine EKG
- Check in at the Admissions Office to complete paperwork
- Escorted to the Neurological Sciences Unit (NSU) on the 6th floor of the Pavilion building. An IV will be placed and you will be introduced to your nurses and physician care team.
Over the course of the inpatient stay, DHE will be administered by IV every eight hours, along with an anti-nausea prevention medication .Withdrawal from short-acting medications contributiong to headaches will be monitored. Headache prevention medications will be adjusted as needed. Pain and withdrawal symptoms will be treated with other medications as necessary. Steroids may also be given to help during this potentially difficult time. If needed, an occipital nerve block to help reduce pain may be given.
Because Johns Hopkins is a teaching hospital, there is a team of multiple providers involved in patient care. The neurology team consists of:
Neurology-trained nurses
Resident physicians
Supervising attending neurologist
Medical students
The NSU nurses will care for your immediate inpatient needs, while the physicians of the neurology team will guide the treatment plan and assess progress. Physical therapy is available if needed for neck-related symptoms.
The specific treatment plan is determined by the Headache Center provider, but will be modified depending upon your response to treatment. It is not uncommon, for example, for the nausea medication to require adjustment.
After the inpatient treatment, you will be discharged on an outpatient medication regimen that you will continue until your next follow-up visit.
Your hospital stay will be a maximum of 3-5 days regardless of whether you improve or not. Not every headache can be successfully treated in this manner.
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