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Hemiplegic Migraine Compazine Treatment

by Mike
(Oregon)

We have a 16 year old daughter with severe hemiplegic migraines. 60 minutes from onset of an acute attack she has had all of the following symptoms at the same time:

* Blind
* Unable to speak
* Paralyzed left arm, right hand and both legs (all completely limp with no control).
* Tremors violent head jerking shoulder and or pelvic thrusting.
* Passing out every 2 minutes due to intense pain.
* Choking and labored breathing.

These symptoms have persisted as long as 6hrs before receiving treatment.

If given 5mg Compazine via IV, she goes from this mess to completely normal within 10 minutes. They don't come back for min 5 days and sometimes not for an entire month after Compazine treatment.

The specialist we are seeing is working on preventative treatment and were optimistic we will eventually get that nailed. In the mean time our problem is that we are being told there is no way for us to take the Compazine with us such that if we travel we have rescue medicine guaranteed to be available.

Are there regulations which prohibit us from being given the Compazine to be administered via IV? Oral and rectal versions of compazine are standardly given out so I don't understand why we cant get a perscription for the IV type to take with us.

There seems to be considerable debate as well as to whether the suppositories would work. Our specialist says not in her case, but I see a lot others even within the same clinic saying it might.

Comments/thoughts much appreciated.

Answer:

Hi Mike,
I am glad she is seeing a specialist..with any luck she may grow out of these migraine symptoms.

My personal opinion is that you could use compazine. It is a great pain medication as it hits all the major pain (dopamine) pathways in the brain. The best method would be suppositories which come in 25 mg. 1/2 might do it but frankly if her symptoms are that bad she may need a full one. Sedation as you know is the main side effect and she may sleep for a few hours. There is a pediatric dose for the suppository and it is available in 10mg pills. Dosing for oral or suppository is usually a little higher than IV.

In answer to your question, IV meds are usually given only under direct supervision of medical personnel such as a doctor, PA/NP or nurse. This is because of the rare possibility of an allergic reaction. Sometimes allergic reactions do not happen on the first dose.

Failing that, if you travel, ask your specialist for written orders on a script. I do this for patients who live out of town. Then if they have an ER visit before revisiting me, the orders clearly spell out to the ER doc what the patient responds to, and has the practice phone number in case the doctor wants to call.

Best of luck!
Mary Kay Betz
MS RPA-C

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