I have had severe migraines for over 25 years and have gone to the same doctor for 35. After years of medications not working and taking over 1,600 MG of Advil a day, nothing worked until she gave me hydrocodone 10/325. My migraines the week before my period will be daily for 4-5 days and then I usually have a migraine 1-2 days every week. She has given me 30 pills a months for 4 years, with the notes to take 1-2 pills every 4 hours as needed. Well, when I have the 4-5 days I will take approx. in those days 20-25 pills, depending on when they hit. If it is closer to the weekend, I can knock it out in 2 days. During the week I try to manage only taking meds at night. So over the last 25 years I now find that I need to take 2 pills at a time. I have asked that she increase my medicine to 45 pills per month. She has refused and now wants me to sign a controlled substance agreement. She says she is concerned about her medical license--obviously not my pain or her patient. She tells me how I am feeling, does not listen to concerns and, considering she has been my doctor for over 30 years, she knows my history since she is the one who diagnosed it. What do I do? Colleen.
Your question has so many layers it is difficult to know where to begin. We'll start by saying that we are sorry that you have suffered with migraines for so long. They can be very disabling and a significant burden on you and your friends and family.
It seems that your physician is likely your primary care provider since you have been seeing her for 35 years. Often, primary care providers are able to help their patients with migraine perfectly well, but if you've not been successful in finding effective treatment options over the past 25 years, it may be time to look for a headache and migraine specialist. If you need help locating one, take a look at Migraine and Headache Specialist Listings. Although we still don't have a cure for migraine, treatment options, including oral medications, injections, physical therapies, and others, have expanded significantly during that time, and some of these may be good choices for you. We have yet to meet someone who has truly "tried everything," although having migraines for as long as you have can certainly make you feel that way.
One thing you mentioned that is concerning is the daily use of ibuprofen. Frequent use of just about any pain medication, prescription or over the counter, can lead to more frequent headaches. This is called medication overuse headaches, or rebound headaches. Often, when medication overuse headache is present, other treatment options don't work at all, or as well as they would otherwise. This could explain why some of your treatments tried in the past haven't worked. For more information on this, please see Medication Overuse Headache - When the Remedy Backfires.
Regarding the hydrocodone, this is a very difficult topic. While there is some disagreement among headache and migraine specialists about the occasional use of opiates like hydrocodone, it is well accepted that even moderate use of these drugs can lead to a variety of problems for migraine suffers, including worsening severity of headaches and migraines, increasing frequency of headaches and migraines, reduced effectiveness of other abortive medications and reduced effectiveness of preventive medications. This is another reason that you may consider seeing a headache and migraine specialist to find other options which don't carry these potential consequences.
Lastly, you have apparently trusted your doctor for many years. She is rightly concerned about the legal aspects of providing you with continuous prescriptions for opiates. Many states, as well as federal agencies, are being much more proactive in attempting to regulate the prescribing of medications like hydrocodone. Physicians are feeling pressure to limit them as much as possible, and are being monitored for overprescribing. While that may not seem to be in your interest, it is the reality in which they practice.
Thanks for your question,
David Watson, MD, and Teri Robert
About Ask the Clinician:
Dr. David Watson is a UCNS certified migraine and headache specialists and director of the Headache Center at West Virginia University. Je and Lead Health Guide Teri Robert, team up to answer your questions about headaches and Migraines. You can read more about Dr. Watson or more about Teri Robert.
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Published On: July 22, 2014