Daily Migraines, prescribed hydrodo/apap, still daily pain?

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    My daughter who is 15 has been suffering from daily migraines since March 2008.  She sees a neurologist.  They first put her on Topomax-nothing changed.  She has now been on HYDROCO/APAP for a month and still has excruciating pain daily.  What should we do next?  Her grades are suffering and she does not sleep well either. Maureen.





    Dear Maureen;


    There are several issues here.


    The hydrocodone and acetaminophen may well be making matters worse by causing medication overuse headaches (MOH), aka rebound. Pain medications need to be limited to two or three days a week to avoid MOH. For more information on this, please see Medication Overuse Headache - When the Remedy Backfires. Another problem MOH can cause it that it can keep Migraine preventive medications from working.

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    How long did she try the Topamax? It can take up to three months to know if that type of medication is going to work for Migraine prevention. Don't lose hope about preventives. There are now over 100 medications and supplements that can be used for Migraine and headache prevention. The frustration of trying to find what works for us can make it seem as if we’ve tried it all, but with so many possible preventives, it’s literally impossible to have tried them all. See Migraine preventive medications – too many options to give up! for more information.


    Does she know what her Migraine triggers are? Trigger identification and management is a vital component of managing Migraine disease. One of the best tools for identifying triggers is a good Migraine diary. You can download a free diary workbook from our article Your Migraine and Headache Diary. Some of us have food triggers; some of us don't. It's advisable to determine if your daughter does, and an elimination diet is the best way to do that. For more information and a workbook on this, see Managing Migraine - Migraine Trigger Foods.


    Not sleeping well can be a major Migraine trigger, so this is something that needs to be discussed with her doctor. Too much, too little, disrupted, and poor quality sleep are all issues that can be triggers.


    If her doctor isn’t able to help her make progress, it may well be time to consult a Migraine and headache specialist. It’s important to note that neurologists aren’t necessarily Migraine and headache specialists. Take a look at the article Migraine and Headache Specialists - What's So Special? If you need help finding a Migraine specialist, check our listing of Patient Recommended Migraine and Headache Specialists.


    Good luck,
    John Claude Krusz and Teri Robert



    About Ask the Clinician:

    Dr. Krusz is a recognized expert in the fields of headache and Migraine treatment and pain treatment. Each week, he and Lead Expert Teri Robert, team up to answer your questions about headaches and Migraines. You can read more about Dr. Krusz or more about Teri Robert.


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    We hope you find this general medical and health information useful, but this Q & A is meant to support not replace the professional medical advice you receive from your doctor. For all personal medical and health matters, including decisions about diagnoses, medications and other treatment options, you should always consult your doctor. See full Disclaimer.


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    Last updated December 17, 2008.


     migraines headaches health migraine headache and migraine

Published On: December 17, 2008