Migraines, CDH, and long-term opioids?

Full Question:

Hello, My name is Megan and I have been suffering from  migraine illness for 18yrs, I am now 30yrs old. I have tried over 35 preventative and abortive medications with little to no luck. Some would work for a short time, however, I haven't really found anything that works except for MSContin and Morphine Sulfate. I was prescribed these after a hospital discharge for intractable migraine in 2008. I took the medications for over 2 months and had some success. I had no ER visits, and only had mild to moderate pain occasionally which the Morphine sulfate managed that.

I have been in the hospital over 4 times. (3) in 2008 and (1) in 2009. I have tried to be optimistic about trying new medications, however, I had found something that had worked, but my new headache specialist is telling me that a 30 year old female cannot be on opioids for long term use.

However, I have done some research, and I disagree with him. For as much as I have to take medications, he has me on Anaprox, Baclofen, and Treximet right now, with Reglan and Phenergan suppositories for nausea.  However, the Anaprox makes me so sick to my stomach, just adds to the nausea, and I have started to get heart burn which I have never had.

My specialist has advised me that I am suffering from Chronic Daily headache, and I cannot use any opioid therapies at all.  Even if I go to the ER, they will not treat me with any opioid therapies at all.  Which is what helps me.

Am I really asking for unrealistic type of management, (the MSContin and Morphine Sulfate)?  I have read a lot of articles on tolerance, dependence, and addiction to these medications. I have also read that once pain is under control for a period of time, there is a great possibility of coming off the medications.  My quality of life right now is in shambles, and I rely heavily on my boyfriend and parents for care. I also have an 18 month old daughter, and this condition is hindering me from the proper care she needs, that's why I have to rely on her father, and my parents.  I feel like such a burden at times. But I had found something that was working for me, why can't I use what works for me?

Answer:

Dear Megan;

It's a bit unclear what your diagnosis is. You state that these opioids were prescribed during a hospitalization for Migraine; then you say your current diagnosis is chronic daily headache (CHD). These are two very different diagnoses.

The basic answer is the same whether we discuss Migraine or CDH. Please understand that we cannot tell you what is specifically best for you. Only a doctor who has full access to your medical records and can examine you can give you specific answers, but we can share information that you can review and discuss with your doctor.

For Migraine or for CHD, opioids would not be our first choice. In fact, they would not be a choice for frequent treatment at all. It's not a matter of addiction. It's not even a matter of dependence. It's a matter of them simply not being the best treatment, particularly long-term. Let's look at some specific reasons: