Migraines, CDH, and long-term opioids?

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    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.

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    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:

    • There's a very real possibility that frequent use of opioids are making matters worse, not better, by causing medication over use headache (MOH), aka rebound headaches. For more information on this see Medication Overuse Headache: When the Remedy Backfires. Being in that cycle of medication overuse can also keep preventive medications from having a chance to work.
    • Medication overuse is also very frequently a factor in Transformed Migraine, which is when episodic Migraines "transform" to a situation of daily headaches punctuated with debilitating Migraine attacks. Please see Stopping Medication Overuse Can Halt Transformed Migraine and Transformed Migraine - Risk Increased by Some Medications.
    • Frequent use of opioids can also lead to changes in the way the brain processes pain, and over time, medications are less and less effective.

    One of the best methods of starting to get intractable Migraines or CDH under control is IV infusion to break the cycle. There are several medications that can safely be used this way, preparing the way for developing preventive regimens that can work for you. There's information on this in IV Treatment of Refractory Migraines.

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    As for preventives, there are now over 100 medications in use for Migraine and headache prevention, let alone countless combinations of them, so it's literally impossible to have tried everything for prevention. You can find a list of these medications in Migraine preventive medications - too many options to give up!

     

    The bottom line, Megan is that the opioids are a very short-term solution to a long-term problem, and they're quite possibly making the problem worse. We understand that you have a young child to care for. Trust us, you're not going to find more time to seek treatment and take care of yourself as she gets older. The time may be spent differently, but she's going to continue to be the center of your universe. The sooner you get working on a preventive regimen, the sooner you'll not only have more time for her, you'll both enjoy it more.

     

    Good luck to you and your family!
    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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    Last updated May 17, 2009.

     

Published On: May 17, 2009