What rescue meds do y'all use? I'm on Verapamil daily for preventative (doesn't work); Relpax for abortive (works well if I can catch it); and Fiorinal w/Codeine as rescue. I've been taking the Fiorinal for almost 20 years. My dr is starting to be concerned about dependency. What/where do I go from here? My migraines don't seem to care about dependency, and I'm not talking about rebound headaches.
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8/24/09 5:58pm
Hi Chronic Sufferer,
I'm sorry you are suffering and in addition taking fiorinal for 20 years may not be the best thing to be doing. In fact, ANY use of opioids or barbiturates and frequent use of triptans and NSIADs are associated with increased risk of transformed Migraine. See Transformed Migraine - Risk Increased by Some Medications for more information on this.
If you're taking Migraine abortive meds such as triptans or any kind of pain med more than two days a week, a big part of your problem may well be medication overuse headache (MOH), aka rebound. See Medication Overuse Headache - When the Remedy Backfires for more information on this. If you're in an MOH situation, nothing you take is going work, neither prescription nor "natural" medications nor over-the-counter. If that's the case, you need to work with your doctor to stop the medications causing the problem - fiorinal. And please don't stop taking this medication suddendly, it may cause unwanted side effects like seizures. Please discuss with your doctor how to taper off it.
At this point, since you have been suffer so very long, it is imperative to get an accurate diagnosis and treatment plan. That means seeing a "true" Migraine specialist, not just a neurologist who says they are headache specialists. See, here's the thing, neurologists treat so many different conditions, like MS, stroke and epilepsy it is hard for them to be experts in one area. A Migraine specialist treats one disorder - ours- Migraine disease and headaches. 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.
There are plenty of other preventive, rescue and abortive medications to try, so please don't lose hope. Take a look at this article: Migraine Preventive Medications - Too Many Options To Give Up!
Preventive, Abortive, and Rescue Medications - What's the Difference? is a good article that discusses what you need to know about the three kinds of medications used to treat Migraine disease.
I know I've given you a lot of information. If you have more questions after you read it, don't hesitate to come back and ask me.
Good luck
Nancy
8/28/09 11:25am
Chronic Sufferer,
I know how you are feeling. I used amitryptaline for preventative 14 years and fioricet and fioricet w/ codeine as rescue. It worked well, no rebound headaches or dependancy issues. And I had one week a month that I would have to take the fioricet without fail two to three times a day to relieve the pain. But after that week was over, I was fine. Something changed two years ago when I got sick with a stomach bacteria. My migraines started a cycle that has not been fixed. Doctors here changed all meds and started over. I have tried four different preventatives since December, six or seven abortives, but the only rescue meds given to me is tramadol which works fair at best. I feel like my past is being held against me even though I used my meds wisely. So, more days than not, I sit in pain and hope the next doctor will have pity on me and my family (who is also suffering from this illness--my husband is about to divorce me). I don't pretend to know the answers, but I do think doctors do treat based on research. But also assumptions. For example: How can we distinguish MOH from other headaches and Migraines?
Differentiating between a tension-type headache, for example, and MOH can be difficult. There are, however, some very discernable differences between MOH and a Migraine attack. Migraine pain is worsened by activity; MOH tends not to be. MOH is also missing other Migraine symptoms such as nausea, vomiting, phonophobia (sensitivity to sound), photophobia (sensitivity to light), hot flashes, chills, dizziness, and so on. My headache specialist never asked if my headaches had changed (they had not...all of them have nausea and actually the phonophobia and photophobia have increased. But I was put into that box and forced to give up the only pain relief that benefitted me. Eventually I lost my job due to the chronic pain. Doesn't seem right. I am currently looking for a new doctor but I doubt they will give me fioricet, which is fine but I would like something that works. Anyway, I feel your pain!!
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By Chronic Sufferer— Last Modified: 12/23/10, First Published: 08/20/09
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Nancy, thank you so much for the information you provided. Because I have endured this agony for so long, I've had much time to research this issue. I understand what you are saying about MOH, and in the past have had that experience. However, it has been years ago since I was in that cycle. The problem I am facing, and have been facing, is that I have found no preventative medication that works for me. As an abortive, the Relpax is the first thing that has worked. (I did Imitrex when it was self-injection - that's how long I've been dealing with this. However, I often wake up with a migraine and the Relpax is ineffective. I understand opiates may not be the best way to go for rescue medications. However, it will knock me out so that I can sleep until the migraine has run its course. The strength of it is also the least I have found that provides any assistance. I am more than aware that I need an effective preventive med; I just simply cannot find one.