Friday, August 29, 2014
Monday, December 29, 2008 HILLEL, Community Member, asks

Q: Without examination/reviewing symptoms, doctor became visibly annoyed, hastily prescribing Klonopin

For years I've had severe migraines, which now feel as if the symptoms could be interpreted as a stroke.

One of my 3 neurologists, the prescribing one, gives me about a 3 minute evaluation every 2 or so months.  I refuse to be on a rollercoaster of medicine again.  I have sucessfully tapered off many meds and am extremely wary when he prescribes anything.  His latest was to get me back on Topamax, which I never filled the script.  To my knowledge and memory, I have been on at least 6 meds that are "anticonvulsants", and have manifested many of the terrible side effects, unbelievably deep depression, even a possible heart problem due to the meds.

At this latest visit of 3 minutes, I told him the migraines were still if not more severe.  He gave me another script for Fioricet which he is more than happy to hand out, to which I said it barely took the edge off the pain and I felt that most of the symptoms could possible be mirroring a stroke or aneuryism.  He then gave me a script for Klonopin, which I've had in the past, but long enough ago that I didn't recall what it did.  When I asked what it was. he became very annoyed and said "It's Valium!". I certainly didn't want to be taking a drug that many get "hooked" on and I certainly try to function no matter what the pain and didn't need to be passed out for a few hours.

What do you do when doctors barely examine you yet are handing you scripts for mind bending drugs that you don't even have a related disorder for?

 

 

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Answers (5)
Teri Robert, Health Guide
1/ 2/09 3:09pm

Traci was right. You deserve better care. It's time for a new doctor. It seems to me that it's 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.

 

Klonopin is in the same broad drug family as Valium, benzodiazapines, but they are very different medications.

 

Do find yourself a good doctor, one who is willing to work with you as a treatment partner. Take a look at our article Patients As Consumers - Managing Healthcare and the Healthcare Team.

 

Good luck,

Teri

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traciputnam, Community Member
12/30/08 6:36pm

This one is very easy, and it just scares me how many patients don't either don't notice it, or don't know they can do anything about it.

 

Your doctor works for YOU.  Not the other way around.  You hired your doctor to perform a service to you - healthcare.  That means it is THEIR job to care for YOUR health.  Every single note they take, diagnosis they make, hour they spend reading their PDR, prescription they write - whatever - is TOTALLY useless to you if they don't LISTEN to you to begin with.


The solution?  You start by telling your doctor you don't feel he (or she) is listening to you, answering your questions, or providing you with the care you feel you might need.  If your doctor is worthy, then he will respect that and make an effort to right his wrong.  BUT, if your doctor becomes defensive and you have very good reasons for your feelings (as it clearly appears to me that you do based on your question), then you FIRE your doctor and seek out a new one.  I have done this many times.  And I still do it today.  A person can graduate from a thousand medical schools and hold a thousand degrees and specialties, but that doesn't make them a good doctor for YOU.

 

I take this even more seriously when dealing with specialists, such as Neurologists.  The medical profession has been sadly reduced to "quantity not quality" in so many places, and patients just figure this is the way it is.  There are excellent doctors out there, but you might have to search for a while to find the right one for you.

 

NOW, as is and was with me, my Migraines have not changed in the 23 years I've had them.  So when I saw my Neurologist every 6 months, the appointments were very short.  BUT, whenever I had something new to report, the appointment lasted however long it needed to last.

 

Aside from this, I will share that I have uncontrollable Migraines with no triggers (I don't care what the articles say, I've spent the last 20 years trying to map these "triggers" and my Migraines just don't have any) and I cannot take triptans or beta blockers.  I can only treat the pain symptoms at this time.  But it has taken me years and years of so many different medication trials to figure this out.  And Fioricet is useless if your migraines are servere.  I have Fioricet also, but only for tension headaches, not for Migraines.  Your doctor should be hearing you on this and acting on it.  I also have Klonopin, but it was never suggested or prescribed for my Migraines.  It's an anti anxiety drug.

 

You have every right to proper pain relief.  Migraine pain is NO JOKE.  And don't let any doctor treat it as if it is no big deal.  While you and your doctor search for a better prevention or treatment, your pain and suffering are to never be ignored.  Since you mention concerns about taking too many drugs, you should know that the only way to get better pain relief than with Fioricet (which contains APAP or Tylenol, a barbiturate called Butalbital and Caffeine - which is well known as a Migraine trigger for some people), is to move over to the narcotics and/or opiates category, and those are far stronger than Fioricet and typically require increased doses to work.  That is why many doctors won't prescribe them for headaches of any kind unless all other treatment attempts have been exhausted.  I highly recommend that if you go that route, seek out a Pain Management Specialist to manage the scrips for you - here in TX, it's required and I wish it was in every State.  My Migraines have me beyond the realm of Fioricet and narcotics like Vicodin (which, with a Migraine, make me sick anyway.)  And I have to meet with a Pain Mgmt Specialist once per month, a Psych once per year, and my Neurologist to get the one pain prescriptions that does work for me.  It's meant to ensure those drugs aren't improperly used.

 

I know it was long, but I hope this helps a bit.  Good luck.  And don't hesitate to research on the web anything you are curious about - even if you don't think you are "qualified" medically to do so.  I research every little thing I have a question about and if I find something out, I ASK the doctor about it.  It's my health, my life, and my money, and plan to stay in control of how I am cared for.  I failed to be pushy with my Mother's health care and figured the doctors were right and I was crazy.  She is no longer with me because of it.  I don't plan to let that happen again.

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Chronic Sufferer, Community Member
8/27/09 8:12pm

I was on Klonopin years ago for a short time, but that was for depression and anxiety.  It is my understanding that it is the middle ground between Xanax and Valium and an antipsychotic.  I've had migraines for 20 something years.  I know some medications are tried for migraines even though migraines are not their primary ailment.  However, I have not heard of anyone using Klonopin to ease that type of pain.  After experiencing what I went through, I can assure you that there is no way Klonopin would come close to easing my migraine pain.  Nor did my migraines lessen while I was on it.  You should consider getting another doctor since the one you have now isn't listening to you, nor helping you, at this time.  I am so sorry; and believe me, I feel your pain.

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Dixiegirl929, Community Member
4/22/10 8:24am

I've suffered from debilitating, life impacting migraines since I was 15 yrs old. I'm now 45. For years I wouldn't take so much as an aspirin. I would be in horrendous pain for days, lying on the floor, vomiting uncontrollably, wishing I would die so the pain would go away. I have a dr. who doesn't believe in pain meds and 3-4x a year they get so bad I go the ER for demerol/phenergan shot. I don't drink, and I don't smoke, I avoid anything possible that would induce a headache. People who have headaches and then don't want to try the Rx their doctor gives them or is lucky enough to have a dr who will prescribe Rx makes me very angry. Unless you are a drug addict you are not going to get "addicted". The Rx is there for PAIN. Obviously your pain is not great enough to warrant medication. You and the drug addicts, are the people that has made it so people like me who actually need pain relief can't get it. Sick of the whiners.

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Daisy, Community Member
11/ 6/10 5:29am

I think this answer is uncalled for. You have called her a drug addict. I work in an ER where people come in drinking Red Bull eating Cheeseburgers and talking on cell phones. You put them in an ER room and THEY say "tell the doc to come back when I am done with my call" THEY are giving migraineurs a bad rep. THEY are giving us the rep that we can't get proper treatment. Why are you accusing her. She may have three neuros which makes no sense. She make not seem compliant and that maybe she needs to be sat down with one of these docs for a reality check. These drugs will cause unpleasant side effects, but does she have to live with these side effects? NO SHE DOES NOT. SHE DOES NOT. IF THEY MAKE HER FEEL BADLY SHE DOES NOT HAVE TO BE A VICTIM OF THESE. Fioricet is NOT addictive. It is tylenol, caffiene, and butalbital I believe. Nothing addictive. Perfectly safe.  Valium short term, safe. If however, she is not comfortable she doesn't have to take it. Yet, it is prudent to point out that the docs are probably frustrated as she has three and not willing to take anything that any of the three are rxing and prudent to ask why she isn't taking anything any of the three are rxing and why she is having three which alerts them to concern for doctor shopping just a reality and concern to them which may be why they are popping off a drug and a sad fact of docs these days you got to be careful with migraines. They are not taken seriously, often in medicine, but before you blame her. Take a look at the people that stagger into ER on their cell phones with cheeseburger and cellphone and redbull to busy for the doctor to interrupt. THEY are giving you a bad rap.  Not her. She is standing up for her self, but it does look questionable to have three neuros and not to be interested in compliance with anyones suggestions. Just a thought. So please find a doctor whom you feel you can work with to the author of the the original question and know it took me years before I could tolerate an anticonvulsant you are not alone. However,  know the docs lay a lot of stigma on patients that they feel may be difficult or overly excitable or anxious or come across as "histrionic" in personality.

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HILLEL, Community Member
11/ 7/10 9:27pm

Thank you Daisy :)

I have no idea why that person took such a hostile/weird route to reply, but whatever.

I've gone to several neuros, I should specify, not all at the sametime, which would look bad.

 

Some have been extremely disinterested and not taken into account what I'm telling them about reactions, as my weight tends to fluctuate from skinny to average, but the skinny being VERY skinny and the migraines being so severe, it's obviously difficult to manage pain/high doses that are effective.

 

I'm back to one of my old neuros , who I'm glad admitted that the "cocktail" I'm on is a bad mix, but it's the only one that has in any way provided an ounce of relief.

It also doesn't help that I have severe migraine history on both sides of the family and by that I mean debilitating, lie down with the shades drawn and you're out of the game for the rest of the day.

 

Anyway, thank you for your considerate and thoughtful response, so much more helpful than someone not from a medical background on a rant.

 

~Robin

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Julie, Community Member
11/ 4/10 10:52am

Hi -- I just wanted to weigh in for the benefit of the original poster and anyone else who may be reading the follow-ups for information about klonopin for migraine management.

 

I too have spent approximately 20 years suffering from migraines that have increased in frequency and severity over the years.  I have also spent years with PHPs and neurologists searching through trial and error for a successful preventive approach that would reduce the migraines without having unmanageable side effects.

 

For me, klonopin was that drug.  Only .5mg per day has reduced my migraines from 12-15 per month to fewer than 5.  It is an anti-anxiety drug and an anti-epileptic drug. Many anti-epileptic drugs have been used successfully in migraine prevention routines.  I also take bystolic (a beta blocker), supplemental magnesium and B vitamins.  I also use abortive and rescue drugs when necessary. So, rest assured that a physician who prescribes klonopin for a migraine patient isn't necessarily acting/prescribing inappropriately. 

 

However, the other issues you identify with respect to the doctor/patient relationship don't seem right, and I completely agree with other responders who have suggested finding a new doctor.  I did not have relationship issues with my prior neuro, but found that my symptoms were simply beyond her expertise as a general neuro.  I switched to a headache specialist and made immediate progress in reducing the number of migraines, as well as eliminating the unproductive drugs from my preventive routine.  I'm now feeling and doing much better, and a 3-5 minute evalution every three months feels appropriate to manage my symptoms. 


One thing I also did that helped tremendously was arm myself with information prior to my neuro visits.  I read message boards of migraine patients, and learned about various treatment options.  That way, I didn't feel so much at the "mercy" of the doctor's decisions -- I had enough information to ask questions and discuss or challenge the doctor's proposed course of action.  Ultimately, that information is what led me to conclude that my symptoms were too severe for my neuro's expertise, and that I needed a full-time nothing-but-headaches practitioner.

 

I don't blame anyone who doesn't want to be on a roller-coaster of random meds.  A headache specialist will help you get off that roller-coaster.  I urge anyone suffering with frequent or severe migraines, or with a less-than-successful preventive routine, to seek help from a headache specialist.  It is well worth the effort to find a specialist, and many migraine message boards will make recommendations for specific geographic areas.

 

Good luck to the original poster, and everyone else suffering with migraines.

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Teri Robert, Health Guide
11/ 4/10 1:53pm

Julie,

 

Thanks for weighing in with some great comments. Much appreciated!

 

I just want to pass on a bit of information about Klonopin, in case your'e not awared of it. Klonopin is a benzodiazepine, and they're generally recommended for short-term use only. My concern is that studies have shown them to increase risk of bone fracture in patients over 60. People with a history of osteoporosis or history of it in their families should discuss this risk with their doctors. Just thought you'd want to know.

 

Thanks again,

Teri

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Daisy, Community Member
11/ 6/10 5:40am

Agree with Teri about weighing such risks, but would like to point out that I have had lots of muscle issues with my migraines and klonopin has actually been helpful for me thought I am on anticonvusants (have been on topamax, then gabapentin).  Also using dysport (very similar to botox and new on the market in the USA, used for a lont time in Europe) as muscles as stated have been a problem for me.  Klonopin is a great muscle relaxant if you read about it, it is also indicated in seizure treatment, but in much higher doses which I would not suspect would be used for migraine.  So I have been using much smaller doses.  I hope this helps and Terri would be the authority on this more than I am your doctor.  Do remember, to find a doctor you are comfortable with. It took me four neurologists before I found someone I was truly comfortable with. However, simply dismissing everything may not get you anywhere and assuming everything is addictive before you research may not get you far either.  Just research it a bit and ask ask ask questions. That is what the doctors are there for and your pharmacist is an invaluable member of your healthcare team. If however, you don't feel the doctor respects you. Move on. Good luck. I just don't feel you are giving migraineurs a bad rap.  I would caution you though. As, it is easy to look like you are doctor shopping.  Cover yourself if you need to, but feel confident to find the right match for you. You deserve that. :) Hugs.

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Teri Robert, Health Guide
11/ 6/10 10:31am

Daisy,

 

Thanks so much for your helpful comments.

 

Thought I'd share with you that Zanaflex (tizanidine) is also great for muscle issues. I was taking Klonopin at one point for a sleep disorder. It worked great, but I was worried about the increased risk of bone fracture because I have otesopenia (precursor of osteoporosis). My Migraine specialist suggested changing from Klonopin to Zanaflex. It works great for the sleep disorder and muscle issues. It's the best thing I've ever tried for muscle spasms. I also discovered another great thing about it. During a very stressful time, my doctor told me I could also use it for anxiety. I was surprised when it worked better than anything ever had for anxiety, including anxiety. Just thought I'd share.

 

Thanks again!
Teri

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HILLEL, Community Member
11/ 7/10 9:32pm

Hi again Ladies :)

 

The Klonopin is also working better now too...I think it was a matter of being on Propanolol or something, because when that was in the mix...yikes! I always felt dizzy...But now I'm feeling "stable" on the migraine preventatives, which has taken years as expected...and I had/have seen migraine specialist and learned tools along the way from them too! :)

 

~Robin

 

PS- A great thing you can use - "Migraine Ice" patches, sold at CVS...they come 4 to a box, about $6 and are great if you need to lie down on put one on your forehead before bed and you have a migraine...I LOVE these things!!!!

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Daisy, Community Member
11/12/10 10:33pm

Teri --- that is incredibly helpful to know. We often get told about steroids or similiar meds, but I've never been told about klonopin affecting osteoporosis and this is a thought being a thin, small boned caucasian woman.

 

Tizanidine, I'd hoped to be a god send, but it dropped my blood pressure so much I had some black out episodes with it -- boogers, eh?

 

As you've mentioned it is always worth looking into the run of muscle relaxers if muscles are considered a problem.  Baclofen aslo is supposed to have muscle and neurological properties which I tolerated better. 

 

As any drug in the family of klonopin could be addictive if there is a better alternative I'd try it first!  Thanks for being the ever-present advocate!!!

 

Cheers.

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Teri Robert, Health Guide
11/12/10 10:57pm

Hi, Daisy,

 

We never know when information will be helpful, do we? I first learned about benzos and the increased risk of bone fracture when I was monitoring my mother's care. I fired one doctor because he changed her from one benzo to another thinking I wouldn't catch what he was doing. She had osteoporosis and a history of bone fractures even.

 

Darn! Sorry the tizanidine presented problems for you. It's been such a wonder drug for me, from treating a sleep disorder to helping with anxiety, it's been great.

 

Anyway, you're very welcome -- any time!

 

Teri

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By HILLEL, Community Member— Last Modified: 04/06/14, First Published: 12/29/08