Doctor concerned about addiction to Vicodin for Migraines

Health Professional

Full Question:

I have migraines all the time at least twice a month. My doctor has given me Vicodin and it really helps. She has also given me Flexeril and Naproxen. I cannot take the Flexeril because it makes me fall asleep and the Naproxen is useless.

My Doctor is concerned that I am going to become addicted to the Vicodin but this was the point of me going to the doc. because I was money on Naproxen and every other over the counter pain and migraine medicine. I don't know what to do to let me doctor know that I'm not going to become addicted to the Vicodin because I only take it when I feel a migraine coming on.

I don't know if migraines are hereditary but, my mother and brother and aunt all have migraines as well. I work at a desk job where I am on the phone a lot and I have some problems with tension in my neck. I don't drink caffeine or eat foods that trigger the migraines but, I believe they are related to stress. I am also on Wellbutrin for depression. I have been on Topamax in the past and it didn't help and I stopped taking birth control because I had migraines so often we thought this was the cause.

I have Imitrex to take but, I cannot take it and go to work because it makes me fall asleep about 20 min. after I take it. I know a lot of docs are scared to give out pain medicine but, what's the point of me going to them for relief if they want to take away methods that work? Thanks to all the drug addicts in the world, people like me have to suffer. I just need some advice.
Thank You, Cari.


Dear Cari;

There are several issues to talk about in what you told us.

Anyone who has more than three Migraines a month needs to be talking with their doctor about Migraine prevention. There's growing evidence that Migraine is a progressive brain disease. A recent study showed that Migraines can cause brain damage, and that people with three or more Migraines a month are more susceptible to this damage. For more information, see Is Migraine a Progressive Brain Disease? and ** Yes, Migraines Can Cause Brain Damage**. You talk about "all the time, at least twice a month for your Migraines. It certainly couldn't hurt to keep talking with your doctor about improving your preventive regimen.

Medications such as Imitrex that work in the brain to stop the Migrainous process are preferred over pain medications by most doctors and patients alike. Imitrex is only one such medication. There are others you can try that might not make you so sleepy and let you continue with your day. The other medications in the family of Imitrex are Maxalt, Zomig, Amerge, Relpax, Axert, and Frova. Your doctor should have samples of these so you can try before filling an expensive prescription.

If your doctor is truly worried about addiction, it's hard to know what will change his or her mind. There are, however, other reasons to try to use the Migraine abortive medications instead of opioid pain medications such as Vicodin. There is now evidence that ANY use of opioids or barbiturates increases the risk of transformed Migraine. You can find more information about this in Transformed Migraine - Risk Increased by Some Medications. The best regimen for Most Migraineurs is Migraine abortives to take first when a Migraine occurs and rescue medications such as pain medications to use if the abortives fail or if you've already take abortives two or three days that week.

Yes, Migraines are hereditary. As for stress being a trigger, there's still some controversy, but I hate to see anyone accept that stress is a trigger without at least trying to see if they encounter triggers during stressful times that they either don't encounter at other times or they're only triggers when the body is stressed. The International Headache Society has removed stress from their list of Migraine triggers and put it on their list of exacerbating factors -- things that make us more susceptible to our triggers. I'd have sworn stress was a trigger for me until I kept a very detailed diary for a few months. More information in Is Stress a Migraine Trigger?. I hope you'll thoroughly investigate this as I think we do ourselves a real disservice by thinking stress is a trigger for us and not looking closely for other triggers during stressful times.

If your doctor isn't open to discussing the options with your or isn't able to help you, 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

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