Migraine more than a headache

The Scary New Migraine Mistake is an article about migraines.  Guess what the scary migraine mistake is?  The surprising amount of people undertreated? Nope.  The fact that man chronic migraine sufferers feel so let down by their doctors that they have no hope of achieving pain management? Nope.  That some of these people kill themselves?  Definitely not, because obviously those people no longer have to manage their pain and are no longer included in the discussion.

Most of us know for a fact that doctors are extremely reluctant to provide painkillers for unmanaged chronic pain conditions, but will rain a shower of painkillers down on those people with temporary moderate pain.  No, it makes no sense.  I did not make the rules.  So this article is rather the opposite of that fact…. ”

While no one knows for sure how many migraine sufferers go on to overuse addictive painkillers, the problem is “epidemic,” says Joel Saper, MD, director of the Michigan Headache and Neurological Institute (MHNI), which administers the in-patient program in Chelsea and an outpatient clinic in nearby Ann Arbor. Who’s getting addicted? At the Waismann Method in Beverly Hills, a rapid-opiate-detoxification center, patients undergoing withdrawal from narcotics taken for migraines tend to be “women in their thirties, forties and fifties, with families, husbands and jobs,” says co-medical director Michael Lowenstein, MD. In other words, women very much like us and the people we know.”

First of all who are these people getting opiates for treatable migraines… and why have I never seen that doctor?  Secondly, why are these people being given opiates and not informed, like triptans, if overused they will lead to rebound headaches and migraine overuse headache? Maybe I don’t want to see those doctors, clearly, they are idiots.  Odd that apparently only women are becoming addicted when statistics show male doctors tend to ignore or underestimate chronic pain in women, often going with the ‘it’s stress’ or ‘all in your head’ business.  Makes me wonder how many are not being treated at all.

” “For every patient who truly needs narcotics for migraines, there are about 100 who are getting them,” estimates Stephen D. Silberstein, MD, director of the Jefferson Headache Center in Philadelphia.” 

Then it goes on to mention triptans, being a very viable first choice of treatment.  Which they are. Definitely. When you can take them and if they work for you. I knew a lady with episodic migraines being treated with codeine and I told her I found it odd her doctor hadn’t even mentioned triptans. She went on to ask about them, infrequent or not, her treatment wasn’t effective for her.

Anyway, what they are really saying here is that patients who have manageable migraines are being given opiates and those with complicated migraines, who are likely using triptans already, are not being given opiates… and therefore there are obviously a vast, vast majority of doctors who have absolutely no idea how to actually treat migraines.  Obviously, triptans, given how they act and are designed, are the number one choice… but when migraines become chronic and they cannot overuse them and are on preventatives, they often need a ‘rescue’ med which is some sort of painkiller or anti-inflammatory.  Part of the problem is not a problem I face, due to a fine drug plan where I work and a fine health care system… but outside of those parameters?  Triptans are insanely expensive, especially if you get frequent migraines. I can see why a doctor might prescribe something else, due to cost. (not as of 2017 by the way, but when this article came out).

“The problem is that a significant proportion of sufferers experience attacks far more often: 37 percent endure episodes one to three times a month; 14 percent have them two to six times a week; and 11 percent, once a week. A patient downing opioids or barbiturates that often is likely to build up a tolerance that will lead her to crave progressively larger amounts of medication, creating a real risk of physical dependence.”

Yep, I am part of the statistic that gets them a crapload a week.  As in occasionally, I don’t have a migraine.  But, mind you, some of my preventatives help decrease migraine intensity, so not every migraine in mind-blowingly acute… thank god for that.  And sometimes my triptan does an awesome job, such that sure I had a migraine, but it went away fast enough.  Still, obviously, my treatment is very complex and includes three preventatives, Maxalt, and Tramacet.  Frankly getting dependant on any medication is not really on my radar, I need the meds to be able to manage pain… not eliminate, not put me in a haze, but to manage, as in slightly dampen so I can get through the day.  That does not mean popping painkillers till the pain goes away… or I would likely overdose, nor does it mean to take as many as possible day after day until I rebound or they don’ work anymore.  I want them to continue to work.  I don’t want to rebound.  Ergo I juggle triptan use and painkiller use and suffer on the weekends.  That is that, but it is still a great deal of pain to tolerate day in and day out.  I get that people would be on more and better painkillers since I know my pain is not really managed at all.  For those of us crippled by pain, where is the choice exactly? But painkillers, are not a first-line, second-line or third-line treatment. They are not effective and they do not last long. And yes, there will be tolerance developing from them.

“What’s more, frequent dosing puts migraine patients on a path to making their headaches worse, not better. Using opioids and barbiturates at least eight days a month can change pain receptors in the brain and make migraines go from being an every-now-and-then problem to a daily affliction, according to a rapidly growing body of research. This is called “transforming,” and it causes a vicious circle: Headaches spur patients to take meds for their pain; dependence and tolerance build; patients require more medication for relief; and the headaches just keep getting more frequent, leading to even more pill popping.”

I do wonder how this applies to those of us who are daily and certainly didn’t get there from medication overuse. But now that we are… how can that get worse? However, occasionally if a patient is put on triptans, or painkillers, and not told about the risks in using either or both frequently it can cause them to become more frequent.  This is likely why we end up switching medications all the time… to trick our brains.  Anyway, chronic migraines and chronic pain of any sort change the way the brain works and we become wired for pain… without any medications.  So with daily migraines being daily no matter what, then what difference does it make if one of the many treatments is painkillers?  But we do have to be careful with All our treatments, not to overuse them, any of them. Which is why pain management is such a massive issue when you are daily.

“f there were a magic bullet for migraine sufferers, physicians obviously wouldn’t be prescribing opioids and barbiturates at the current rate. “But the reality is that the conventional therapies create side effects that not everyone can tolerate; plus, no single medication or treatment works for every patient,” explains Saper. “For the most difficult cases, we might have to try 30 medicines, in different dosages and combinations, before finding something that is effective.”” 

Bingo.  It is not an easy problem and it does not have easy solutions.  Don’t lump everyone in the same damned category when some of us deal with a great deal of pain all the time and are a little sensitive when we are labelled drug seekers.  Not that I have ever had that problem per sa.  Most of my docs have been very reluctant to prescribe painkillers and it was only last year after more than a decade with chronic migraines I was put on a rescue med, likely because the emotional impact of the pain was becoming apparent and obviously simply tolerating it was becoming a problem.  Funny story: I once had an ER doctor review how many times I had been in the ER in the last few years and said that since I had few ER visits I was obviously not ‘seeking drugs’, to which I found sadly amusing because a) I don’t go to the ER unless I have had a status migraine for longer than seven days because they treat every migraine the same, and 90% of the time it is ineffective, but occasionally I feel desperate enough to try, and its still ineffective, b) going to the ER if I wanted opiate drugs would be idiotic since they always prescribe Toradol, which as I said, by that point is damned ineffective. As is, I live with more pain than I can actually treat.

““For many physicians, prescribing opioids seems like the easiest way to address a patient’s pain in the short term.” Or even the long term. “So many doctors put me on painkillers because they didn’t know what to do with me. I ended up on those drugs for 33 years and never improved,” says Stebbins, who has been narcotic free since her first stay at MHNI three years ago.”

I have found this to be exactly the opposite, so I don’t know who these doctors are. I was immediately put on triptans when I was diagnosed. Then preventatives… seemed longer than it should have been for that. And just recently 18 years in a rescue med.

90% of us with complicated migraines are doing all of the right things.  Often we learn the hard way, try several doctors to find one who has different options and do our own extensive research to figure things out.  Most of us use triptans, as much as we can, assuming we can.  Most of us have tried dozens and dozens of preventatives and continue to do so.  Some of us, eventually, get some sort of rescue med, even if it is T3’s, to help manage the pain when there is nothing else that cannot be done.  Most of us do not get any sort of rescue med.  Most of us juggle our medication as best we can and are wary of overusing them. (often learned the hard way as well. I had a doc who told me to take a triptan every single time I was getting a migraine, even if it was daily and that led to a brutal rebound headache. Thankfully, I did my own researching and learned that was not such a good idea).

This article ticks me off by saying opiate addiction in migraine sufferers is a bloody ‘epidemic’.  If anything most of us are undertreated until we find the right neuro.  Most of us are bloody well suicidal before we are offered a mild painkiller.  It just makes doctors that much more reluctant to prescribe them when they are needed, when clearly the message should not be that we are all drug addicts but that doctors are poorly trained to handle any migraine sufferer, let alone those of us with chronic migraines.  Must we always be the ones to suffer because of a doctor’s ignorance?  Apparently so.  I want them to write an article describing the effects of those of us who have been undertreated for migraines.  Those of us whose pain is not well managed.  I want them to write an article about the depression and suicide statistics when it comes to migraines… directly related to the lack of treatment by doctors and ER staff.  How many people have to die before that rates an article or anyone’s notice?

But no, it has to be that some people are being given opiates when they should not be and some people were not informed of the risks and some people were not regularly monitored in regards to their medication use because of their doctor’s ignorance.  Well, those people had doctors who sucked balls and obviously needed a little training.  And we have all had our share of such doctors.  I’ve had doctors say there was nothing that could be done for me.  That they had tried everything available… when I knew there were literally hundreds of preventatives to try.  I had one doctor tell me that she could not give me a painkiller for my status migraine, never mind that I did not ask for one, and suggested I ‘take a hot bath’.  I cried when a doctor told me there was nothing they could do… I thought I would never have any relief.  Not even the hope of it.  I changed doctors, found a good neuro and now I do have some hope I might find the right preventative.  So doctors that occasionally over-treat some patients because of laziness or ignorance does Not Even Compare to doctors who undertreat for the same reasons.  Those of us with chronic migraines sometimes Live only because we have some hope.  Don’t make them even more reluctant to consider all available options.  We need options.  We need hope.  Don’t take even that away from us.

Anway clearly this article should be called “Epidemic of ignorant doctors leads to migraine mismanagement”

See other posts

Chronic pain: don’t steal lives, doc

Pain awareness: the opiate issue

Chronic pain widespread in Canada

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