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"Opiates and Migraines"

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bluecar007 Click to EMail bluecar007Click to check IP address of the poster Jun-01-07, 10:22 AM (CMT)
"Opiates and Migraines"
Has anyone here had success with Opiates as Migraine and CDH relief for a sustained period of time? Without going into the gory details on how I got here, I have had zero success with preventitives (tried them all with no success and/or very bad side effects) and no success with knowing my "triggers".

Have also tried Botox, heart mammogram for "holes", hypnosis, the "Imitrix's" etc, etc....

Hydrocodone dulls my headache, however also "dulls" me. If I take it more than a few times a week, the "hangover" effect the next day is rough and eventually I end up on a daily dose with rebound headaches as well as the Migraines. I have gone off Opiates multiple times in the last 4 years for weeks to see if any new preventives will work, however the intensity of the Migraine will force me back.

There seems to be mixed reception to using Opiates for Migraines in the Neurology community.

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 Table of contents

RE: Opiates and Migraines, sailing muffin, Jun-01-07, (1)
RE: Opiates and Migraines, Ewokn8r, Jun-01-07, (2)
Pain Management, LTAYLOR, Jun-02-07, (3)
RE: Opiates and Migraines, dreamweaver, Jun-02-07, (4)
RE: Opiates and Migraines, enigma, Jun-02-07, (5)
RE: Opiates and Migraines, Sandy L, Jun-02-07, (6)
RE: Opiates and Migraines, Stef, Jun-03-07, (7)
RE: Opiates and Migraines, bluecar007, Jun-03-07, (8)
RE: Opiates and Migraines, janetc, Jun-13-07, (9)
RE: Opiates and Migraines, charmed quark, Jun-14-07, (10)
RE: Opiates and Migraines, LTAYLOR, Jun-14-07, (11)
RE: Opiates and Migraines, juneleaves, Jun-15-07, (12)
RE: Opiates and Migraines, joanie234, Jun-15-07, (13)

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sailing muffin Click to EMail sailing muffinClick to view user profileClick to check IP address of the poster Jun-01-07, 12:14 PM (CMT)
1. "RE: Opiates and Migraines"
Hi,

The use of opiates in migraine control has always been somewhat controversial. I have had chronic intractible migraine/new daily persistent headache since age 17, I am now 26. For the first five years, I was able to get by with Tylenol 3 or something for pain.
Eventually, (about 5 years ago) the pain got so bad that my neurologist decided to try using some pain control medications along with preventive medications.

My neurologist is very understanding and has been willing to treat the pain aggressivey, and also allowed me to try several different forms of long acting pain medications. It took awhile to get find the right one, but I finally did. l I have had very good luck with MSContin- a long acting form of morphine. So I have had pretty good results.

There is a balance between treating the pain and dealing with the headache. If you are having headaches all the time you might want to talk to your neuro about how to manage the pain more effectively without getting rebounds. The other option might be to try a medication that does not have tylenol or aspirin in it- such as oxycodone.

iI would definitely talk to your about all of this, as there is that balance. It appears that you may need something for pain, but not something that would cause bad rebounds. Also, your neuro may want you to talk to a pain dr/manager, which could also help you figure out what works best for you.

One of the problems is that everyone is so different. Also some neurologists are willing to treat pain aggressively and some just aren't.

Others here will also be able to add their input.

Pain free days,
sailingm

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Ewokn8r Click to EMail Ewokn8rClick to check IP address of the poster Jun-01-07, 09:43 PM (CMT)
2. "RE: Opiates and Migraines"
LAST EDITED ON Jun-01-07 AT 09:50 PM (CMT)

Hello,

I had tried preventatives from A-Z for the last 14yrs and none of them helped so I decided to talk to my Pain Dr about opiads. I've been on opiads since March for CDH which is helping very much. I only had to increase the dosage once to get the pain down to 1-2. As for the migraines I would say that they're less severe and had only one bad M for a few days in the month of May. I still get the 3-4 migraines a wk but am not in bed all day only take a 2-3hr nap and I'm pretty good for the rest of the day/night.

Yvonne

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LTAYLOR Click to EMail LTAYLORClick to view user profileClick to check IP address of the poster Jun-02-07, 00:13 AM (CMT)
3. "Pain Management"
If this is a route you think will help or that you need to pursue I would recommend seeking out a good Pain Management Doctor. Try to find an Anesthesiologist who now specializes in Pain Management - they seem to have a much better knowledge of meds available and dosing info. good luck - Peace, L
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dreamweaver Click to EMail dreamweaverClick to view user profileClick to check IP address of the poster Jun-02-07, 08:51 AM (CMT)
4. "RE: Opiates and Migraines"
Hi Blue...

I have had migraines since I was a child. I am now 56. They eventually developed into chronic transformed migraines, meaning I now have combination tension migraine headaches. It's horrible because they play off each other. I have never taken opiods for them.

However, these past four years, I developed a problem with chronic pain, used vicodin for quite a while, then eventually had to go to a pain clinic and have been using narcotics for about a year now. I started with oxycontin and after a few months they switched me to low dose methadone.

Let me tell you... not one of those pain meds did squat for my migraines, in fact some mild pain meds prescribed for me during my early migraine years made my migraines worse!

I assume the narcotics are treating part of your pain syndrome. I guess that is something, if it makes your life livable for the trade-off of having to use narcotics and being managed the rest of your life on them.

I hope within the next year or so I can wean from my narcotic use... However, I'm afraid chronic pain may be with me for the rest of my life. It's just too bad, the meds for that doesn't help with the pain of my migraine.

P.S. - I do get botox injections which help a lot to lessen the severity and intensity of my migs. However, it took me 3 sessions over a six month period before I saw results. Don't expect one session to show results. Even the third one only gave me results for a few weeks. Each session, it lasted longer and longer. I have gotten them for 5 years now. Insurance quit paying for them, so I had to spread them over a 4 month intervals instead of 3. 3 month intervals worked great - 4 is OK - better than nothing... As you probably know, migraine sufferers will take any relief we can get. Most don't get complete elimination of migraines, just a few days a month to live w/o pain is joyous to me !!

I hope you find some relief soon. It takes time, don't dispair - hang in there !!


Through our pain we grow and learn compassion for others... I have to accept this as a positive thing, otherwise our pain is for naught.

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enigma Click to EMail enigmaClick to check IP address of the poster Jun-02-07, 10:59 AM (CMT)
5. "RE: Opiates and Migraines"
Opiates work well for a lot of people with migraines. I believe the short acting meds should only be used for three days in a row because of rebound. This includes fioricet as it is known to cause rebound and I will rebound from it on the third day no if's and's or but's.(even though fioricet is a barbituate and not a narcotic)

I think there is so much controversy about opoids and migrains that docs are afraid to prescribe narcotics to us migrainers and that sucks because when I ask for narcotics I'm treated like a drug addict.

Anyway, my ideal way to combine narcotics with migraines would be the long acting meds, not the short acting. Docs know about rebound but keep us on meds that will rebound us when instead they should just put us on long acting pain meds for those of us with chronic pain.

That's just my input on the subject but everyone's different.

Around here (Indiana) it is very hard to find a doc that will give you a long acting narcotic for migraines.....heck, it's hard to even get a short acting narcotic.

Laura

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Sandy L Click to EMail Sandy LClick to check IP address of the poster Jun-02-07, 07:49 PM (CMT)
6. "RE: Opiates and Migraines"
Opiates are generally very much third line drugs for treating migraine; they make it more bearable, but don't stop it, whereas WHEN THEY WORK, which sadly is not always, triptans can pretty well shut the headache down. If the triptans do not reliably abort the headache, and especially if the headaches are long enough or severe enough to warrant taking something daily to decrease the frequency and/or severity, preventive measures (not just prescription medicines) are second line. If triptans are contraindicated or don't work, you are left with opiates or opioids. The last patient I gave opiates to had basilar symptoms. The prescribed medicine (OxyContin, because her headaches lasted for three days at about the time of her period) seemed to work well for a while, then I lost track of her for a while until the local police came to talk to me about prescriptions she had forged.

Drug abuse is a problem that hurts a lot of people besides the abusers. Migraine diagnosis is based almost entirely on the history. Addicts get very good at learning the natural history of the disease they claim. I still prescribe opiates for a variety of conditions, but I've had to become a control freak to protect myself from predation.

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Stef Click to EMail StefClick to check IP address of the poster Jun-03-07, 01:33 AM (CMT)
7. "RE: Opiates and Migraines"
I despise taking any type of opiates for migraines. Sure, at the time they take away the pain but the next day when I have that hangover effect and the migraine comes back.

What I have found that works best for me (when I have to get seen in the ER) is a combo of Toradol, Decadron and Reglan.

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bluecar007 Click to EMail bluecar007Click to check IP address of the poster Jun-03-07, 02:21 PM (CMT)
8. "RE: Opiates and Migraines"
Sandy,

Unfortunately, as I research the issue of pain management, your example of the wrong folks abusing the system seems to be more common than we, as a society, would like. That said, there are many that may not get appropiate help because of the "physician getting burned" factor. Kudos for your example.

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janetc Click to EMail janetcClick to view user profileClick to check IP address of the poster Jun-13-07, 09:32 PM (CMT)
9. "RE: Opiates and Migraines"
I suffer with classic migraine with aura and familial hemiplegic migraine. FHM excludes me from taking ANY and ALL migraine specific abortive drugs such as triptans, ergots, etc... I have tried and been on every preventative med you could think of and currently trying 150mg Topamax twice a day and 30 mg Cymbalta twice a day to see if they help any with preventing or at least lessening the migraines.

I have tried all the non-narcotic abortive meds that I can take like magnesium infusion, decedron infusion, oral prednisone, feverfew, butterbur, etc.... None worked!

So that leaves me with - Narcotics.

Currently I can take:

1 percocet 5/325mg tab every 8 hours 1 day per week as needed for migraine.

100mcg Fentanyl intravenous push and 25mg Phenergan piggyback intravenous drip once per calendar week (Sunday thru Saturday) as needed for migraine.

I also have oral Phenergan at home to take for the nausea and Ambien to take to help get me to sleep when I have a migraine.

But to get this all set up took a long time and effort and talking with the docs -- they really have to trust you and to actually WANT to help you before they will do anything. It's a struggle and it's never easy but if you end up with some relief from a migraine I think it's worth it in the end.

Good Luck!

Janet

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charmed quark Click to EMail charmed quarkClick to check IP address of the poster Jun-14-07, 08:21 AM (CMT)
10. "RE: Opiates and Migraines"
I think everybody is different on this one. I have heard of people who have gotten very good pain relief using long-duration opiates like Methadone or patches.

I've never tried them long term. The problem I have is that they make me nauseous. Since I'm already horribly nauseated with a migraine, this seems like a bad side effect. So they give me a drug to deal with the nausea and another to deal with the constipation from the opiates. It seems like a downward spiral to me. Plus I feel really hung over the next day. But this is probably less of a problem with long acting drugs.

I'm sure if my pain was worst I would have a different opinion toward opiates!

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LTAYLOR Click to EMail LTAYLORClick to view user profileClick to check IP address of the poster Jun-14-07, 05:19 PM (CMT)
11. "RE: Opiates and Migraines"
I forgot to add that i have had very good long term success going on several years now with morphine. It acts as a vasoconstrictor but not as constricting as the triptans I guess because I cannot use those. However, everyone is different and what works for me may not work for someone else. It is all trial and error. Peace, L
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juneleaves Click to EMail juneleavesClick to check IP address of the poster Jun-15-07, 04:28 PM (CMT)
12. "RE: Opiates and Migraines"
I have had excellent success with a dilaudid suppository. I am used to it, so I function reasonably well on it. Though sometimes for the real screamers, it is only partially effective. Most of the time I cut it in half and take with phenergan to prevent nausea.

I also use a triptan which is about 50% effective. When it (zomig) does work, it is great, when it doesn't work, it can be disastrous and send my headache off the charts with vomiting and insane pain. Lately I have been using more dilaudid than I would like, which makes me nervous. Almost one suppository daily, though my overall pain at this time of the year is always much worse compounded by allergies and thunderstorms. Dilaudid is very helpful, but can make me feel somewhat stunted.

Up until a few years ago I was getting to be non-functional because of migraines and fibromyalgia pain. I am a high functioning photographer at an ivy-league university and was beginning to think that my life was over at age 33. Opiates have given me my life back. The trade off is possible dependence, but I'll deal with that should it occur. I've been using dilaudid successfully for three years now, though not usually daily, just for the menstrual migraines and mid month ones that sporadicly hit.

I don't think that there is a cut and dry answer. Every doctor has a specific approach. Using narcotics was a last resort after many years of trying everything under the sun.
good luck.

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joanie234 Click to EMail joanie234Click to check IP address of the poster Jun-15-07, 07:11 PM (CMT)
13. "RE: Opiates and Migraines"
Did you try a high enough dosage of Imitrex? Because when I first started using it, they put me on 50 mg and it did NOT work. I thought it was useless and didn't try it again, until a few yrs later-- the doc said why don't you try 100mg and I have been on it for almost years.

I have no success with any pain medication BESIDES fioricet with ASPIRIN, (NOT acetaminophen)... It is a tranquilizer mixed with caffiene, codiene, and ASPIRIN. I tried the one w/acetaminophen and it didn't help AT ALL. I have tried many medications and this is the only one that worked for me. Davocet-D did okay for me--because it has ASPIRIN in it. Vicodin is mixed with acetaminophen, too..which is worthless in my opinion.

Good luck!

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