ON A LATE afternoon in April at the Head Pain Treatment Unit of Chelsea Community Hospital in Michigan, everything feels muted—window shades are drawn, and patients are speaking just above a whisper. Linda, a migraine sufferer who does not want to reveal her last name, is on day four of her detox treatment and is feeling nauseated. Wearing an elegant maroon and orange shawl, Linda describes her previous night to a group of doctors, nurses and psychologists: “My legs were twisting and jumping so much, there was no way I could sleep. I was miserable.”
Like 70 percent of the patients at this headache-treatment center of last resort, Linda is under medical supervision while she withdraws from addictive painkillers that were prescribed to quell her debilitating headaches. Ironically, when her neurologist back home recommended she take powerful opioids for her daily migraines, Linda, who sells real estate for a living, was reluctant. “I did my research and read about how quickly you can become dependent,” she says. “I told my doctor how worried I was, but he basically said there was nothing else that could help me. And here I am, nine months later, physically dependent on a drug I never wanted to be on in the first place.”
Most other headache sufferers don’t choose to be addicts either—but an estimated one in five migraine patients is prescribed opioids such as OxyContin, Vicodin and Percocet, and barbiturates such as Fioricet; almost 20 percent of the opioids prescribed in this country are dispensed to relieve the pain of migraines and headaches, according to a study of medical-insurance claims published in 2009. 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.
As the number of prescriptions for potentially addictive painkillers soars in this country, experts predict the dependency problem will only grow worse. “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. Every now and then we hear about breakthroughs in migraine treatment, such as the development of a group of drugs called triptans—so why are so many doctors prescribing narcotics? The answer says a lot about the nature of migraines and the American medical system.
A MEDICINE CABINET OF SOLUTIONS
Headaches come in many forms (see “Name That Headache,” at the end of this article), but when sufferers end up with a painkiller problem, it’s almost always because they are among the 30 million Americans struggling with migraines. Women are three times as likely as men to experience this particular kind of headache, which produces a debilitating pain that Shawn King, singer, businesswoman and wife of television personality Larry King, likens to having “an ice pick in my head.” But pain is only part of the package. Migraines are complex conditions that can also produce extreme nausea, pain at the slightest touch and an acute sensitivity to light. “Migraine symptoms can incapacitate a person for hours or days at a time,” notes Cathy Glaser, cofounder and president of the Migraine Research Foundation in New York City.