The Scary New Migraine Mistake

Millions of women are being prescribed pain relievers that they get addicted to—and that make their headaches more frequent.

By Peg Rosen
migraines medicine hammer mallet prescription drugs picture
Photograph: Dan Saelinger

“People with migraines are vulnerable to overreacting physiologically to a variety of triggers,” says Saper. The triggers can be generated externally (by a stressful event, for example) or internally (by hormones—migraines tend to strike around menstruation and during perimenopause). “It’s not the presence of estrogen that acts as a trigger but the fluctuation of it,” Saper notes. That explains why migraines often diminish or even abate after menopause, when sex hormone levels take a dive.

Dilated blood vessels, long suspected to be the cause of migraine pain, are now seen as just part of a cascade of events that include, among other changes, inflammation of brain tissue and shifts in levels of the pain-regulating neurotransmitter serotonin. “Pulsating blood vessels irritate the inflamed tissue around them, and this contributes to the pain,” says Saper.

A variety of drugs are available to relieve this misery. Most, including narcotics and barbiturates, are taken on an as-needed basis to stop a headache that has already begun. Triptans, which have been heralded as a migraine breakthrough, work best at the onset of an attack; they provide relief by reducing blood vessel inflammation. Other drugs are preventives that are prescribed for daily use. For instance, older tricyclic antidepressants that affect levels of serotonin and norepinephrine, such as amitriptyline, may lower the frequency of migraine episodes. Antiseizure drugs like Topamax also reduce recurrences for some sufferers. Last year the FDA approved a novel treatment: Botox injections around the head and neck. These have been shown to help with certain types of migraines, possibly because they block pain receptors or reduce inflammation.

WHEN MOST REMEDIES DON’T WORK
Many patients are able to effectively reduce pain through these conventional therapies. But about 10 to 25 percent of chronic-headache sufferers (of all kinds) don’t find relief. Overwhelming migraine pain is responsible for more than a million patient visits to hospital emergency rooms each year.

Recurring migraines can take a huge toll on sufferers’ lives. “I have never known what it is like not to have a headache,” says Jeanne Stebbins of DeForest, Wisconsin. Decades on painkillers and ever-worsening attacks led her to leave her longtime job as a legal secretary and file for disability. Shawn King believes that her use of migraine painkillers endangered her life. By the time she entered treatment in 2008, she was taking up to 20 Vicodin a day, and a physician sometimes went to King’s home to inject her with morphine. “I could easily have died,” the singer says.

Kathleen Cresong, who works for a payroll company near Philadelphia, believes that brutal migraines prevented her from attending college and contributed to the dissolution of her first marriage. “I was and am still willing to do anything to stop the pain,” she says. Now 50, Cresong had her ovaries and uterus removed at 33 in an unsuccessful attempt to stop her headaches by ending her production of sex hormones. She finally found relief last summer after undergoing an experimental procedure that involved implanting an electronic device at the base of her skull.

THE PAINKILLER PARADOX
Compared with such extreme measures, swallowing a Vicodin or Percocet can seem like a relatively tame way for migraine sufferers to escape the hell of an attack. “Patients essentially trade debilitating sedation for debilitating pain, but it’s not a ridiculous choice to make, considering how severe the pain can be,” says Richard B. Lipton, MD, director of the Montefiore Headache Center in New York City.
For people who experience only a few episodes a year and get insufficient relief from other pain medications, powerful opioids and barbiturates can be a relatively low-risk and effective treatment option. 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.

First Published October 10, 2011

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Comments

Ewizobeth Noyb07.14.2013

Wow, it's articles like this that have turned an already hostile environment for Migraineurs into a combat zone. By pigeon-hole Migraineurs along with street addicts and criminals, you have given the already insensitive, contemptuous doctor justification for moral outrage. In other words, the migraine is blamed on the Migraineur.
In medical settings, the Migraineur, already at high risk of stroke or aneurysm, is further endangered by the abusive treatment of angry doctors. In fact, imagine a ticker tape registering each unfortunate Migraineur's death caused, in part, by this bombastic article. Did you know that in the U.S. more people die each year from migraine strokes, than are killed by handguns? Picture the gunshot victim being wheeled into the ER at the top of the triage list, while somewhere in a dark back room, the lowly Migraineur sits, quaking with fear as to what comes next.
I have used morphine at home for twenty years, never needing any increase in my prescription. Recently, I have changed pain clinics, and during the interim, I stopped using morphine without tapering. I wanted to experience withdrawal full force, so I could find out what I'm dealing with.
After four days, I began wondering when the withdrawal suffering would begin. It just never happened. No physical withdrawal, no psychological withdrawal, and no change in my mental state. I had always asked my husband if he could tell when I was using morphine, and his answer was always no. But any time I use Ambien, he knows within five minutes. He says “you just took Ambien, didn't you?”
Right after discontinuing morphine, my dad was gravely ill and placed in hospice. My family took shifts 24 hours a day so that he would never be alone. This was a highly stressful situation in which a narcotics addict would be scrambling for any drug to self-medicate against the intense emotions. It never crossed my mind, except to wonder why it wasn't happening. I was fully present for my dad, and I experienced the entire spectrum of emotions from sadness to joy, without pulling away.
But before you do the Snoopy dance because I stopped using narcotics, I need to let you know that discontinuing morphine was a total disaster. I knew I was in trouble when my visual migraines returned after a 20 year absence. Since then, I've had my first seven day migraine (that's seven days in bed). The left side of my head got covered in welts. My migraines spun out of control. But at least I know I'm not such an idiot as to become a drug addict. They say that addicts have a black hole inside that can never be filled. I'm not like that. The most common nickname people give me is “Smiley”.
MAGNUM (Migraine Awareness Group for National Understanding for Migraineurs) has an excellent article about the true nature of Migraine at http://www.migraines.org/myth/mythreal.htm that you should read. Basically, all five senses are amplified in Migraineurs. Using myself as an example:. TOUCH: when I was a child, my family called me “Princess and the Pea”, because they were certain I would feel a pea under 18 mattresses. HEARING: I tell people that I have “radar” ears to explain why pick up on every conversation near me. TASTE: while the family enjoys a delicious meal, all I can taste is freezer burn that no one else notices. SMELL: I always smell things that no one else does, or I smell things first, like burning leaves in a neighbor's yard. Migraine is a genetically inherited disease, not a headache. It involves the entire body, not just inflammation of the head region.
Ever since I read the MAGNUM article, I've had one “aha” moment after another. Finally, a credible breakthrough in the understanding of migraine.
I've had to go to the ER a few times recently, and conditions have deteriorated during my 20 year absence. I can only describe the current conditions as barbaric. The doctors are barbarians. I didn't think I would have ever have a use for the word “barbaric”. Never say never. The situation is dire and dangerous for Migraineurs.
And into the mix comes your article. I'm sure your colleagues are all patting you on the back for your “insights”. You are like every other interloper. You are on the outside, looking in. You are building your own reputation on the backs of people who are already stigmatized and abused. And don't say you have migraines, because you have never had my migraines. With friends like you, Migraineurs don't need enemies.
By the way, I bookmarked your article under bullsh*t.

Gillean McLeod09.24.2012

Last year, after five days straight of the scariest migraine ever, I was driven to the emergency room of a local hospital in Los Angeles. I was given an iv for fluid, and into
that the er doc. put a dose of benadryl. It took four hours for the headache to wear off.
He claimed that this particular hospital treats migraines as an allergy. From that
day forth I have had no alcohol, no gluten, no wheat, very little dairy and the headaches that have plagued me for 45 years are virtually gone. Of course hormones must play a large part in the disappearance of the weekly headaches, but I feel like a new person. So glad that I no longer have to take any medication.

Teri Robert08.26.2012

The basic premise of your article, stated under the title - "Millions of women are being prescribed pain relievers that they get addicted to—and that make their headaches more frequent. - IS FLAWED.
Medication overuse IS NOT ADDICTION. What's more, medication overuse headache (MOH) can occur if we use pretty much any type of medication to treat a Migraine more than two or three days a week - opioids; triptans such as Maxalt, Imitrex, Zomig, etc.; simple analgesics such as acetaminophen; NSAIDs such as ibuprofen or aspirin; anything. We're caught between a rock and a hard place.
Migraines are already very misunderstood and surrounded by stigma. If you're going to write about Migraine, be responsible, and get it right instead of adding to our problems.
Teri Robert
Migraineur, patient educator and advocate

M.K. Hajdin01.27.2012

Yet another scare story that would have us believe that opiates are evil and turn all migraineurs into drug addicts.
The stigma of "drug addict" or "drug seeker" is all-powerful in our society. Why? Drug addicts are scapegoats, viewed as lazy, weak, irresponsible, sociopathic. Nobody wants to get tarred with THAT brush. Nobody asks why we need to scapegoat people in the first place.
Opiates work well for many migraineurs. But they're being increasingly restricted and rationed - hoarded for the wealthy, who can get whatever they want with no questions asked. The poor had better content themselves with triptans and NSAIDs, if they even get that much, if their pain is even believed at all.
Stories like this only rationalize and justify anti-opiate paranoia. Even if a frequent migraineur develops a tolerance to opiates, tolerance is not addiction. And in cases of very frequent debilitating migraines, it would be better to have an addiction than constant uncontrolled pain. This is of course, anathema to our puritanical nation, who hate and despise drug addicts more than anything. We should try the U.K. model of harm reduction rather than deprive suffering people of cheap and effective medicine that works.

Jennifer Nelson10.26.2011

Headaches are troublesome enough; but when it gets to the point that you become addicted to your pain meds, you've added additional trouble in exchange for only temporary relief. This is such a great article, particularly because it shows how important it is for doctors to have the right training to treat headache sufferers. I know it is difficult when patients have many different triggers and reactions to medications, but that is why, right now, it is important for patients to go to a headache specialist. Once primary care physicians become better trained in headache and migraine, I hope that patients will be able to go to them for questions, but this is something that is so lightly covered in medical school. I recently read a great article on Headwise.com about when it is time to go to see a specialist (see http://www.headachemag.org/Articles/Lifestyle/The-Benefits-of-Seeing-a-H...).

Deborah 10.20.2011

Thank you for this article. I discovered/realized my husband's addiction to his migraine medication seven years ago. He's been free of pain meds now (specifically ultram/tramadol -- which he was prescribed by a well-known pain clinic back in 1997) for almost four years.
I started blogging about it this year and have found that we are far from alone...and your article is further evidence that this silent epidemic has been going on unnoticed and unheeded far too long. Sad to me that this is "new" when for too many migraine sufferers, it's been going on for decades.
My blog is enduringandafter.com. Maybe some who read this article will find encouragement from our story.
By the way, my husband has had MAYBE three migraines in the past four years -- ever since he came clean from the drugs. Prior to that, migraines were at minimum, a weekly occurrence.
Also, some of these drugs, like Tramadol, are dangerous to get off cold-turkey. Finding the right doctor or clinic to help you do so is critical. We know from far too much experience.

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