Physicians are also inclined to prescribe opioids and barbiturates because there is less red tape involved. “Triptans are expensive [$24 to $124 per dose], and many insurance plans limit accessibility to them,” says Christina Peterson, MD, medical director of the Oregon Headache Clinic in Clackamas. “Tylenol with codeine, on the other hand, costs just pennies per pill. It’s easy to prescribe because the insurance industry promotes the use of anything that’s inexpensive.”

Concludes Lipton: “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.

THE WITHDRAWAL BONUS
Overcoming an opiate or barbiturate dependency does not necessarily cure the migraines responsible for the problem, but it almost always helps. Within days of Linda’s withdrawal from opioids at MHNI’s inpatient branch, for instance, her headaches went from occurring daily to a few times a week. “I was shocked and angry when Dr. Saper told me that the drug itself may have been making my headaches more frequent,” says Linda, who is working with the Michigan facility to identify an alternative regimen that can keep her condition in check.

For Stebbins, a second trip to MHNI provided a big boost. “Before I came, I was getting bad migraines four or five days a week. Now I get a bad one once a week. I love the days when I have no headaches,” she reports. King benefited from both detox and changes in her hormones. “I was approaching menopause around the time I left rehab, so I’m sure both of those factors contributed to my getting better,” she says. “These days I’ll have an occasional migraine. But they’re nothing like the violent ones I used to get. Most of the time, a frozen gel pack on the back of my neck helps relieve the pain.”

AVOIDING ADDICTION
Managing migraines effectively demands exceptional patience, commitment and drive—not just from physicians but also from patients themselves. “Research has shown that headache patients who are proactive have better outcomes, probably because they feel they have more control over their lives,” says Alvin Lake, PhD, director of behavioral medicine at MHNI. One way to gain more control is to experiment with mind-body practices such as biofeedback, relaxation and meditation, which have been found in numerous studies to significantly reduce the frequency and intensity of migraine attacks. Stebbins, for instance, has been experiencing some relief after hypnotherapy sessions with a psychiatrist.

It is always important to find the right doctor, but with migraines it is crucial. Certified headache specialists are likely to be up to date, but they can be hard to find. Here’s how to get the best treatment from whatever doctor you consult, whether a family practitioner, internist, neurologist, pain specialist or headache specialist.

KEEP A HEADACHE DIARY “Not only does it help you determine how frequently your headaches are occurring, but you may also see what is setting them off,” says Carolyn Bernstein, MD, assistant professor of neurology at Harvard Medical School. There is a free iHeadache app (or pay $9.99 if you want to avoid ads) for iPhone and BlackBerry users.

SEE YOUR DOCTOR REGULARLY AND OFTEN Having frequent headaches? Then your doctor should ask to see you every two to four weeks to learn how you are progressing. “If you are told to come back in three or six months, that raises big questions about how interested your doctor is in treating your problem,” says Frederick G. Freitag, DO, medical director of the Comprehensive Headache Center at Baylor University Medical Center in Dallas.