Breaking medication overuse
I’ve had migraine my whole life. From the very first attack, frequency remained consistent at 10-12 attacks every month. When I was sixteen, my parents thought I was old enough to begin managing my own acute symptoms. We didn’t have much to work with — just aspirin and Advil. The idea of preventive therapy or more aggressive abortives wouldn’t be introduced for at least five more years. I had learned enough to know that I needed to treat an attack at the first sign of trouble. So I did just that.
Nobody knew about the risks medication overuse.
I’m sure there were researchers at some university hospital somewhere who were starting to figure out the dangers. But nobody in my little backwoods town had ever heard of it. The doctors in my town still thought that migraine was caused by emotional problems. So did the therapists, dentists, teachers, and anyone who dealt with kids. Naturally, I made a point to hide my symptoms as much as possible.
That meant taking a lot of Advil.
I took 4-6 200 mg coated tablets every time I felt that warning twinge that a migraine attack was on its way. I was determined to never let anyone see me in pain or to let migraine be the reason I missed any activity. In a short while, I needed more and more doses to keep those twinges at bay. Sometimes I couldn’t stop an attack no matter how many pills I took. It wasn’t long before I was taking 800-1000 mg of Advil nearly every day. Without proper treatment, I took matters into my own hands and it backfired.
It stayed like that for years.
I got a brief respite while pregnant only to discover they had returned with a vengeance just after my daughter’s first birthday. I didn’t know it at the time, but I am sure that my doctor’s prohibition against taking anything stronger than Tylenol broke my very first episode of medication overuse headache. It didn’t last long though. With no other available treatment options, I went right back to taking Advil nearly every day.
I heard there was hope.
A professor heard about my troubles with migraine and gave me copies of published studies about a new drug called Imitrex. It had just arrived on the market and was contraindicated for pregnancy & breastfeeding. So I waited as long as I could, fighting my way through daily pain and twice weekly vomiting sessions. I had insurance, but couldn’t use it to get treatment for migraine for 6 months because it was a pre-existing condition. I marked the date on the calendar and counted down each pain-filled day until I was finally free to schedule that first appointment. I’d had plenty of time to do my research, so I knew exactly who to call. I arrived early, fully expecting to leave the office with a prescription.
Not so fast!
I was escorted to a conference room with natural lighting and quiet music. After completing a mountain of paperwork, a nurse walked me through the finer points of trigger identification and keeping a headache diary. The doctor gave me a thorough neurological work-up, including ordering an MRI. Then we had a rather one-sided conversation about medication overuse headache. His approach was gentle and non-judgmental. He explained that this happens to a lot of patients, and doesn’t mean addiction. He also made it clear that we wouldn’t be discussing any new abortive treatments until I broke the medication overuse headaches by quitting Advil “cold-turkey”. He assured me calmly that the attacks would get worse and more frequent for a few weeks and that it could take 8-12 weeks to fully break the cycle.
I broke down.
Tears streaming down my cheeks, I begged him to explain how I was going to work or take care of my daughter in that kind of pain. I swore I’d never touch another bottle of Advil if he would, please, just give me some of that new Imitrex.
He gently insisted that I work on breaking the habitual use of Advil while we waited for the test results. I left the office with a fist full of instructions, an appointment for an MRI, and the after-hours number to call if my pain got out of control.
I only remember using that number once.
To my surprise, it was the doctor who called back with a prescription for a small dose of ketoprofen to break the pain. It worked so well, that when an over-the-counter version became available, I used it sparingly as an add-on therapy to the Imitrex he would eventually prescribe.
His compassion that day convinced me to try even harder to keep a detailed headache diary. By the time we met again in 90 days, he was pleased to see my attack frequency back down to its baseline. Finally, after almost 10 years, I was getting less than a dozen attacks each month. I felt like a new person. It got even better when he agreed it was time to try Imitrex.
I never again faced medication overuse headache.
No one had to tell me twice. It was too painful to break. Over the years I have questioned many doctors about the risks of medication overuse headache from one drug class after another. Gradually the warnings got stronger and the number of medications on the list grew to include every single class of pain reliever, including triptans. Each time, I tightened my personal limits and learned to make do with fewer and fewer pain relievers.
Currently there is no class of pain medicine that is risk-free.
Everything from Tylenol to Oxycontin can cause medication overuse headache and the monthly upper safe limits keep shrinking. As few as 10 days of use per month of some medications can induce medication overuse headache. These headaches are as frequent as chronic migraine (15 or more headache days per month) but generally resolve after discontinuing the use of the triggering medication. Patients may or may not be able to reintroduce this medication in the future. Some patients may take months to return to baseline headache frequency as medication overuse headache causes long-term changes in the brain.
This is why I am so militantly opposed to taking any combination of pain medicines more than 2-3 times per week. If a bottle of Advil could do it to me, then it could happen to anyone.