Can you afford to put life on hold?

No? I didn’t think so. Neither can I, but migraine attacks to cause me to push the “pause button” on life from time to time.

Let me tell you what it costs when migraine puts my life on hold:

• I can’t prepare healthy meals for my family.
• I can’t complete routine household chores like washing dishes, doing laundry, or sweeping the floor.
• I can’t monitor our finances.
• I can’t shop for our needs.
• I certainly can’t work and earn a paycheck.

Some people might say, “Well if you’d just stop taking so many medicines all the time your headaches would go away.”

Really? Maybe “some people” can keep their mouths shut since they know absolutely nothing about how frequently I take medication. All they see are the three times a day that I take preventive prescription medication and vitamins that actually do prevent most attacks. FYI – I never take acute medication more than 2-3 times a week without my doctor’s orders. In fact, lately it’s been more like once or twice a week.

That’s great news, but it still doesn’t stop migraine from putting my life on hold at least once a week.

There’s this commercial that’s really starting to irritate me. If you’re still reading this, take a guess. Yes, it’s that blasted Excedrin Migraine commercial — the one for people “who can’t afford to put life on hold because of a migraine.” It’s a nice sentiment, but it’s commercials like this one that set people up for a dangerous medical condition called Medication Overuse Headache.

When you’re busy with life and those familiar signs of an impending migraine start to creep up it’s easy to think, “Oh, I can’t afford to get a migraine now!” So you remember that little commercial and reach for a couple of Excedrin to knock it out.

(FYI – most migraineurs do not experience relief from Excedrin. Many would have better luck with a handful of M&Ms or a Tic-Tac.)

Medication Overuse Headache (MOH) is a serious complication of migraine characterized by migraine-like pain or tension headaches that go away when acute medication is taken and returns as soon as the medicine wears off. Over time the medicines lose their effectiveness and the temptation can be to take more and more of it. This isn’t the same as addiction. This is a situation where pain relievers actually make a patient experience more intense pain, more frequently. The solution is to stop taking the medication. But that is a lot easier said than done when you are in excruciating pain. MOH is best resolved under a doctor’s supervision.

Any combination of pain relievers can set off MOH when used more than 2 or 3 times a week for more than 3 consecutive months. If you’ve been taking anything for migraine relief with that frequency and for that long, it’s time to see your doctor. It doesn’t matter if you are “just taking aspirin” or “don’t use narcotics”, you can still get MOH from:

Analgesics – The most common is Tylenol. The active ingredient is acetaminophen. Read your labels as this is a common ingredient in a lot of OTC pain relievers, cold medicines, and sleep aids. It is even present in pain patches and arthritis creams. An older migraine abortive, Midrin, falls into this category as it contains acetaminophen, isomethepetene, and dichloralphenazone

NSAIDs – The most common are aspirin and Advil (ibuprofen). Aleve (naproxen sodium) is also an NSAID. NSAIDs such as Toradol (ketorolac) are sometimes used intravenously to abort intractable pain. A new migraine abortive, Cambia, is also an NSAID.

Triptans – These are the most commonly used migraine abortives. It was once thought that triptans did not contribute to MOH. Now doctors are urging caution with their frequent use, asking patients to limit use to no more than twice a week. Triptans include: Imitrex (sumatriptan), Amerge (naratriptan), Axert (almotriptan), Maxalt (rizatriptan), Relpax (elatriptan), Frova (frovatriptan), Zomig (zolmitriptan), Treximet (combination of Imitrex and Aleve).

Ergotamines — These are older medications that have a history of use for acute migraine treatment. They are still used in some cases for patient who cannot tolerate triptans or for those whom triptans have no effect. DHE (dihydroergotamine mesylate) is the most commonly prescribed ergotamine. It is prescribed under the name Migranal. Sometimes ergotamines are combined with caffeine, as in Cafergot and Migragot.

Caffeine – While technically not a medication, caffeine does have drug-like properties and is addictive. In small quantities and for limited use it can sometimes help abort a migraine. However, daily use of high doses is not recommended because of the risk of caffeine-induced headaches which can resemble migraines. Sudden discontinuation of caffeine can trigger caffeine-induced withdrawal which often includes headache.

Narcotics & Opioids – These are very strong painkillers used most often as anesthesia during surgery. They are often prescribed for pain management post-surgery or after a severe injury. Sometimes they are combined with acetaminophen. These medications can lead to a condition known at central sensitization in which pain receptors become hypersensitive, causing the patient to experience widespread, worsening pain. Examples include: codeine, fentanyl, hydrocodone (Lortab, Lorcet, Norco, Vicodin), hydromorphone (Dilaudid), myperidine (Demerol), methadone, morphine, oxycodone (Oxycontin, Percocet)…or any combination of the above!

MOH is not the same a chronic migraine. Some patients may think they have chronic migraine when they are actually experiencing MOH. That’s why it’s so important to consult a headache specialist who can work with you to determine the kind of headache you are experiencing and help you manage it.

For more information about the risks of MOH, please visit these pages:
International Headache Society – Medication Overuse HeadacheHelp! How can I not overuse migraine medications
Painkillers may be making a million headaches worse
Standards of Care for Headache Diagnosis and Treatment
Responsible Use Of Opioids

Excedrin Migraine is made by Novartis Pharmaceuticals Corporation.
You can make a difference by contacting them to share your concerns.

Customer Interaction Center
Novartis Pharmaceuticals Corporation
One Health Plaza
East Hanover, NJ 07936-1080

1-888-NOW-NOVA (1-888-669-6682)
Monday – Friday, 8:30am – 5:00pm EST

Email Customer Service

Novartis Pharmaceuticals Website

You can also visit Change.org and sign this petition:
Campaign to get Novartis to add a warning statement to this commercial