Dilaudid: Great for the pain, but blistering headaches post-dose?

Hi all,

I stumbled across this site with an internet search and decided to register as I have found some great advice and contribution amongst users and I'm sure I will have some questions down the road.

I suffer from chronic abdominal pain due to problems in my common bile duct resulting in biliary inflammation and pancreatitis. For pain management, my doctor has had me taking OxyNEO 20mg (oxycodone HCl controlled-release) twice daily and until recently MS-IR 20mg (morphine sulfate) for breakthrough pain during periods of intense inflammation.

The morphine has been less effective recently as the pain has been worse than in the past. My doctor has changed my breakthrough pain medication to Dilaudid 4mg (hydromorphone HCl) as needed up to four times daily (realistically, I only actually need to take it maybe 3-4 times per week). In terms of pain relief, I have found it to work quite well during an attack, bringing the pain down to something I can tolerate and allows me to assume regular activities. However, I am finding that once the dose starts to wear off (at around 3 hours after dose administration or so) I get a blistering headache every time. The headache comes on strong and sudden, and it has an intense throb with every pulse beat which I can feel in my temples and my lower forehead immediately behind my eyes.

Has anyone else experienced this while taking Dilaudid? If so, does it get better over time as the brain gets used to it? I have been taking Tylenol to help the headaches, which maybe helps a little bit, but I'd rather avoid the continued use of acetaminophen as part of the reason my doctor doesn't have me on a combo opioid/APAP product is to avoid long-term use of acetaminophen.

Thanks for any insight or suggestions. I have made note to discuss this at my next follow-up appointment with my doctor at the end of the month, but in the meantime I just wanted to see if anyone else experiences this and if there are any suggestions based on their own experience. I did a search of the forum and found a few instances of people reporting headaches but there was very little follow up with any tips that seemed to work.

Cheers

Hello Killer,

How often were you using the Morphine Sulfate? How long has it been since the switch?

The headaches might be your body's way of experiencing a bit of withdrawl.

4mg Dilaudid (when taken in pill form) is not comparable to 20mg morphine sulfate. The bio-availability of Dilaudid in pill form is extremely low.

Which means that the pill doesn't stand up very well to the process of digestion and most of the medication is destroyed before it can do it's job.

So it's possible that while the dose of dilaudid is in your system, it's enough to help with your pain and to stop you from having withdrawl symptoms. Especially in combo with your other med.

BUT when it runs it's course (after 3 hours) your body starts protesting the lack of the morphine sulfate you were taking before.

That's just my guess. I could be wrong :)

Post Edited (LexiRae) : 1/19/2014 6:07:49 PM (GMT-7)

LexiRae said...
Hello Killer,

How often were you using the Morphine Sulfate? How long has it been since the switch?

The headaches might be your body's way of experiencing a bit of withdrawl.

4mg Dilaudid (when taken in pill form) is not comparable to 20mg morphine sulfate. The bio-availability of Dilaudid in pill form is extremely low.

Which means that the pill doesn't stand up very well to the process of digestion and most of the medication is destroyed before it can do it's job.

So it's possible that while the dose of dilaudid is in your system, it's enough to help with your pain and to stop you from having withdrawl symptoms. Especially in combo with your other med.

BUT when it runs it's course (after 3 hours) your body starts protesting the lack of the morphine sulfate you were taking before.

That's just my guess. I could be wrong :)

Thanks for the insight. My doctor went over the conversion table with me prior to prescribing Dilaudid... as far as I understand, orally administered Dilaudid when compared to orally administered morphine (for chronic use, not acute) is approximately 4x as strong, after the bioavailability adjustment for both medications. So 4mg of oral hydromorphone would be the equianalgesic dose to about 28mg of oral morphine (for chronic morphine treatment, approximately double that for acute use), which is higher than the dose of morphine I was taking.

It could be some withdrawal symptoms like you mentioned. It has been two weeks since the switch and I am taking the Dilaudid on approximately the same time interval as I was the morphine, so perhaps after the effects wear off I am feeling withdrawal from morphine. I will see if these headaches get better over time, I just wasn't sure what they could be from. I had thought of withdrawal before, but since hydromorphone is a derivative of morphine I thought it might prevent withdrawal symptoms.

Angelzmama said...
I experienced that in the hospital while on IV meds for inflammatory (bleeding colitis) the first time in, I was on morphine and I told the nurse I was having horrible headaches. She told me that happens sometimes for some reason, they don't know why with both morphine and dilaudid. The doc changed the IV meds to dilaudid and the headaches went away. I was back in a few weeks later and they started me on dilaudid instead and I'll be darned if I didn't develop a headache, and you're right, they are BAD headaches. They switched me to morphine and headache gone.... weird, but they say it's relatively common. So good luck I guess if I am in again they will have to probably switch at some point, based on past experiences.
Good Luck! I think when a bad headache sets in toradol helps too, it's helped me at times better than the narcotics.

Interesting - thanks for your insight. I haven't experience this while in the hospital before on IV pain medications and I have been administered both morphine and Dilaudid in the hospital as well. It just seems to be recently after the oral breakthrough medication switch.


Thank you to all for the feedback, it is greatly appreciated and I will be sure to bring it up in my discussion with my doctor. I will also report back if I happen to find a solution or if the headaches begin to go away over time.

In the meantime, if there are any further suggestions from others who have experienced this I would love to hear feedback with regard to whether or not they went away or if a change in dosage was necessary.

Cheers

Just a quick update. The headaches that I was getting after my dose of Dilaudid seem to have gone away. I mentioned it to my doctor and he wasn't sure what exactly it was - it could have ranged from many things including withdrawal from morphine to my body adjusting to the change.

In any case, they went away after about two and a half weeks, so if anyone else experiences these headaches they may pass in time as mine did.

Thanks to all for the previous suggestions. Cheers