LONGTERM MEDICATION OF MIGRAINES

Hey Guys,

I'm just coming off a wicked two day migraine, and I'm so pissed off I can't stand it.  I've had migraines for over thirty years (I'm 40), and during that time, I've been on or tried virtually every medication used for migraines.  I'm currently taking 200mg Topamax as a preventative, Stadol Nasal Spray as an abortive, and whatever I can get my doctor to prescribe for pain management(sometimes Lortab) if she's in the right mood.  I get no relief from any pain medication other than something narcotic at this point.  This has been the case for a long time.  I've been averaging having to get a pain shot (nubain/phenergan) from my doctor's office every 8-10 days, but I have to use the Stadol NS a lot more frequently. 

Well, Friday I started fighting off a migraine with the Stadol NS in the afternoon.  It kept trying to come back (weather front moving in) all evening and by 3am, I had a full blown migraine.  I got my mom to drive me the the doctor's office when they opened at 7:30.  The doctor on duty was actually just a nurse practioner, but he's a wimp.  He looked through my chart, and I've seen him before for the same problem.  He decided I was having a rebound headache (NOT!), and would only give me a shot of Toradol or Ultram.  Well, Toradol does nothing for me, and Ultram doesn't work because I take Effexor.  I explained this in detail, but got nowhere.  That was all he was willing to do.  My other choice was to leave and he would refund my appointment charge.  Gee, what a guy.

So, off to the ER I went.  Of course, it took three hours to get seen by the doctor (but he was HOT!!! ) We had a nice little discussion about my migraines, symptoms, medication history and so forth, and I promptly got a shot of 10mg of morphine and 25mg of phenergan.  Unfortunately, it took so long to get some relief, I ended up having to get a second shot of the same thing, which took care of the migraine nicely.  He also gave me a prescription for a few percocet, for after the morphine wore off.  Good thing, cuz I felt like a horse had kicked me in the back of the head.

It is amazing to me how wide spread the medical profession is on pain management.  At the ER, I've been given everything from Nubain to Dilaudid.  Some doctors will prescribe narcotic medication for later and some won't.  I am having the worst time finding decent pain management.  Even the pain clinic here won't prescribe medication to keep me comfortable.  Unless my doctor is at the office, I guess I'm stuck going to the ER when I need a shot.  Doesn't seem like a great plan to me, but oh well.  If I could just find a good neurologist.

Thanks for letting me vent.

Leigh Ann

Leigh Ann

Your circumstances almost mirror mine.  My family doctor was very understanding of the fact I needed pain meds and he did prescribe them.  What I liked about him (he moved away over a year ago and I still miss him ) was he did not think I should settle for pain meds and try someone who could work on preventing them.  He admitted he did not have much experience with controlling migraines and I respected him a great deal for that.  He sent me to 5 or 6 neurologists.  The first one pretty much "dropped" me after he found out I did not have a tumor he could operate on.  He wanted to settle for pain meds so I moved on.  It seems every neuro I went to was ready to give up after a couple of medication trys.  My new family doctor (who continues to prescribe pain meds) sent me to a neuro he went to med school with.  What a fiasco!  He wanted to try a couple of different treatments (which involved painful injections) and I was willing to try anything.  The pain clinic decided they could no longer prescribe narcotics so my family doc. continues to.  No one told me that the insurance was covering only a small portion of the treatment costs and I did not get a statement from the insurance company until the treatments were finished.  Now I owe the doctor so much money they won't let me go back until I get the balance paid down. I used to go in for the nubain/phenergan shots but they quit helping.  The family doc switched to demerol/phenergan but they quit helping.  Now I pretty much rely on the ER as well and if I am luckly I get a doc that will give me morphine, only about half of the ER docs will.  I am to the point that morphine is the only thing that works.

Sorry, I did not mean for this to be so long.  When I start thinking about the whole situation I just need to vent and this seems to be the only place I can do it.

Thanks,

Dan

Had A humdinger of a migraine on Monday afternoon.  Had been fighting it off since Sunday afternoon.  Went to my DR Office as a walk-in and it was standing room only.  This was about 3pm, and I couldn't get in.  Went home for a little while.  I couldn't stand it anymore, so about 7:15, went to the ER.  DIDN'T GET A FREAKING SHOT UNTIL 2AM!!!!!    Needless to say, by then, I was dying, and my poor father looked like death warmed over.  At least he got to watch the entire Monday Night Football Game.  It's never taken half that long to get seen by a doctor before.  The Doctor's choice of medication was, (are you ready for this now?) Thorazine.  Two great big huge needles of the stuff.  I looked up its uses, and it's primarily an anti-psychotic, but about half way down the list of uses is "intractable pain".  I had to look up "intractable"  which means stubborn or difficult.  The shot didn't work particularly well, but nobody checked on me for an hour.  By then, I just wanted to be discharged and go home. 

I gotta work out some kind of deal with my doctor that they slide me in for a shot, regardless of what else is going on, and that I get at least a Nubain injection, regardless of what doctor is on duty.  I'm sick of the doctor d'jour and the medicine d'jour.  Especially when I know that I'm not going to get any pain relief from some weenie guy whose too afraid to prescribe strong enough medication.

So many doctors, so many medications,

Leigh Ann

Leigh Ann

During one of my trips to the ER one of the doctors finally told me it was possible for my doc to give the ER a standing order of treatment for my migraine.  My family doctor did this and it worked great.  Once I told the triage nurse I had a standing order I got right in.  The doc was happy because he did not have to stick his neck out for the morphine it takes to get rid of one that sends me to ER.  Unfortunately it seems to be difficult to find a doc willing to do that.  My doctor moved over a year ago and I have not been able to convince my new doc to give me one.  He will rarely stick his neck out for anything stonger than demerol which doesn't work anymore.

My best advise - talk to your doc about a standing order in ER or look for one that will do it.  I am still searching.

Droll...

Missed you!

Propranolol...is Inderal (generic form) I take that daily and it helps some...not as much of a difference as Topamax, but I am taking it for blood pressure also.

The low white blood count, I have found more common with depakote than with Topamax (not that it is COMMON with either, but I had a doctor that refused to prescribe depakote for some of the side effects that were possible and I think that was one that he ran in to!)

Tell me what's been going on with you!!!!!!!!!

Sara

Hey Guys,

Thanks for the input.  I'm going to see my GP tomorrow and get a referral to a new Neurologyst.  I'm also going to see if I can get something done about that "standing order" as I'm sick of the drug d'jour approach, that is, if I can get anything at all.  I'm also going to address my lack of sleep issue again.  My Dr. was suppose to get with my PSYCH to work out some medication for that, but it's been weeks and it's causing a lot of headaches.  My counsellor said she would hit my PSYCH up for a sleeping pill prescription for me in the meantime if I didn't get through the other way.  Anyway, we'll see what's happening tomorrow.

It's comforting to know that I'm not the only person getting the run around, but in your posts, I saw a couple of scary things...

DAN--You said you had been super careful to hide the severity of your headaches from your boss.  I've been there myself, but you should share the information immediately with either a HEALTH & SAFETY department or HUMAN RESOURCES manager.  This information is confidential, and cannot be used against you, but can come in helpful to save your ass if a particular situation calls for it.  Been there, done that my friend.  Trust me.

Nicky--Be very careful when mixing herbal remedies or high doses of vitamins/minerals unless specifically recommended to do so by your doctor.  You have to remember that these are not currently regulated by the FDA(which is the way we would like to keep it), but along with that flexibility, comes a wide variation in quality, concentration, and purity.  Plus, so many of these remedies haven't been studied well, so interactions and side effects are unknow.  Just be careful girlfriend.

I'll give you an update when I get back. Let me know how you're doing.

Leigh Ann

I forgot to mention!!!

There is a form that you can have your doctor fill out ahead of time, in the event you do need to go to the Emergency Room...it will have what medication you take regularly and what your doctor would like them to give you in the Emergency Room to break the headache cycle...that way, they know you are not a drug seeker and they know you are seeing a neurologist etc...and it has specifcs there and that you have already discussed this with a reputable doctor.

I will tell you though, sometimes this will irritate the ER staff if they have the GOD complex because they feel they are being told what to do. I personally don't care (smile) because it is what my physician wants done and I know I will be treated properly and with respect.   

I am going to find that form and maybe a few others and post the links...Stay tuned!

Hi Leigh Ann,

Thanks for the warnings about the herbal remedies. I check everything with my doctor before taking them and he's given me the okay. I also received some advice from a naturopath on the brands that are reliable concerning the makeup and concentration of the various herbal brands.

Have you considered trying another doctor? and then setting up a treatment plan? I have a plan in place with both my doctor and neurologist so that I'm not put in the situation that I'm asking for medications in the middle of the headache. I also keep track of all of my medications in a headache diary so that both doctors can see what I'm taking and how often and see that I am using my medications responsibly. Just some thoughts.

I looked up Stadol NS on many websites because I had never heard of it and it was often grouped with Tylenol with Codeine which is what causes me rebound headaches. Just a friendly question - is it possible that some of your headaches could be rebound if you're using a lot of Stadol NS? When I'm suffering from a rebound headache from Tylenol with Codeine, nothing works including Toradol except for a narcotic that is as strong or stronger. My rebounds can trigger migraines. I'm only suggesting this for you to think about.

Good luck - you'll figure it out.