opiates for migraine prevention

A man, age 29, came to me for treatment of incessant headache. It would awaken him about 6 AM and last all day My life, he said " is a constant headache". He gad not responded to any of the many antidepressants and anticonvulsants which we use for migraine. His only relief came with the use of aspirin in high dosage, some 12-15 tablets each day. Without that drug, he told me, he simply could not function. But he paid a price. He had been hospitalized twice for gaastrointestinal bleeding due to his aspirin therapy and had required blood transfusions on both occasions.

He had a strong family history of migraine and also a history of attention deficit disorder requiring treatment with Ritalin. That therapy was discontinued about age 10 for the drug as beginning to speed him up rather than slow him down. (Please see my previous blog- our response to drugs change occording to time and circumstance)

I believed the young man suffered migraine although it's presentation was most atypical. It lacked most of the defining features of that disease but I viewed the positive family history of typical migraine (father and sister) as supportive. Also supportive was the appearence of headache at the same time every day, very tycical for migraine. Lastly, the past history of attention deficit disorder because that disease and other features of the bipolar spectrum (see my books and blogs) has a high concordance with migraine. Interestingly. his.  headaches began at age 10, shortly after he stopped Ritalin. A coincidence?????.  Personally, I kind of doubt it.

My treatment options? He had failed conventional therapy. Would resumption of Ritalin have helped? Perhaps, but he refused. He recalled its unpleasent effects. He then offered my an incredible clue ( as my patients often do-and I have written on this subject) He told me that he had recently had dental surgery and been given the pain killing opiate, hydrocodone ( brand named Vicodin, Lortab, and Lorcet). The drug gave him immediate relief from headache and he remained pain free until his supply was exhausted.

It was an easy trade off for me. A marginally functional existence and repeated intestinal bleeding both under the sponorship of 12-15 aspirin tablets versus freedom from headache pain under the sponsorship of a widely used and relatively safe low order opiate. I prescribed hydrococone, 10 mg.

 four time daily (a rather small dose of opiate) and now several months into treatment is is doing quite well and his infrequent mild headache always respond to a couple of aspirin tablets.

Opiate therapy is not without risk but it can be effective in preventing migraine.

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james ledbetter Posts: 4
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Re: opiates for migraine prevention
Reply #2 on : Fri September 07, 2012, 17:54:59
I think more doctors should open the door to this kind of treatment for migraines.. I suffer wiwith them too. But because of the "pill problem" in my state, its impossible to get an opiate solution, and this is the only thing that helps my migraines. So I turn to buying these meds on the street, for street prices. 60 dollars a week is a small price to pay to be migraine free for over a month now. I used to take 8 to 10 excedrin migraine a day.
justin Posts: 4
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Re: opiates for migraine prevention
Reply #1 on : Sat April 14, 2012, 23:16:16
I hope that docs realize that people will go to extremes and perhaps try or do dangerous things when desperate. A dose of 10-15 asprins a day sounds disgusting, and poisonous. To me thats like saying to a patient who comes in with a broken leg, "just go ahead and break up one of your fingers,and you'll forget about your leg hurting". Your just causing more damage by ignoring a patient (another human being) because you choose to be self rightous and say "my way is right, my way work better". A person in desperate need of help is going to tell you the truth because they dont have time to waste. Docs should listen because their patient may end up trying something that could kill or worse.