I’ve been addicted to drugs, prescription meds and over the counter painkillers. Twice. Maybe three times.
Technically, this is not true. Technically, I’ve had Medication Over-Use Headache (MOH) a couple of times, but I say I’ve been addicted to drugs when I want to sound cool, or get people’s attention. Like now.
The lyrics of the Verve song (quoted above) make me shiver, not because I think it’s a beautiful song, but because it always make me think of Medication Over-Use Headache (MOH). MOH is an incredibly easy trap for people with migraines to fall into. I first succumbed to it in 2004 when I was living in Hanover, New Hampshire, U.S.A. studying for a Masters degree. My migraines were out of control and I knew nothing, even though I’d had migraines for about 5 years and been on nearly every preventative under the sun. At this stage I hadn’t read one single book about migraines, I didn’t know there were phases of a migraine attack, I didn’t know one should keep a diary or look for triggers. No Doctor had ever taken the time to explain any of this to me (partly because my condition wasn’t fully diagnosed yet), and I didn’t realize I needed to educate myself. At that time my vertigo was also pretty severe. I had a ‘wobble’ board in my room that I would religiously stand on each day and look at a spot on my wall, doing some vestibular rehabilitation exercises I had been given to do by a Doctor. They, of course, made me feel even dizzier. I once stumbled home from a lecture clinging to lamp posts the vertigo was so bad. I think the Yanks just thought 'there goes that drunken Brit again!'. At this point I thought jogging would help, even though every time I went for a jog I’d get a pounding migraine about half an hour later and the room would spin. And my neck and back hurt almost constantly (I also didn’t realize the extent of my neck damage).
So, I’d basically pop painkillers like they were Smarties. My painkiller of choice at that time was Solpadeine. It’s lethal for MOH as it’s very effective, but more because it contains codeine and caffeine which, for some medical reason, make them more prone to MOH. I was also using the Triptan (acute migraine medication) Naratriptan, a slow release Triptan pill that takes a while to work. So, I’d often take a Naramaig (or Amerge in the USA) preemptively, or take two as I didn’t know if they’d worked. I also had Sumatriptan injections which I was happily self injecting on top of all this… If you know the pain of migraine this doesn’t sound so crazy. I’d wake up each day in pain, so obviously I’d take pain killers, they’d ware off, a migraine or headache would come on so I’d take more…. and the problem with these migraine medications is that eventually they actually give you a headache if you mis-use them. And the added problem is MOH feel quite similar to migraine so it’s hard to tell them apart.
There are clues to look out for, such as you’re getting a headache of some sort every day, you feel foggy headed most days, the pain is worse when you wake up etc etc. With ‘true’ migraine you should have patches, days, in-between attacks where you feel completely fine.
|Image from http://healthlob.com/ & also used in the fabulous That M Word Migraine Blog.|
The advice for avoiding MOH is to try not to take Triptans on more than 2/3days a week (or @ 10 days a month.) The dose is not so important, but the number of days per week.
To spell it out, if you take Triptans on more than 10-15 days a month, over 3 months, you might get MOH. Obviously, this makes life really hard if you have Chronic Migraine and other pain inducing conditions. Life becomes a juggling act. Incidentally, a frighteningly large percentage of people with Chronic Migraine also have MOH. Fun times. All this makes getting prescriptions for the sacred Triptans from some Doctors quite tricky as they often say ‘Now, Victoria, are you getting into MOH territory this month’…..But I've found sticking to the 2/3 days a week rule keeps me clean!
Anyway, the treatment for MOH is basically go Cold Turkey i.e come off the offending drug. But, if like me, you’ve managed to get MOH from TWO types of drugs you can’t be expected to give up all painkillers/drugs entirely. Most migraineurs get MOH (which, by the way used to be called Rebound headaches) because they take too many Triptans – in this instance they come off Triptans and are sometimes given other, carefully selected NSAID (usually Naproxen), or alternative pain preventatives, in tapered doses. But obviously I couldn’t do this as the other drugs they usual give MOH patients instead of Triptans were also giving me headaches….you see the sticky situation I was in!
Some mean Doctors will suggest you have to go completely Cold Turkey, i.e you can have NOTHING! To them I say – telling me I can have no pain relief at all is like:
- Telling a Granny with a rotting, pus-filled tooth that she needs root canal and some fillings but the dentist doesn’t want to give her those nice numbing injections. He’s just going to slowly pull out those teeth, then cut out those nerves while she’s fully conscious. And actually maybe she should just go around with gaping holes instead of teeth, leaving those rotting nerve ends exposed….
I could go on. I don’t think I’ve found the perfect analogy yet, if you can think of another, let me know. I’m a bit paranoid about this as can tell. But basically, if a Doctor offers you no relief find a new Doctor as you can get a lot of support (more info at the bottom). Some people, with severe cases, even 'detox' in hospital. Obviously every case is individual. For some, ceasing all medications straight away is the quickest and best way to get over MOH. I, however, was put on a tiered course of the steroid, Prednisone for about 15 days and also had, I think, a Greater Occipital Nerve Block. It worked wonders and broke the cycle. However, being an idiot, about four months later, I, um, got lots of headaches again so started taking loads of Ibroprufen and maybe Solpadeine and Triptans…..um… You’ll be pleased to hear I have not touched Solpadeine since 2004! But this is before I realized getting educated about your migraine is the key to managing them! (see Tried & Tested) Also, I’m not alone in getting MOH twice, or even thrice, there is a very common reoccurrence rate within a year… see, I’m not that stupid! It was only years later that a lovely Migraine Specialist took the time to explain to me, that the danger and trouble with MOH is your body basically runs out of its own natural pain killing abilities, i.e the tiniest trauma will trigger migraine/pain. New research suggests MOH makes our brains more sensitive to pain. Plus, if you have MOH other migraine preventatives probably wont work.
Anyway, the real reason I wanted to talk about MOH today is not because I currently have it/them (?), touch wood, but because of my lovely new friend Fran, aka the writer of the fabulous blog Skulls and Ponies. Fran had been going through a very tough patch with her migraines, (which she’s had for over 8 years) so tough she actually googled ‘migraines’ and for some reason, known only to God, came across my hysterical interview with Talk Radio Europe - that went out in Spain. If you want to listen to it – click here. I sound like a very posh 12 year old. But luckily this led Fran to my blog. Yay! But poor Fran did not realize that I would then find her email address and stalk her. I get a bit overexcited when I meet fellow migraineurs, especially ones who need to go to the National Migraine Centre, as Fran consequently did (and got the help she needed.) But Fran was already pretty clued up, so would have got there eventually.
I shall now let Fran take over the story and tell it far more eloquently than I! Click here to get to the relevant post. She is currently in week 4 of Cold Turkey. And it is hell. Going Cold Turkey sucks big time. You feel sick, get dreadful headaches and generally feel lousy. However, once Cold Turkey is over, usually you feel a whole lot better and your migraines fit the ‘normal’ pattern and acute attack medication works far more effectively.
Please read Fran’s story and support her through her Cold Turkey Hell. Go Fran, you’re nearly there! Also search for other migraine posts in Fran’s blog as she’s written some brilliant pieces recently and in the past. They're informative, insightful and much shorter than mine! Go Fran, Go!
|This is Fran's very cool Twitter pic. Follow her @skullsandponies|
For more detailed information about MOH check out:
Managing Medication Withdrawal - Migraine Trust
Managing Medication Withdrawal - Migraine Trust
There are also two fabulous chapters in “Coping with Headaches and Migraines”.
And here is a nice article showing that MOH is not an addiction! http://migraine.com/blog/news/migraine-aint-an-addiction/
As usual if you think you may be suffering from MOH get thee to the National Migraine Centre henceforth!
P. S - Usual legal disclaimer applies. I'm not a Doctor and the drugs mentioned should NOT be taken without first consulting your own Doctor. The drugs mentioned were only given to me due to my specific circumstances and diagnosis.
ADDENDUM: Since writing this post NICE (National Institute for Clinical Health and Excellence) have issued new Guidelines on managing and diagnosing Headaches. A portion of the Guidelines are concerned with MOH - they state that:
- Triptans, opioids, ergots or combination analgesic medications on 10 days per month or more or
- Paracetamol, aspirin and an NSAID [non-steroidal anti-inflammatory drug, e.g. ibuprofen], either alone or any combination, on 15 days per month or more."