Migraine

Hi everyone. I am still a bit new to the forum and you'll find me reading more than writing but I could really use your expert opinions today.

Background- I am 28 and have had migraines since I was 17. My current preventatives are amitriptyline 30 mg and Lexapro 10 mg. I take Midrin as an abortive and my rescue medicine was hydrocodone for 5 months and is now darvocet. I also take Frova in the three days leading up to my period but I haven't tried it yet (new from my last neurologist appointment). Before this online community NO ONE had ever spoken to me about MOH. At one point I was taking 8 hydrocodone every day

MOH Issue- I know that the Darvocet is a risk for MOH and could interfere with my preventatives working. I am trying to take only 1 or 2 a day now and I hope to have a day soon where I don't take any. I have a demanding job and get nervous about missing work so I feel like sometimes I take a Darvocet when I feel a tiny headache coming on because I'm afraid it will blow up on me. I have extreme anxiety about my headaches and about MOH at this point (I am taking klonopin for the anxiety). I have read a lot of older posts but I would love some insight from you all on my plan. I am proud to be completely off hydrocodone for 4 days now but I know I need to do better.

Thoughts???

Thank you so much!!

Hi Cori,

I can't remember if I've welcomed you already so just in case: Welcome to the forum

I'm both lucky and thankful that I don't have any personal experience with MOH. I know several of our forum members have had to go through it themselves and I'm sure they'll be along shortly to share their experiences.

You may have seen this article already but it's worth repeating and even sharing with your doctor:

Medication Overuse Headache

I'm glad to hear you're headed in the right direction and tapering down off of the possible MOH culprits.

Have you considered seeing a migraine specialist? I started seeing one in January and have had fantastic results already.

A specialist will also be aware of the over 100 preventive medications available for migraine prevention.

Again, welcome to the forum!!

Unfortunately, if you're taking hydrocodone or Darvocet every day, or even more than 2 or 3 days a week, you're probably in a rebound cycle. As you've read here, the only way out of a rebound cycle is to stop taking the offending drug. And preventives usually don't work if you're in rebound.

One of the moderators will give you a link to Teri's article on MOH.

It's not how much you take in a day, but how many days a week you take a med that affects MOH. So even if you're only taking 1 or 2 Darvocet a day, if you're taking Darvocet more than 2 or 3 days a week, you're at risk for rebound.

However, you need to be careful how many Darvocet you take a day for another reason: Darvocet contains acetaminophen (Tylenol), which can destroy the liver. If your hydrocodone contains acetaminophen, taking 8 in one day could be very dangerous. A couple of years ago, a 16 y/o girl died of liver failure 3 days after taking 16 acetaminophen tablets in one day for a severe migraine attack.

Have you tried any of the triptans as abortives?

I know it's tempting to take Darvocet at the first sign of pain, but if you're doing it every day, you're risking rebound.

Good for you for getting off the hydrocodone. It's my rescue, too, and I won't drive when I've taken it.

I've been in a rebound cycle at least twice. It's miserable to be in, having a MOH every day, and it's miserable to get out of. But the only way out is through.

Hang in there!

Gretchen in Mississippi

Thanks so much Gretchen and Laura!

Laura, I printed that article and do plan to share with my doctor. Basically, I need to just stay away from every day use of what he's giving me and he doesn't seem to get that! Since I've joined here I feel more empowered to be my own advocate which is a nice feeling. I have thought of a migraine specialist but I'm not aware of one in my area (Iowa/Midwest) so I'm going to keep away from the MOH causing drugs and see what happens with my neurologist.

Gretchen, I totally agree with you and your concerns and appreciate your perspective! I am concerned about my liver and now that I'm done with hydrocodone I'm going to have my liver enzymes tested next week. I'm hoping I haven't done too much damage since we want to have kids once my headaches are more under control. I have tried some all of the triptans except Frova. I'm getting mixed responses, my family doctor is saying no forva with Lexapro because of serotonin syndrome and the neurologist says it's ok. Thoughts? Regardless, the neuro wants me to try the Frova in June so I can't get it until then. I have Maxalt and Relpax at home but got scared after reading about serotonin syndrome. I think I'm going to trust the neuro and see what happens! Thanks so much for your support, it will be a hard road but I'm going to quit daily use of darvocet and hopefully get out of MOH. If you don't mind my asking, from you personal experience, how did your rebound cycle last?

Thanks again, back to work I go

Cori

Many of our forum members (including me) take SSRI's such as Lexapro, and also take triptans when we need to abort a migraine. Do discuss seratonin syndrome with your doctor. Seratonin is a very serious matter, but fortunately, it's rare. If you are going to follow your neurologist's recommendation, do be sure you know the symptoms of seratonin syndrome, and what steps your doctor wants you to take in the unlikely event it occurs. (My doctor wants me to head to the ER. But she's never seen a case of seratonin syndrome.)

Many of our forum members travel long distances, even by air, to see their migraine specialists. In fact, both Gretchen and Laura travel by air to see their specialists. So don't rule out seeing a migraine specialist because of distance. You probably won't have to go that often. It can make a tremendous difference to your quality of life, as well as your productivity.

Take care and good luck.

You've gotten some really good advice here. I would add that if your doctor seems to be unaware of rebound headache risk, you may need to consult a migraine specialist.

I'm allowed to take rescue medication 2-3 days per week (preferably two). When I realize that I've used up my two days, it is easy to panic about "what am I going to do if a bad one hits?" Now that I have a doctor that I really trust, I know the answer is, "I'll call my doc and he'll tell me what to do".

You don't want to burn out a good abortive by using it every day. I always think of it as "if I want to get a good bang for my buck, I better stay within the guidelines". I'm actually struggling with that today - I've had trouble breaking up a cycle, today is a "no abortives day", and I SO want a shot of Benadryl and a muscle relaxant. But, I know that if I have to wait till Friday, then my meds will work better, and if I get into an actual emergency situation before then, I have somebody to call.

Good luck getting a better plan. I'm glad you've figured out the rebound problem. It is SO important.

Lynne

I don't know if I've gotten to say hello yet, so hello!

So you know, serotonin syndrome is rare. I do understand your doctors concern though.

As far as the MOH goes, yeah, it stinks! It's painful - if you think you are in it - you should call your doctor for some help. He/she maybe able to give you something to help.

I had a horrible rebound headache from Vicodin. Mine only lasted 2 days, this was after taking Vicodin everyday for 3 weeks for an injury. It was the most horrible experience ever! I don't wish it on anyone!

And remember - there are so many drugs out there that can cause MOH, taht we may not even think of! All your OTC pain relievers, triptans, narcotics...etc. Keeping a headache diary may help you keep track of what you are taking, when you took it, and what you still have left as an option. I find it very helpful in keeping track of what I've taken to avoid MOH.

It's been several years ago, but I think I was out of rebound about 3 weeks after I stopped the offending drug. Some people are out within a few days; others take longer than I did. I don't know whether it depends on what the offending med is.

Mine were Vicodin (hydrocodone with acetaminophen) one time and Midrin the other. I don't remember whether one took longer to get out of rebound.

Gretchen in Mississippi