Help! How Can I Not Overuse Migraine Medications?

By teri-robert

January 21, 2011

One of the biggest issues facing those of us with frequent Migraines is that of medication overuse headache (MOH), aka rebound. As with most things related to Migraines, the susceptibility to and which medications cause MOH can vary from person to person. The International Headache Society has gathered research and set diagnostic and classification criteria for MOH that are quite complete in listing which medications can cause MOH:

8.2 Medication-overuse headache (MOH)¹8.2.1 Ergotamine-overuse headache
Overuse defined as ergotamine intake on 10 or more days/month on a regular basis for more than 3 months.8.2.2 Triptan-overuse headache
Overuse defined as triptan intake (any formulation) on 10 or more days/month on a regular basis for more than 3 months.

8.2.3 Analgesic-overuse headache
Overuse defined as intake of simple analgesics on 15 or more days/month^don a regular basis for more than 3 months.

8.2.4 Opioid-overuse headache
Overuse defined as intake of opioids on 10 or more days/month^d on a regular basis for more than 3 months.Comment:
Studies show that patients overusing opioids have the highest relapse rate after withdrawal treatment.

8.2.5 Combination analgesic-overuse headache
Overuse defined as intake of simple analgesic medications^e on 10 or more days/month on a regular basis for more than 3 months.

8.2.6 Medication-overuse headache attributed to combination of acute
medications
Intake of any combination of ergotamine, triptans, analgesics and/or opioids on 10 or more days/month on a regular basis for more than 3 months without overuse of any single class alone.^f

8.2.7 Headache attributed to other medication overuse
Regular overuse^g for more than 3 months of a medication other than those described above.

8.2.8 Probable medication-overuse headache
^d Expert opinion rather than formal evidence suggests that use on 15 or more days/month rather than 10 or more days/month is needed to induce analgesic-overuse headache.

^e Combinations typically implicated are those containing simple analgesics combined with opioids, butalbital and/or caffeine.

^f The specific subform(s) 8.2.1—8.2.5 should be diagnosed if criterion B is fulfilled in respect of any one or more single class(es) of these medications.

^g The definition of overuse in terms of treatment days per week is likely to vary with the nature of the medication.

As you can see, any acute medication (medication used to treat a Migraine when it occurs) can, if overused, cause MOH. Even alternating the types of acute medications leaves us vulnerable to MOH (see 8.2.6 above). Most specialists recommend limiting use of any acute medications to no more than two or three days per week to avoid MOH. They have good reasons for that recommendation. Dr. Fred Sheftell of the New England Center for Headache told me:

"MOH continues to be a vexing problem in tertiary care centers and a major challenge to primary care physicians with these patients often requiring referrals to specialists. AMPP data demonstrates that butalbital and opiates are the 2 agents most likely to lead to overuse and are a major risk factor in the genesis of CDH (Chronic Daily Headache) Transitioning patients from MOH (10 or more days of combination products, opiates, triptans or 15 or more days of single ingredient OTCs) can be difficult as patients get worse before they improve. Pharmacologic treatment, preventives and behavioral therapies are often required. 80% will improve with a 50% or more decrease in frequency and intensity. Failure to address MOH will likely reduce the potential efficacy of any preventive intervention. Kudrow was the first to point this out in a landmark prospective study more than 30 years ago. Many studies since that time have shown similar results.”³

Simply put, medication overuse headache is avoided by not using medications for the relief of Migraine and/or headache too frequently. That statement might seem quite simple to someone who doesn’t have frequent Migraines. However, it leaves those of us who have or have had frequent Migraines with an obvious and sometimes urgent question:

How can I not overuse Migraine medications?
The long-term answer to that question is an effective preventive regimen, but that can take time and patience, and we need relief during that process. If you’re at risk for MOH, it’s time to have a frank discussion with your doctor. Here are some topics to discuss with your
doctor:

Find which acute medication works best for you. Finding what works best for you can reduce the number of days you need medication.
Speak with your doctor about a rescue medication, a medication to be used if your primary acute medication fails.
If nausea is a problem for you, talk with your doctor about how to treat it. It’s possible that you can treat the nausea even on days when you’re beyond your limit on acute Migraine medications.
Don’t forget that some complementary therapies might be helpful to you. Some insurance companies will even pay for acupuncture or therapeutic massage with a prescription or referral from your doctor.

Another issue not to overlook is the use of comfort measures. These can be especially important if there are days when you have to forego acute medications to avoid MOH. Often helpful comfort measures include:

Thermal therapy: warm or cold packs
Ginger or peppermint tea for nausea
Aromatherapy: Essential oils can be helpful, but use these with caution. They shouldn’t be applied directly to the skin full-strength, and some oils, such as peppermint, should not be used by children or pregnant women.

When taking acute medications stops the pain, it’s tempting to take them despite the risk of developing MOH. Two points helped me resist that temptation:

Taking the medications was tantamount to sentencing myself to a headache very day.
The point Dr. Sheftell mentioned in the quote above about MOH reducing the potential efficacy of preventive treatment.

It can be very difficult to not overuse acute Migraine medications, but it’s essential if we want to make progress in our efforts to control our Migraines. Our doctors should be willing to help and encourage us. If they’re not, it’s probably time for a new doctor, probably a good Migraine specialist.

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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Join the conversation

jewels3081
January 21, 2011
Thank you for another informative article, Teri. This has been the most frustrating part of migraine treatment for me, knowing that there are medications that will ease the pain, yet I cannot use them on certain days. However, I have managed to regain some quality of life and become a bit more dependable to my friends and family by developing a system of basically ranking events in my life as "medication worthy" or not. I am not sure if all migraine sufferers do this and just don't talk about it, but deciding which days each week I will allow myself to take meds beforehand actually helps me feel like I have some control over what happens to me and keeps me from overusing my medications. I also keep a calendar marking the days I have used abortives or pain meds, so I don't accidentally take more than my allotted amount in my migraine-induced stupor. Some weeks I don't need medication on a day that I had something scheduled as "medication worthy" so I get a freebie on another day that I have a migraine because I get to take meds to abort that one! Woo hoo! Funny what us migraineurs can get excited about. When I just took meds sort of at random, I never really felt like I could schedule anything or promise someone I could be somewhere, because I might have already taken my quota of meds for the week, and now at least I know I'll have saved meds for that day, even if I have had to force myself to suffer on other days. As I mentioned, this has greatly improved my quality of life. Keep up the good work here, Teri, Nancy, and all the other contributors! Julie
stormlaughter
January 21, 2011
Glad to see standardization of MOH diagnosis. Many insurance companies only pay for 9 triptan doses per month anyway. These guidelines dovetail with the insurance status quo quite well. This would give a doctor a...pardon the puns...heads-up that a patient might be headed towards a MOH if they asked for more than 10 doses per month. Yet more reasons to work, work, work, to tweak prevention and work, work, work to determine your own triggers. Stop these attacks before they start if it's within possibility, I say!
teri-robert
January 21, 2011
Julie, You're very welcome, always. Ack. I hate it that you have to rank events and days. I used to do that, and it does help. Still, I wish you didn't have to do it. Are you not having any success with a preventive regimen? Can we help you with any other information or a doctor recommendation? Thanks so much for commenting too. I love to hear from our readers. Teri
teri-robert
January 21, 2011
Stormlaughter, I couldn't agree more with this... "Yet more reasons to work, work, work, to tweak prevention and work, work, work to determine your own triggers. Stop these attacks before they start if it’s within possibility, I say!" On the insurance though - If one dose of triptan would do the job, I might not have so much trouble accepting the way they limit triptans. But what about people us often need two doses? Nine tablets a month lets them treat 4.5 days a month. I don't think the insurance companies care about MOH; I think they limit because triptans are expensive. They really need to leave practicing medicine to our doctors. Teri
1. jeffpoleet
 November 13, 2012
 Exactly! I can only get 9 Amerge with my medical insurance (BCBS), even though I have a prescription for 12. The pills cost about $50 a pop, and that is the reason my insurance will not pay for it. If we could get insurance companies out of the picture we could all do much better with what treatments we recieve, preventative treatments, etc. It is amazing to me that certain treatments are not even available to some people because their insurance will not pay for it. What is the use of having insurance then?
jewels3081
January 24, 2011
Oops, I realize I signed off mentioning "Teri, Nancy, and all the other contributors..." I forget which site I am on sometimes. I don't know if Nancy posts here or not. Anyway.... I admit, ranking days and events in life isn't ideal, but I am much better now than I have been in years. I actually am having more success with preventive treatments than I have had in quite some time, yet still I have more migraine days than I have medication days most weeks. Really though, the fact that there is ever a day that I can schedule something and NOT need meds is quite an advancement in my treatment. So, I am not complaining. I am able to do more things and enjoy life more in the past 8 months or so than I have been in probably 12 years. So even if I feel like I am juggling medication days and constantly prioritizing and re-prioritizing events based on their medication worthiness--I'll take it over where I've been. I feel good about my doc and the progress we have made and I think I am definitely headed in the right direction. Thanks for your concern. I always appreciate it. Julie
teri-robert
January 24, 2011
Julie, You're very welcome. Thank you for replying and telling me more about how you're doing. I'm so glad you're headed in the right direction. 😀 Teri
tbrooks
February 5, 2011
I can completely understand this Medication overuse and rebound headaches....I am a migraine sufferer and have had intractable migraines for at least the past 5 years; needless to say I overused every medication given to me as my head would relentlessly pound daily and what is one to do when this occurs; over use the medications..... Well, after long thought I sought the help of a migraine specialist neurologist: Dr. David Watson at WVU Hospital. Got my visit and could not wait to see him; needless to say he was wonderful. He explained to me what I already knew, I was an overuser of all of my medications. We agreed that I be admitted to the hospital and undergo DHE infusion treatments. And hopefully some botox in the future as he is trying to get it approved from my insurance company. Well, I arrived at the hospital and they were all wonderful to me; beyond belief. That very day I got my first DHE treatment I suffered a very severe reaction; My BP went through the roof it was 225/146, I was flushed, sweating profusely, sick to my stomach beyond belief, HR off the charts, chest pain, shortness of breathe to eventually be rendered unconscious... Well needless to say I am just giving my experience and not trying to scare someone away from DHE but this is what happened to me. They got me stabilized and over the course of the next 5 days I was withdrawn from all of my overused meds and given IV depakote, benadryl, magnesium, toradol, and B complex solutions, along with oral zanaflex, neurontin, prednisone and Ambien for sleep as I also suffered from insomnia another great trigger for a migraine sufferer.... I truly lost hope and thought that I was wasting my time....well on the fifth day I awoke after sleeping a whole 4 hours (yeah, that's a lot of sleep for someone like me) and I realized that for the first time in 10+ years I was migraine free. Now I just arrived home from the hospital and even the 2 hour car ride did not trigger my head.. I know that I have no real long term evidence that this is gonna be a success but those five days is well worth the one day I got pain free even if I am worn out and on the mend...I will keep you all updated to see if this is my GOD sent plan. But if anyone out there thinks that you can't take anymore, keep trying; I did and one day at a time..... Also if you are looking for an excellent Dr. and excellent facility; please consider Dr. David Watson at WVU hospital and Ruby Memorial Hospital.....The experience was life saving
dfonner
February 11, 2011
I've been pretty good w/head pain last couple months so my pain med use is way down. But nausea has been almost daily since last summer w/ no reason PCP and I can find. Just using lots of phenergan. My coworker (who gets really pukey migraines) and I were discussing this after I had an unusually sick migraine unresponsive to phenergan. We were wondering if you can get resistant to nausea meds. Do you think that fits into this picture in some kind of way? I've never seen anything about it but it's funny we were just talking about it a couple days ago. And a sad thought to tie into the whole "medication worthy" theme, because believe me, I'm not fooled for one minute that this little happy time zone I'm in will last. It all started when I upped my topomax and I've got to cut that back sooner than later because of kidney stones. But I'm working on that. I've missed plenty of events - just missed a board meeting Monday after emailing the correct location less than 2 hours before it occured. And just b/c my head isn't pounding, my neck is always letting me know it's back there. Ice and heat are my closest buddies! But ironies of how tolerant of pain we become: I just went yesterday for a "kidney-oscopy" (a lot of oscopies in tiny places to see why I have a big fat kidney and kidney stones) and they gave me good pain drugs to take afterwards. HAHAHA! I rode out a kidney stone over a long weekend last summer before a CT scan showed what the pain was, I've spent the last 6 years w/ CDH/migraines, I took motrin after my c-section 11 yrs ago (b/c the spinal made me vomit on my baby so I was scared to take anything else they gave me) and I get monthly cramps that would lay out a football player. What we women go thru! So what is a little "oscopy"? Though I did fill that prescription by gosh.... Apparently he didn't lithotripsy or pluck out the stones still in there.... Sigh.
teri-robert
February 11, 2011
tbrooks, Before I forget, hope you don't mind, but I broke your comment into shorter paragraphs, just to make it easier to follow. I'm so sorry you're going through such a rough time, BUT I'm also so very glad you found Dr. Watson. He's a gem! I live in West Virginia, and his arriving in Morgantown marked the first time we've had a true Migraine specialist in the state. MOH is such a bear. It's kind of like we're darned if we do, darned if we don't. It's just not fair that the meds we count on to relieve our Migraines can turn on us and cause MOH, but that's life, I guess. You certainly found that out. Use your imagination a bit, and you'll see me, here in West Virginia, cheering you on! Thank you so much for sharing with us. Remember, you're not alone. We're right here if you need any help and support. with a gentle hug, Teri
teri-robert
February 11, 2011
tucker, My personal opinion is yes, you can build a tolerance to some of the nausea meds. I too used Phenergan for nausea for quite some time. Then it got to a point where it just seemed to do nothing. I'm using metoclopramide (Reglan) these days, and it works as well for me as Phenergan used to. Prochlorperazine (Compazine) is another option you could discuss with your doctor. Yes, we can become very tolerant of pain. Your experiences are great examples! On the Topamax -- there are lots of other medications you can try for prevention. You said you're working with your PCP? Hopefully, he or she will be able to help you find something that doesn't give you problems with kidney stones. Hang in there! Teri
not found
July 30, 2011
Very useful and important info. I had ran into this problem after taking Relpax and ibuprofen for too long, not knowing that this was even a problem until I saw my headache specialist and he told me I HAD to stop taking so much Relpax because I was on the verge of having a heart attack. Glad I know now. Now, I am aware that virtually any pain reliever can lead to rebound headaches and how important it is to have a preventative. I have not found an effective preventative yet though. Anyways, great info!
gonzohunter
September 8, 2011
I am curious about this. I will admit I have felt a hangover effect after cerain meds. But have been perscibed many dailey different meds....but this says any pain reliver can cause moh such as ibpro, celebrex, non narc, etc? So why are these drugs ever perscribed dailey
not found
December 22, 2011
I know I over-use Imitrex (at least 20 100 mgs a month), but I have to work. The Imitrex still works for me but, obviously, I am re-bounding. I try SO hard not to take it, suffer for a day or two, then I just can't function through the pain anymore. I feel depressed and hopeless. I have tried Botox treatments twice, with no relief. I am so tired of living with the pain and compromising my life style because of it. I can only hope it gets better as I age.
1. not found
 May 10, 2012
 I totally understand. Feel the same sometimes.
not found
January 10, 2012
Have u tried to get on topamax that's what I take and it controls mine.
1. not found
 January 11, 2012
 I took it for 3 weeks. The neurologist told me it can cause problems with short term memory. He was right! I stopped it immediately when I was lost in a VERY familiar area of OKC. It literally scared the crap out of me.
2. not found
 May 17, 2012
 Topamax is jokingly referred to as "Dopamax". I could barely remember my address when I was on it (150 mgs). It might have helped a bit, but I could not do my job (loan processing!) properly, so I had to stop it. I've been on two Botox trials, neither worked. Weaning myself off triptans works the best, as it did reduce the number of headaches, but it is not an easy thing to do. Good luck to you!
not found
January 10, 2012
I take ketamine when things get too bad. Nothing really helps. Seems like things are worse with age.
not found
January 10, 2012
More great information Teri. It'e so important to learn how to manage the medication we take to help reduce these types of headaches from occurring.
not found
January 11, 2012
I kniow I overuse my medications. But I have to work and I have the headaches everyday..I have found no preventative that works so far except maybe Topamax and my doctor wants to try me on it again. The neuro was no help at all. I can't afford acupuncture as it is not covered by my insurance. My primary doctor says that maybe we will try the Topamax again , so here I am back at the beginning. Stress from work and home(my husband is going through chemo) are 2 major stress factors. My middle daughter is getting married in 4 weeks(another stress factor) but a happy one. Mostly it is frustration that I have the headaches everyday and no one can seem to offer any other suggestions regarding relief other than pain management)which I cannot afford ) with my husband being sick and not working much right now.I am not using that as an excuse just stating facts. So to anyone out there who says medication overuse can cause the headaches , well maybe they are right but if they are not migraine patients and have never experienced it firsthand then they don't have a clue...sorry. Jan
not found
April 10, 2012
I have been on topamax for 3 months now. I have only seen a slight decrease in pain.I have also noticed the memory issues topamax causes and am trying to work through them. I still have the daily headache. I still have to work so when the headache comes on I can't just do what I really want to which is climb in bed in a dark room with a cold rag and quiet and try to make it go <a href='http://away.But' target='_blank' rel='noopener noreferrer nofollow'>away.But</a> I can't always do that because I have to work and take care of my family. So I suck it up and probably take too much medication which yes I know it leads to MOH. I just want my life back.....
1. not found
 April 10, 2012
 Wish I could help but I don't have the answers either. Hope you feel better in the a.m.
not found
May 14, 2012
Extremely helpful information! Thank you!
not found
May 14, 2012
Yea, and try and explain the game of Migraine Musical Meds to someone who thinks Migraine is just a bad headache. It`s sad when someone attempts to tell me about a "new" treatment that cures me. And I really get angry at the party that tells me I am taking "too" many meds. Most do not really even have a clue on how this disease wreaks havock on a happy life.
1. jeffpoleet
 November 13, 2012
 This bothers me as well, as the statement implies that you are just supposed to sit there an experience the worst pain of your life, when no person is capable of withstanding that amount of pain. If the prevenatives worked, we wouldn't need the pain medication, and this is a point of logic that seems to miss the MOH bandwagon. If we cannot treat the pain of a pain condition, what are we supposed to do?
not found
May 14, 2012
I'm a little confused about the terminology used in the article. When the word 'headache' is used, does the International Headache Society mean headache and not migraine? I use both ergotamine (works very well for me) and butalbital. I try to use them alternately whenever possible, or start with 2 doses of ergotamine at onset then switch to butalbital for the 'rest' of the migraine. I think the reason I've been able to avoid rebound, even when having 3-4 migraines/week, is that I have diazepam to use when a migraine lasts more than 24 hours. Diazepam reduces the anxiety ('oh no - still have a migraine - going to lose another whole day - hope I don't have rebound' - etc) and is 'different' enough from the other two drugs.
1. not found
 May 14, 2012
 Teri Robert I know you're careful about distinguishing the terms, but not everyone (including professionals) is, so I wasn't sure if the IHS was using the term 'headache' interchangeably with migraine. I now understand that they mean headache and not migraine. On a similar note....I am participating in the online migraine trial (apoaequorin or placebo) and their online survey uses the term 'headache'. I really think they mean migraine because that's the term used in the migraine diary provided with the study. 
2. not found
 May 14, 2012
 Sally Colby Scholle, glad I could clarify that for you. I understand your frustration. That drives to up a wall too. It's hard because even the field of medicine encourages calling everything a "headache," "headache medicine." One of my pet peeves.
not found
May 14, 2012
I use Fioricet w/codeine <a href='http://capsules.This' target='_blank' rel='noopener noreferrer nofollow'>capsules.This</a> medicine works for me most of <a href='http://time.it' target='_blank' rel='noopener noreferrer nofollow'>time.it</a> says to take 2 every 6 hours until pain is <a href='http://gone.RARELY' target='_blank' rel='noopener noreferrer nofollow'>gone.RARELY</a> do I have to do <a href='http://that.My' target='_blank' rel='noopener noreferrer nofollow'>that.My</a> doctor told me also take this for any headache even if it might not turn into <a href='http://migraine.Does' target='_blank' rel='noopener noreferrer nofollow'>migraine.Does</a> anyone agree with that? Because that's what I <a href='http://do.If' target='_blank' rel='noopener noreferrer nofollow'>do.If</a> I wake up in the morning with a headache I know it's going to get <a href='http://worse.Sometimes' target='_blank' rel='noopener noreferrer nofollow'>worse.Sometimes</a> if the meds don't work I do find myself in the <a href='http://ER.But' target='_blank' rel='noopener noreferrer nofollow'>ER.But</a> again RARELY does that <a href='http://happen.AND' target='_blank' rel='noopener noreferrer nofollow'>happen.AND</a> my migraines usually don't come <a href='http://back.THANK' target='_blank' rel='noopener noreferrer nofollow'>back.THANK</a> GOODNESS!
1. jeffpoleet
 November 13, 2012
 Yes, I completely agree with that and so do many other patients and doctors. Tripants do not work for everyone, and some of us simply cannot take them do to contraindications. Topomax does not work for everyone either, and again, some of us have to use our brains to think, and in my experience that is impossible while taking Topomax. Do whatever works for YOU regardless of what anyone else says about how you should treat your migraines. If it works for you, then you are not in need of their opinion anyway. Glad you found something that works for you!
not found
May 14, 2012
The important thing to remember is that there are too many possible treatment combinations to have "tried them all". Getting a good doctor who knows more to try than a triptan and Topamax is the first step toward good prevention. I have tried over 30 preventives, abortives, and rescue meds since 1985. Only recently have I begun to see the kind of relief that gives me hope. My doctor and I have a dream that I will someday have fewer than 2 migraines a month. We are a long way from that goal yet still making progress. Giving up is not an option so I just keep trying.
1. jeffpoleet
 November 13, 2012
 This is simpy not true, although it is a constant mantra lamented on this board. The fact is, many of us have suffered through migraines for over 30 years, and we have "tried them all." Just because it is not true for you doesn't mean it is not true for other patients. Please quit issuing blanket statments that are not supported by evidence. Some people have tried everything with any reasonable expactation of working for them.
2. teri-robert
 November 17, 2012
 Jeff, It's certainly easy to feel as if we've "tried them all." Still, there are over 100 medications and supplements in use for Migraine prevention. To give each of them a full trial would take over 25 years. In all the years I've been doing this work, I've yet to meet anyone who has truly "tried them all," and that, to me is encouraging. It means there are still options.
not found
May 14, 2012
I have been on Topamax and increased it to 100mg a day, I am now taking co-Q 10 supplement along with it and it has begun to help. I had researched all the holistic and herbal rememdies because there is no migraine specialist in my area and the closest is over 4 hours away. Also , the out of pocket cost is just not in the budget, even with my insurance as my husband just finished chemo and is just starting back to work slowly....So I have to put mine on the back burner for now...but I have tried numerous preventatives(not all, just quite a few and they either don't work or make it worse, or I am a zombie) I have to work so I have to be able to function...I am a nurse so I have patient s to care for and cannot be off my game....So I have tried the herbal path but without too much luck...then I read several studies on the co-q 10 enzyme and it is helping somewhat....I think? I so have some slight short term memory issues with the topamax but I write everything down so that helps....we will see if this works...I do take butalbitol if the migraine gets really, or one of the triptans if I have to....we will see if this works....I am my own advocate.....I am determined to figure out how to not have a migriane everyday and luckily my priamry care doctor is awesome and really tries to help me and figure it out.
not found
May 14, 2012
I've been on topamax for 2 years now and still have migraines. My neurologist just upped my does of it to 150mg at morning and night. I also take Imatrex as needed and Benadryl shots as needed. None of this works for me. I get migraines anywhere from 2-3 times a week and the hospital is getting tired of seeing me. My doctors are getting tired of seeing me and my neurologist doesn't believe in narcotics. I don't have the greatest insurance either. I've tried other things too but not much is working anymore. Not sure what more to do! HELP PLEASE!
1. jeffpoleet
 November 13, 2012
 In my opinion, any doctor that issues a blanket rule to never use narcotis is not doing their job, and you need to find another doctor. Most of this, in my opinon, is a holdover from prohibition, and the idea that taking pain medication is somehow a moral decision. The fact is migraines are one of the most painful conditions on the planet, and anyone that would begrudge you pain medication for this disease does not need to be treating them. Pain medication is absolutely necessary for relief, just as it is for cancer patients and people suffering froma traumatic injury. Any doctor that forbids the patient from taking pain medication has no idea what it is like to suffer though a migraine, and they have no business treating migraine patients. I would get another doctor who is not a sadist.
not found
May 15, 2012
I am going to see a doctor for Botox! That is the next step for me! I have been have migraines so much that I have no choice but to have the rebounders!
1. not found
 May 15, 2012
 I wish you luck on that one!
jgs350
December 30, 2012
I am on preventive meds and i only use abortive when needed but I only use them 4x a week and have to take 3 days off a week in which I have to use alternative methods that are NON medication methods-ice, heat, massage, meditation, darkened room, stretching and I repeat this cycle. I do NOT use OTC medications like tylenol or excederin PERIOD as that would put me in a rebound migraine cycle and yet I still get migraines on a daily basis. I've been on this 4 day on and 3 day off abortive/pain med cycle since I went to Diamond Headache Clinic in 2006/2007 and yet no one can explain to me why I get daily migraines when I do NOT take any pain meds at all 3 days of the week-this includes RX as well as OTC meds. Besides a lot of my preventive meds would be contradictive of OTC meds to begin with. I bristle when someone, even my doctors suggest medication overuse migraines because that is not the use and on my 3 days off I find myself in extreme pain rolling in the floor suffering in silence and complete agony as I cannot take anything at all!
jgs350
December 30, 2012
I cannot due aromatherapy but recently tried essential lemon oil on the temples and scalp. A very little bit and massaged in those areas very well. Not only were those areas very tender and sore to touch it started a warming effect. The jury is out still if it had an effect but the lemon oil is not an offending smell like others-smelled clean and not overpowering and it was soothing.
1. teri-robert
 January 1, 2013
 Hi, Julie, Whatever works for you is great. In aromatherapy, the citrus oils are also good for feelings of depression. A VERY important note that may explain why you had tender and sore areas is that almost all essential oils, including lemon oil, should not be applied to the skin undiluted. They should be mixed in a carrier oil before being applied to the skin. My favorite carrier oil for purposes like this is fractionated coconut oil. It has no fragrance, is very light to the touch, and washes out if you get it on clothes or linens. Teri
jgs350
December 30, 2012
I was under the impression, or was told a few years ago, that taking pain medication daily without end was cause to create rebound migraines and that if you don’t take a few days break in between that your body becomes adjusted too rapidly to the abortive medications and therfore they lose their effectiveness too rapidly than they would otherwise. For those of us that suffer severe migraines when pain level goes to 7 or beyond that is when abortive meds are used but when pain level is 6 or lower I do not use and regardless what pain level I’m at I always incoperate non-medication therapies: ice, heat, meditation, darkness, massage, exercise/stretching, hot baths, essential lemon oil on pressure points. What is a person to do when they are in constant pain that exceeds on what others consider an “acceptable” amount of days a week when they’ve tried other methods traditional and non. I have tried Botox and the insurance does not cover it-it is too expensive to pay out of pocket to try it again at my own expense. I have done acupuncture and it didn’t help and it too is too expensive-insurance doesn’t cover. I did chiropractic up until just this fall and it didn’t resolve the issue and insurance didn’t cover that either. I did biofeedback and it didn’t seem to help, I even paid out of my own pocket for an expensive unit to do the sessions. I follow a strict diet to avoid my triggers and then some to no avail, but I still follow it none the less. I take my preventive meds as prescribed but yet have found no relief. They cannot tell me why I went from sporatic migraines to sudden daily migraines as of May 2010 with no relief. To me that is puzzling and disturbing why I would have a few sporatic migraines here and there and then all of a sudden BOOM here we go daily non-stop debilitating migraines that cannot be stopped and they cannot find an organic reason for them and I’ve never abused my medications and followed my doctors instructions to the T. And when I felt like I was getting nowhere with a doctor I’d get referred to another doctor and start over again. It’s been one heck of a roller coaster ride and I hate roller coasters. Grasping for answers and just getting depressed more and more with the whole thing. If I’m in migraine rebound why would my doctor be prescribing me these medications and telling me that on my abortives not to take them more than 4 days in a row and then to take 3 days off before resuming? I’m totally confused and frustrated. That was the instructions when I was with Diamond Headache Clinic and those are my new instructions with Indocin and w/Sprix-can only take for 4 days a week then stop. With Migranal I can only take 1 dose then wait 12 hrs to repeat w/another dose then I have to wait 7 days to repeat. I am only following Doctors instructions. So are the doctors setting me up for failure? And if so why?? I guess I have a lot more questions to ask my doctor than originally intended when I see him in a little over a week away… PS, Prior to May 2010 I did not abuse OTC pain meds that would cause medication abuse or migraine rebound migraines. So what would a person in my situation take from this-or do in this situation-doing what I've been told if this is the wrong thing I've been doing per Dr. Orders medication wise.
1. teri-robert
 January 1, 2013
 Hi, Julie, I understand your confusion. There's been a great deal of confusion about medication overuse headache (MOH), even among the medical community. Fortunately, there's been a significant amount of research on it in recent years, so we know more now. What happens with MOH, is that if we take pain medications or abortive medications too frequently, our bodies essentially say, "Hmmmmm. I liked that. What did I do to get it? Oh! I made her head hurt. If I make her head hurt, maybe she'll give it to me again." That's a separate issue from losing their effectiveness. Different doctors have different thought on how many days is too many. You can see from the International Headache Society information in this article what the "official" view is. It's really important to look at 8.2.6 and realize that we have to count every day we take anything to relieve a Migraine. In other words, we have to count the days we take abortives and the days we take pain medications of any kind and look at the total number of days. I'd suggest you talk with your doctor about when you take your abortives. You mention that you don't use them until your pain level goes high. Recent research has shown that abortive medications work best when taken early in a Migraine attack. They may not work at all if taken too late in the attack. It could be that you'd get better results on the days you use abortives if you took them earlier in the Migraine. None of us have any good answers for what to do once we've reached the maximum number of days in a week that we can treat Migraines and still avoid MOH. Trust me, I wish I had that answer too because my own Migraines have been chronic again for the last year. I can tell you what I do, which is to use antinausea medications along with non-medication therapies such as those you mention on those days. Reading through your comment, I'm struck with how similar your situation is to what mine was at one point, and it brings a question to mind. Have any of your doctors ever suggested a lumbar puncture (spinal tap) to rule out idiopathic intracranial hypertension, aka pseudotumor cerebri? You can read more about it in our article <a href="https://migraine.com/blog/migraine-comorbidities-idiopathic-intracranial-hypertension/" target="_blank" rel="nofollow">Migraine Comorbidities - Idiopathic Intracranial Hypertension</a>. Breifly, with IIH, the body either produces too much cerebrospinal fluid or doesn't absorb it well. That results in high cerebrospinal fluid pressure. IIH can cause headaches, AND it can trigger Migraines. I was having nearly daily Migraines, but could identify my triggers only about half the time, and preventive medications weren't working. When I was diagnosed with IIH, and it was treated, I had an immediate reduction in my Migraines - the half for which I'd previously been unable to identify the triggers. After that, I could identify the triggers for the Migraines I was still getting, AND we were able to find preventive medications that worked. Does any of this help with your confusion? The best suggestion I have for you is to find a good Migraine specialist - a real Migraine specialist, realizing that neurologists aren't necessarily Migraine specialists, lay out for him or her what you've tried and what you've been doing, and work with him or her to identify your triggers and find a treatment regimen that will work for you. Feel free to contact me directly if I can help you. This series of posts has information that could be helpful to you - <a href="http://migraine.com/blog/migraine-management-essentials/" target="_blank" rel="nofollow">Migraine Management: The 7 Essentials</a>. Teri
jgs350
December 30, 2012
My current RX preventive regimene: Tizanidine 4mg 1x in am Tizanidine 4mg 1x at bedtime Topomax 300 mg 1x at bedtime Verapamil 180mg 1x at bedtime Junel 1-mg 20mcg 1x in am Valium 1/2 of 5 mg in am Valium 1 full 5 mg in at bedtime Remeron 30mg 1x at bedtime My current RX Abortives: PRN Zofran ODT 8mg, 1-2 tablets every 6-8 hrs as needed for nausea Indocin 25mg, 1 capsule 3x daily as needed Migranal Nasal Spray, 1 spray in each nostril. Repeat in 15 min. Repeat dose in 12 hrs if needed. Do not repeat until 7 days . OR use Sprix 15.75 MG Nasal Spray (Inhale 1 spray nasally nasally every 6-8 hrs as needed (not to exceed 4 days in a row) Portable Oxygen 6 Liter/Min for 15 min, use PRN for migraine/cluster headache abortive OTC pain medications are prohibited and are not taken.
1. teri-robert
 January 1, 2013
 Hello again, Julie, Is there a particular reason your doctor has you take your Topamax all in one dose? All the prescribing information says that once it's over 50 mg per day, it should be split into two doses per day. This is for a couple of reasons: <ul> 1. It lessens the chances of side effects. 2. It keeps a steady level in the blood system and makes it more likely that it will work. </ul> Just a note on the Indocin - it's not an abortive. It's an NSAID, and NSAID's don't have the actions necessary to abort a Migraine. It's often used as a rescue medication to offer some relief if triptans can't be used or if they've failed for a particular Migraine attack. Sprix isn't an abortive either. It's ketorolac, the same thing as Toradol, and is also an NSAID. Teri
body
February 4, 2013
Boy, have I been there big time. I loved Imitrex so much. Thought it was my miracle cure. Popped it the moment I felt the first signs of a headache (at that time thought migraine was just a really bad headache with a lot of nausea and vomiting) and away I could go...until I crashed. In between doses, I'd swallow Advil like candy. I discovered that when you get into the pattern of overuse, you can get into chronic migraine. It took me close to six years to clear the toxins from my system. In the process, with the help of a traditional chinese medicine doctor and the guidance of my physician, I introduced a number of integrative therapies like acupuncture, biofeedback, meditation, moderate exercise and healing touch into my treatment plan and changed my lifestyle to eliminate as many triggers as possible. I have to tell you, it was tough those first few years. But now, I am forever grateful that I pushed through it.
1. teri-robert
 February 4, 2013
 Hi, Sharron, Thank you SO much for sharing your experience. Shared experiences often speak more loudly than the medical literature. Teri
2. annie64
 June 2, 2014
 Your post gives me hope..Thankyou x
annie64
June 2, 2014
I have been taking analgesics since my teens. I am now approaching 50 & have never even be offered a blood test to check if my liver is ok. I am afraid to ask, just incase they take them off me. I am currently taking DiHydrocodeine 4 x 30mg tabs 3-4hrly & oxycontin 10mgs added today.I also take citalopram 30mgs od. I have previously tried Migraleve, co dydromol. distalgesics etc.. Anti-inflammatories upset my tummy, as does aspirin. I have also tried the neuroleptics but found them over sedating. I have tried to come off them many times, unsuccessfully. I always say to myself that I will get a proper detox, but the worry just triggers another migraine! it is a viscious circle.
laurabm
September 11, 2014
I'm worried about Bupap withdrawal. I've had a status migraine for 166 days, and I've been taking Bupap almost daily for probably about 5 months of that time. I just read online (don't ask why I didn't realize that barbiturates are addictive--ugh!)that withdrawal can be a serious problem (seizures, convulsions, delirium, even death). I've made an appointment with my general practitioner tomorrow to discuss it, but I'm worried and upset that I've been getting refills for months with no mention of addiction or withdrawal from my doctor. I'm currently taking Cymbalta (from depression and anxiety, but antidepressants are supposed to help prevent migraines as well) and 100 mg of Topamax 2x/day. I take other meds for other issues, but that's it for daily migraine related care. I've tried lots of meds since I began having status migraines last year. I had one that lasted 13 days, another that lasted 69 days, and now my current ongoing one. I've started botox on my physical medicine doctor's recommendation; I got some relief after the first round, but it was during a migraine and it didn't "break" it. I am scheduled to get more botox next week. I'm also going to see a new neurologist. I've received an inpatient infusion of four meds: depakote, magnesium, prednisone, and phenergen. That is what cured my second status migraine. We tried it twice during this migraine to no avail. I've tried blood pressure medicine and amitriptyline also as preventatives. Anyway, I'm mainly wondering if anyone here had withdrawal issues with Bupap (or any other drugs that contain butalbital) that they are willing to share? Thanks, Laura
annequin-harkin
October 31, 2014
I would like to read the entire study. I think it's flawed, as headache is not the primary definer of a migraine. I went without any medication for several months when I was out of work and could stay home. Not only was it excruciating, it didn't lessen the severity or frequency of my migraines. I think they should do a separate study that just looks at migraine sufferers without lumping them together with headache sufferers.
nonster59
November 8, 2014
I have a general on using my meds to NOT get MOH. When I treat my headache on the same day with both Zomig and Indocin, does that count as 1 day of treatment or two treatments? IT is very confusing and I'm pill counting. We can't find a preventative that works for me yet...the human gineau pig right now....
devgurl00
February 12, 2019
i've had a migraine headache since Christmas (almost 2 months). Lots of stress in my life right now and i'm seeing a therapist for that. but the headaches! i'm seeing my primary care and have been given a number of meds -- aimovig, zomig, toradol, zanaflex, and of course excedrin, tylenol and ibuprofen. some days i take them all (watching the acetominophen intake). sometimes that's what it takes. i'm worried about the MOH. but i can't imagine living a day with this headache without relief. what comfort measures work for you?

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