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Migraine ain’t an addiction

Pardon my poor English, but the sentiment is clearly true. I have spent a career working in pain management. When people have chronic pain, the issue of using potentially habit-forming painkillers, like narcotics, comes up pretty often.

By the time patients would get to see a doctor like me at a specialty pain clinic, they’d probably have taken their share of narcotics. Many patients were even referred because doctors would be uncomfortable that the patient was taking too many pain pills. Which leads to the question, “Is this patient addicted?”

Patients, their family, and their doctors often wonder if addiction might be a problem. The good news is that it rarely is—even among people seeming to take too much medication. Often, when people seem to be overusing painkillers, this is because the pills aren’t helping and they’re hoping just taking more will make a difference—which it usually doesn’t. There are a few simple facts about narcotics:

  • Pain pills are intended to cause a mild decrease in disabling pain. While you’d think that taking more pills would make the pain get even lower, this is usually not helpful. More pills usually gives more side effects without more pain relief.
  • Pain pills only work on certain types of pain. Migraine pain and fibromyalgia, for example, are generally not very responsive to narcotics.
  • People with chronic pain usually have lots of symptoms besides pain—like anxiety, poor sleep, etc. It’s easy to start taking pain killers to “treat” these other symptoms, which generally doesn’t relieve the symptoms and causes inappropriate medication overuse.

People overusing narcotics or other habit-forming medications are usually not addicted—they’re often inappropriately using their medications to try to make their pain and symptoms better. The overuser takes more medications to get better. The addict, on the other hand, is not trying to reduce symptoms—they’re simply feeding an addiction and continue to take medications even when they see that the medication use is harmful to them. For the overuser, it’s all about trying to control symptoms to get better. For the addict, it’s just about getting medication.

I’ve spent a lot of my career talking to patients and their families about the difference between overuse and addiction. The pain doctor treats overuse, while an addiction specialist manages addictions. So when I saw a new article in the journal Headache comparing personalities of headache sufferers who overuse analgesic medication and addiction patients, I was a bit concerned. It should have been no surprise to these authors when they reviewed their results and concluded personality traits of dependency were not the same in medication overusers treating frequent headache and individuals addicted to substances of abuse. Just seeing the title of the article asking about differences in personality traits in medication overusing headache patients and addicts, however, may result in some people incorrectly equating medication overuse or complaining of frequent migraines with addiction or addiction behavior.

Overusing medication to improve your headaches is generally not helpful—but this is not addiction. It’s important for both migraine sufferers and their doctors to recognize why medication overuse is occurring, which in most cases is to treat symptoms and not to feed an “addiction.”

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.

Comments

  • Lynne Lee Bennett-Cassaro
    8 years ago

    I appreciate most of your article. But, again the tone is diminishing the benefits of opiates. I believed this, when I was an LPN, too. I have a 6 year old “mixed headache”. I have osteo & inflammatory arthritis…and right-sided neuropathy. I cannot tolerate most meds. I take 3-4 Narco a day but it took years and near OD on NSAIDS to get fentanyl patch…the combo helps but again..dose too low at 50 on patch. Opioids have fewer side effects than other meds for chronic pain and they are only underused due to gov’t over-regulation scaring md’s and patients along with gross misinformation and stigma. Steroids destroy bones/immune system and adrenals. NSAIDS destroy GI & kidneys. Tylenol is useless while destroying liver. Seizure meds and antidepressants make us dopey or can cause weight gain or weird side effects. The RA injections are too scary for me too even try. So opiates are my only option. Or, as I told one so called physicain…a bullet.

  • Dr Marcus author
    8 years ago

    Be careful when using narcotics — many, like Vicodin, contain aspirin or Tylenol in addition to the narcotic. It’s important to make sure you’re not taking an excessive dose of aspirin or Tylenol when using these drugs. Some narcotics come without the additional aspirin or Tylenol. Be sure to let your doc know if you’re also using any over-the-counter analgesics, which would also need to be counted in with the total aspirin/Tylenol dose total.

  • Lori Sanford
    8 years ago

    amen.

  • Tracy Brooks
    8 years ago

    The reality of the situation is that the pain meds really do not help with the pain of fibro and chronic migraines; but what other alternatives have been given to sufferers? To no avail I have tried treatment after treatment year after year and still suffering; so if overuse of a certain med makes your life more bearable; go for it!

  • De'Anna Barnes
    8 years ago

    My migraines are caused from having brain surgery..go figure.

  • Nicole Rund
    8 years ago

    Me too!

  • Noreen C. Richards Frederick
    8 years ago

    I’ve had migaines for 43 years, and was given narcotic pain meds for all but the last year, when the neurologist I was seeing left the practice, & now the nurse practioner that took over for her will only give me 9 imitrex for 2 months, and has me listed as a drug seeker! Now I can’t get anything that really helps, from her or my primary care Dr. Where do I go from here?

  • Noreen C. Richards Frederick
    8 years ago

    Yvonne Hersha-Krellwitz I don’t know if our insurance (TriCare-military) will cover that, but I was going to a headache clinic in Ann Arbor for a while, till tricare decided that my neurologist here, could do just as well, but she is gone now, so when I am recovered from the disk replacement surgery, which I hoped would stop the numbness & achy tightness in my arms, but I still have, I am planning on checking into going somewhere else. I see the surgeon in a couple weeks, & start physical therepy tuesday, & the doc said if things haven’t improved, he might have to do more surgery, going through the back of my neck instead the front, that he did the first time. I was hoping it might help with the headaches, but not so far. Anyway, when this stuff is all over, I am going to see about going someplace that knows about migraines, which none of the docs here dol!

  • Dawn A Marcus
    8 years ago

    Narcotics for migraine are a sticky issue — mainly because they really don’t work for most people. Docs are also afraid of addiction, which can limit appropriate prescribing. You might want to look for a mulitdisciplinary pain clinic (not just a place that does nerve blocks) that’s affiliated with a medical center and call to explain your story. They’ll probably tell you upfront if they don’t prescribe narcotics. They will likely also have a broad range of other likely more effective therapies you may wish to try. Good luck!

  • Yvonne Hersha-Krellwitz
    8 years ago

    Mayo’s???

  • Yvonne Hersha-Krellwitz
    8 years ago

    I assume you’ve tried a chiropracter,and have had x-rays.MRI..and the like???

  • Kaylee Goforth
    8 years ago

    my mother has had chronic migrains for years. she has been on pain medication and is overusing medication to help control her pain level. She has had trouble with them for years. I hope and pray when she goes to her neurologist that there is some miracle medication.

  • Dawn A Marcus
    8 years ago

    It might be worthwhile to get your mom some information on medication overuse headache. Although most parents probably won’t respond to their kids telling them what to do, they may respond to the “found this article about headaches that I thought might help.” You could also try a migraine book that includes this info as a holiday gift. If you know her neurologist, they can’t give you information, but you can let them know you’re concerned with how much medicine your mom’s taking — they may actually be surprised to learn how much from you. Good luck!

  • Laurie Sweet
    8 years ago

    I have chronic migraines.

  • dshermjr
    8 years ago

    Thank you, the infromation was very helpful. I currently use 750mg of vicodin jus to help curb the pain. It has been somewhat helpful, but when my attacks are severe I’ll take 2tabs wait 2hours & take more, and still wind up going to the E.R. It makes me feel good to know that someone recognizes the difference between treatment attempts and addiction.

  • gonzo
    8 years ago

    Interesting article. I have even had issues with pharmicists having the “everyone” is an addict philosophy.

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