Migraine & Medication Overuse Headache versus High Dose Opioids

High dose intravenous opioids given in a short burst may become the new treatment of choice for chronic pain conditions. How might this affect Migraineurs?

A recent study showed pain *memories* that occur at the cellular level and help increase the feeling of pain that patients experience, may be erased by a specific opioid treatment protocol.

Doctors in Vienna incited a pain response on the cellular level. This created a *memory* of the pain that made it easier for pain to travel along the pain pathways. When doctors gave opioids in moderate doses as usually is done for pain treatment, the pain pathways remained active and busy. When the doctors gave opioids in high doses over a short period of an hour, the results were different. The pain signals stopped. The *memories* of pain the body retained were gone.

This reminds me of a controversial treatment available in other countries utilizing a medicine called Ketamine which resets the body’s pain pathways, relieving chronic pain conditions.

The way we feel pain is similar to how a freeway comes into existence. Roads usually began as cow paths that people began using. Eventually the road became more popular and more traffic was able to use it. We paved it and more traffic was able to use it easily and faster. Eventually we turn it into a freeway because of the increased traffic and our desire to be efficient, fast and to make our lives easier.

Acute pain may become chronic in a very similar way.

We may feel acute pain because of an injury, however our pain pathways haven’t yet been warmed up and super efficient at letting pain travel through them. Within a short time, these pathways are activated, warmed up and ready to warn you something is wrong by giving you pain, but now at the tiniest stimulation.

Eventually pain travels too easily along these pathways (called amplification) and something that shouldn’t be painful becomes painful. In this case, sometimes something as simple as a breeze can be excruciating. This is one way acute pain may become a chronic condition — the body *remembers* pain that isn’t there.

Migraine is not technically a pain condition, although pain is usually a part of these neurological attacks we endure. When we treat Migraine, our best option and the best first line of treatment is not to treat the pain, but to treat the attack itself by aborting it and stopping it in its tracks. In this way we are attacking the root cause of our pain and the pain goes away. This is only one reason why it is so important that patients treat their Migraines as soon as they are aware of them… to stop the pain pathways from getting good at signaling pain.

Sometimes this is difficult or even impossible. Aborting the process isn’t working. It is then that pain control becomes important. Doctors will sometimes give us pain medicines to help us deal with the Migraine pain while we wait for the attack to resolve itself.

This is a paradox however, because the very medicine that helps temporarily take away our pain can cause further problems when our brains change in response to those medicines.

Even small doses of opioids and narcotics can leave an excitatory neurotransmitter called glutamate between the neuronal synapses in our brains rendering other therapies useless. Physiological changes occur within several areas of the brain that create another painful condition called Medication Overuse Headache (MOH). Migraine itself is tough enough to endure, but MOH is the cherry on the top of the Migraine cupcake of pain.

Now add a chronically painful comorbid condition to a Migraineur’s mix of problems, and it becomes clear that, while we might not want to treat our Migraines with pain medicines, we don’t want to leave Migraineurs suffering.

Will this new pain protocol be useful or helpful to Migraine patients? I hope to come back from the American Headache Society’s Scottsdale Conference next week with more information.

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.
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