The Danger of Abruptly Stopping Migraine Preventives
There is an enormously long list of potential Migraine preventive medicines available to patients whose Migraines have begun to take over their lives. When we start to take these medicines, our doctors give us basic instructions how to get started with them. In the odd circumstance where information on starting our medicine comes from our pharmacist or medication label, at least we are receiving the information that will hopefully lead to a positive experience with starting the medicine.
Not so with discontinuation of preventive medicines.
Patients must have their doctor’s seal of approval when beginning a new preventive medicine, however there is no *prescription* for stopping a preventive. In other words, we can’t get a medicine without our doctor’s written instructions and approval, but we can stop it without our doctor’s knowledge, approval or instructions.
Just because we can, doesn’t mean we should.
The fact is, preventive medicines often take a very l-o-n-g time to build up in our systems to a point that they can begin to help us. Once our bodies have begun to adapt to the presence of these powerful drugs, discontinuing them abruptly creates an imbalance that is often serious, and potentially even fatal.
Start low and slow
Patient compliance is the willingness for a patient to take their medicines as directed. We want to do everything in our power to make it easy for all of us as patients to continue taking medicines, and our doctors want to help us too.
Doctors use a system called Titration to help us slowly build up the amount of medicine we need in our bodies to be helpful in preventing our Migraine attacks. In a nutshell, titration means – – beginning a medication at a very low dosage, and increasing it very slowly over time until an effective and helpful dosage is achieved. The more sensitive a patient, the more time it usually takes to titrate their medicine to a helpful dosage.
Some reasons doctors titrate preventive medicines:
- We don’t want to start a medicine too fast, as that can lead to unwanted side effects that often won’t be as much of a problem if dosage is begun low and increased more slowly. Most of these preventives were never designed for Migraine, but helping reduce frequency and severity of Migraine attacks was discovered as a beneficial side effect. This means there can be other potent effects that Migraineurs don’t want or need — a less than ideal circumstance to be sure. Because many of these medicines are strong and come with a myriad of side effects that are often dose dependant, starting out low and increasing our dosage slowly is usually the most conscientious way to begin a new preventive as our nervous systems and bodies slowly adapt to the changes being made by the medication. Typically, the slower, the better. If we don’t give our nervous system enough of a chance to adapt slowly, side effects can become unbearable to the patient and compliance is likely to drop. Patients will be tempted to stop the medicine on their own before they have achieved the maximum benefit. Not only does this often lead to discarding a potentially helpful medication that could change their lives for the better, but discontinuing some of these medications inappropriately can actually be a dangerous proposition.
- We don’t want to start a medicine too high, because it is possible the patient doesn’t need a high dosage to achieve the preventive effects both doctor and patient are seeking. Higher doses also often lead to more significant side effects, and a more difficult life for patients who are already compromised by their Migraine attacks. Again, more side effects often lead to decreased patient compliance and frustration for everyone involved.
Physicians know that abrupt discontinuation of some medicines can be dangerous, but they often forget to tell their patients about the importance of working with their doctors closely during the titration period, and how vital it is not to discontinue or change any medicine in their management protocol abruptly, no matter how long they have been taking it.
Most preventive medications must also be titrated back down to safely discontinue them. This is best done under the guidance of your physician.
Patients are often frustrated when an unwanted side effect hits. This is compounded by the frustration of trying to contact their busy doctors for information that might be vital to their experience.
Please, do not ever change anything in your Migraine management protocol without first discussing it in detail with your doctor. This means adding or subtracting or otherwise changing in any way any prescription medications, over the counter preparations, vitamins, minerals, herbs or other *natural* therapies.
As a medical first responder, I have seen many cases where patients ran out of expensive medications they couldn’t afford, or were unable to get a new prescription because a doctor has been away on vacation, or many other problems that lead to abrupt discontinuation of medicines and serious consequences. Sometimes it is the patient’s choice, and other times it is beyond their control.
The fact that immediate emergency medical aid was necessary for these patients, should emphasize to everyone the seriousness of the situation. I have not yet been with our team when a patient died as a result of discontinuing their medicines, but I am sadly aware of other times it has needlessly happened.
Tips to avoid abrupt discontinuations:
What is within patients’ control is to manage our condition thoughtfully. Plan ahead both financially and with our time. Here are some ideas:
- Calendars. Write in your calendar at least one week before a prescription needs to be refilled.
- Technology. Set a reminder in your phone at least a week in advance of your next needed refill. I have even tweeted myself direct messages to help me manage my medicines.
- Labels. Look at your prescription bottles when you receive them, so you’ll know when you are using your last refill. Use that month’s time to contact your doctor and get a new prescription.
- Responsibility. Do not depend on your pharmacy to contact your doctor when a new prescription is needed, that is your responsibility. If your doctor is not in when they try to call, your prescription will not be refilled.
- Ordering. Do not wait until the last moment to order your next refill. Pharmacies sometimes run out of medicines and if they are unable to fill your prescription at a day’s notice, this may leave you without your needed medication.
- Planning ahead. If your insurance insists you mail order your medicine through them, it is possible you may not receive your medicine on time or without damage. Consider asking for an additional spare prescription for your medicine, to be used only if necessary to avoid an abrupt discontinuation of your therapy.
- Coupons. When it’s time to order your next refill, check online for money saving coupons by searching for the name of your medicine and the word *coupon*. Ask your doctor if he/she may have money saving coupons that can help you with your medicines.
- Shop. Contact all local pharmacies to see where you can get your medicines for the least outlay of cash. If this is a frequent issue with you, be sure you do this every time you need a refill. Prescriptions can be moved from one pharmacy to another, and often instead of moving a prescription, pharmacies will often offer to match prices.
- Remember. Side effects often lessen over time. Sometimes they even disappear altogether. One of the hardest parts of using preventive medication is the patience it takes for us to get through the titration period and trial weeks or months, so we’ll know if the drug will even work for us. Nobody will tell you it is an easy process, but most will tell you that it is really worth it when you can find a medicine that will help you.
- Talk. Keep the lines of communication open with your doctor and his/her staff. Expect time, explanations and action, but not miracles. Doctors and their staff are people too. If you have trouble with this, it might be time for a second opinion or new doctor.
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