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Migraine and prescription history what options now??

I’ve had migraines around 4-5 times monthly for about 10 years now, no aura, single side, set off by smell and pressure changes. I’ve been working with the same Neurologist that entire time who specializes in migraines.

I’ve tried literally every combination of daily and abortive treatments (over 40) including combos thereof. The only one I currently take is Toridol, which can lower the intensity and length from 24-48 hours to 6-12 and pain at maybe a 7 instead of a 9. As this causes potential kidney damage I use it very sparingly.

My main question is around painkillers. It’s obviously a very touchy subject in the US, but I’m at an en passé and want advise. The problem is a combo of general tolerance over time and a genetic resistance of 80% requiring larger than normal doses to begin with.

I started with Tramadol at larger and larger doses 10 years ago starting at 100mg and moving to a dangerous 300mg before finally moving on when even that dose had no effect on pain. I used Stadol next for several years and had some luck with it over a couple years, but eventually I only got the dysporia and strange thoughts with no painkilling effect.

I Then moved to Vicodin and eventually Vicodin HP which I take 4 at a time. The acetaminophen is dangerous at these levels and even 40mg of Vicodin is not even allowing me to sleep or work when I have a full blown attack. I’m sure this sounds like an addiction story, but we did 3 months off the Vicodin to see if my tolerance waned and what side effects I had, and all I had was a bit of diarrhea and sweats for 2 days, no dramatic cravings or massive DTs. The biggest side effects was I had to use all my sick days at work and couldn’t leave bed or go to work during attacks.

My neurologist has suggested likely need the stronger opiates, but is unwilling to take the risk of prescribing them as he says in the current climate it’s far too much trouble.

Based on my history should I pursue the stronger options? And if so how do I approach it? A family member with a chronic pain issue suggested a pain mgmt clinic as they are better setup for it. With monthly drug tests to ensure you are following their protocol and using only their Rx’s.

Sorry for the long post but I just wanted to make it clear I just want relief. Without working painkillers I’m bedridden and have issues working steadily. With them I’m fully functional and am productive and don’t live in fear of the next attack. Thanks in advance for your help!!

  1. Hi Adam! Sorry you're currently dealing with this.

    You mention painkillers, but don't list any of the other drugs/preventatives you've tried. Have you gone through all 7 of the triptans that abort migraine attacks? What happens when you take those? What about DHE? Have you tried infusions/botox/nerve blocks? Has your doctor discussed the new targeted migraine drug that just came out, Aimovig?

    1. Hi Adam,

      Thank you for sharing your story with us. As GardensatNight said, I'm sorry you are dealing with this. Chronic pain in any form is debilitating and exhausting.

      I'm sorry to say pain medications are not the best option for migraine prevention, as they mask the pain, not stop an attack, which is one of the goals of a good migraine management plan. The other thing about taking pain medications is they can change our pain receptors. This article has more information on this topic;

      When we have four or more severe migraine attacks a month, it's time to discuss migraine prevention with the doctor. You mentioned your doctor is a headache specialist - is he/she a "true" migraine/headache expert? A doctor who is board certified in headache medicine? This special certification is different from being certified in neurology and many neurologists who treat migraine/headache patients say they are experts, but that many not be the case. These articles discuss how these doctors are different and how to find one; and

      Don't lose hope! There are over 100 medications and supplements that can be used to treat migraine and it would take over 25 years to try them all in the various combinations and doses!! Here is information on migraine prevention medications;

      I hope this helps,

      1. I share almost the same story moving from tramadol to Fioricet and oxycodone, I was getting addicted always needing more when I consulted with my doctor, he advised to change my prescription to Zanaflex which is also suggested at which didn't work for me. But my addiction and pain never stopped with the help of old friends my hunger was satisfied which actually was creating more trouble, I also started taking medication from different online pharmacies when I stopped at where Leo (employee in the pharmacy) I call him my savior asked me to go with ayurvedic treatment which actually worked for me. Now I even can't remember that when I took any pain medication before for migraine its being 2 years now. here is the link

        Hope that it will help you my friend.

        1. Your story is similar to mine except I have been on to the strong opiates (150mcg fentanyl) -and still failed. I am going to a pain management clinic today.

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