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Why is my neurologist so reluctant to prescribe abort meds for my migraines?

I have dealt with migraines on and off for the last 10+ years. 2 years ago I woke with one that has lasted everyday since..until I had my first set of Botox injections end of April of this year. During that time, she has prescribed many preventative medications, but very few (2) abortive medications.I started to get daily migraine about 2 weeks ago again. I understand taking preventative medications, but what about breaking the migraine cycle that I get? Or the migraine that is so severe that it basically disables me from doing anything. Why would my neurologist be so reluctant to prescribe an abortive medication? I originally was on Fioricet which she eventually told me to stop taking as it would cause rebound headaches, that is all well and good..I stopped taking that. I then had a Oxycodone prescription from a surgery. That did more for my migraine pain than it did for the pain I had for the surgery. Obviously I cannot take a narcotic forever so, that leaves me with nothing. No OTC works, I have tried Magnesium, increasing my VIT D levels (was low), ice, rest, increasing my fluid intake, changing my diet to eat better, chiropractor, had my vision checked, MRI, CAT scan, x-ray, checked for allergies, I get enough sleep, taken caffeine pills, coffee..the list goes considering all of this why would she be so reluctant to prescribe anything considering that I have tried all of the above. (she just put me on another preventative today)
Thanks for any information and help.

  1. I think it is because so many pain patients get addicted or misuse the meds. I am on narcotic pain meds and have been for many years. I go to a Pain Management doctor. My neurologist is like yours and if you do go on narcotic pain meds expect a strong resistance or struggle with some doctors you may need to see. The struggle can be exhausting especially if you need to be hospitalized. I currently have a recurring illness and have been in the hospital 4 different times this year. I get lots of opposing opinions and horrible treatment from hospital doctors who do not agree with that type of treatment plan. I have done nothing wrong yet i am treated like a drug addict. It is a struggle for sure. However with the right pain management doctor you can get improved pain control and a better quality of life. That has been my experience. I have learned, however, that if you don't take too many narcotics, and have the mindset that you can live with some pain, not try to be pain-free, you can live your life without being too medicated or too drugged out to function. It is a balance you have to find when you go on narcotic meds.

    1. Avadak,
      I can understand your frustration. I, too, get some relief from taking opioids. However my doctor gives me a small amount that has to last a long time. She knows me well and knows that I don't abuse them. I'm very careful about how many I take and when as they can cause rebound headaches, like so many other Migraine abortives.

      Many doctors are afraid of prescribing too many opioids as the government has really cracked down on doctors who over-prescribe them. It's true that the abuse rate is high, however that leaves those who are truly in pain with less options for treatment. Also, a narcotic will mask the pain, but it does not get to the root of the problem and stop the Migraine cycle.

      Is your doctor a Headache Specialist? This is a neuro who only deals with headache/Migraine patients. Headache Specialists tend to have more "tricks" up their sleeve to use when trying to break a bad cycle.Some will prescribe opioids, while others have a strict policy against it. Here's some info on finding a headache specialist near you:

      There may be some other abortive drugs that may work for you. You mentioned you have 2 now. Are they triptans? And do they help? There is another abortive medication called DHE that many Migraineurs take when triptans don't work anymore. DHE can be given at home as a shot or sometimes an IV infusion of DHE is used to break a bad cycle. Ask your doctor about it if you've never tried it.

      I hope some of this info is helpful.
      -Katie Moderator

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