Breaking my own rules
Okay. It’s confession time.
I was packing for my final trip of the summer when I made a startling discovery. Flipping open the pill box containing my naratriptan, I found just four little green pills. Quickly calculating the worst case scenario, I realized that I might need more to safely navigate the round trip.
Normally, four pills would last me almost a month. But traveling was full of atypical triggers, any of which could swallow up all four of those pills and leave me without any abortives for the rest of the month. So I hopped online to request a refill. A few hours later, the pharmacy called to inform me that my insurance had denied my request.
I was not surprised and prepared to pay out of pocket using a discount card just for peace of mind. That meant that I would pay for a month’s supply of medication out-of-pocket. I didn’t like shelling out an unnecessary $60, but I would do it again if that’s what it took.
This may seem odd to those of you who are familiar with my writing. I have taken a pretty hard-lined stance against the use of pain medicines more frequently than 2-3 days a week. My willingness to use triptans more frequently must seem hypocritical. I can certainly understand how it seems that way. I was planning to have access to enough medication to treat 6-13 migraine attacks within a very brief window – far more than just 2-3 times that week.
Within the first week after my last refill, I’d already blown through 5 pills in just 12 days because Botox wore off before my appointment for the next round. This was in excess of the recommended frequency and also highly unusual for me. At the Botox appointment, my doctor and I discussed the matter (as well as my impending travels and the trigger risks). We both agreed this was a temporary setback and not a long-term reality. If I were to continue experiencing attacks of that frequency, we would assume that Botox was no longer working and try a different preventive treatment.
We are watchful, but not yet concerned about medication overuse. Here’s the deal with medication overuse that often gets overlooked. Using too many medications increases the risk of developing medication overuse headache. It doesn’t guarantee it will happen. Plus, short-term increases in use are not the problem. It’s when we use too many medicines day after day for months on end that we can create a problem. The official diagnostic criteria state that medication overuse headache occurs when patients use pain medicine more often than 2-3 times per week, every week, for 90 days or more. It’s this kind of chronic overuse that can get us into trouble.
That doesn’t mean there aren’t times when it is absolutely appropriate to use pain medicine more frequently. It’s a judgement call that is best made in collaboration with our respective doctors. This time, it was my turn. Maybe next time, it will be yours.
Can you tell when a migraine attack is coming?