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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.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.


  • Candy Meacham
    3 years ago

    Lately, thanks to the SpringTMS, I am usually able to stay within the recommended limits of my abortive meds (naratriptan). However, when I get sick w/ a cold or flu or travel, I invariably need more. Then, as soon as I get better or return home, my headache frequency declines. I recently got a one-year insurance approval for daily naratriptan use – which I don’t need or use, but it means that I don’t have to pay out of pocket for those short-term extras. There is evidenced-based research that supports daily use for migraine for some.

  • Brooke H moderator
    3 years ago

    Hi Candy, Thank you for sharing your experience with abortive meds. It sounds as though you’ve done an excellent job advocating for yourself with the insurance company for an approval. Also, as abortive meds typically don’t benefit most people when used too often, everyone is different and it’s important to develop a plan that works for one’s specific needs. It sounds as though that’s what you’ve done! Please feel free to share here anytime and keep us updated as to how the TMS is going. Best, Brooke ( team)

  • Elliegal
    3 years ago

    Last February hubster treated me to a well deserved 4 night vacation in St. Croix. Needless to say, as a migraineur, I suffered thru the first part of the month just to make sure I could take as much of my abortives with me as possible. Not only flying, sunlight, And noise, but alcohol too can all be triggers for me. I, like you, can totally relate to wanting to ENJOY my vacation. It’s so not fair to have to resort to rationing medication that helps us function!

  • ddnben
    3 years ago

    I find it interesting that we all know (or at least I do): 1. How many pills we have left; 2. When we can refill our scripts; and 3. How long we can make it with our current script. I find myself doing that as well when I know I am going somewhere. And while you are definitely correct about rebound headaches, it is hard to think that way when your are in the middle of an attack. I completely relate!

  • Tammy Rome author
    3 years ago


    I guess I didn’t make that clear. My doctor visit occurred AFTER the trips, when I received my last Botox injections. We discussed the events (as I always do when my attack frequency increases) and determined the spike was due to Botox wearing off and agreed I would contact him if the frequency didn’t decrease back to baseline.

  • AFFoster
    3 years ago

    @tparma Unfortunately not all of us have any great way to be proactive about our migraines. Steroids just mean I won’t be sleeping anytime in the next two weeks, so any good they might do is cancelled out. All my doctor could possibly do is write extra abortives, and I’ve never found a doctor or insurance willing to go there. Hoarding and praying for good days it is!

  • AFFoster
    3 years ago

    The mandatory monthly ‘survey’ I had to fill out for each appointment with my former pain management doctor asked patients if they kept count of their meds, worried about having enough meds, had times where your meds weren’t enough for that month, etc. Answering yes to any was a ‘negative’ score in their way of measuring who was most likely to become a med abuser. Needless to say, they were less than exemplary in treating migraine patients!

  • tparma
    3 years ago

    The fact that you discussed your upcoming trip with your physician along with your concerns of having a migraine bothers me that they weren’t proactive. My Neurologist, after such a conversation, wrote me a script for a 10-day steroid which I started three days before a trip for my daughter’s wedding (lots of triggers there). I had a wonderful experience! No abortives required. The weather (stormy at times), alcohol (which I did avoid), last minute stressors and, of course, the emotional roller coaster were all conquered thanks to Botox and the steroid and my phenomenal Neurologist! I have great memories not new migraine ones.

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