Blue Figure holding neck and looking forlorn

Chronic Migraine and Pain Management

Speaking as a caregiver for someone who has suffered about 10 years living with chronic migraine, I have seen actions, or more to the point, inaction from more doctors than I care to count. It makes me question the oath doctors take when they begin their careers. There seems to be a philosophy that since there is no clear cut diagnosis or specific set of medically testable or provable things that cause some individual’s migraines, then either the patients are making it all up, or that it simply cannot be as bad as they would lead the doctors to believe. This thinking leads to problems for the patient.

Not all doctors view pain management the same way

It would be naïve to say that all doctors view things this way. Unfortunately, it seems they are growing in numbers. I personally know several chronic migraine patients with doctors that freely prescribe them with enough oxycontin to take as many as 4 or 5 per day. I am not saying this is the right way to handle things or that it is the wrong way. As a result, there are a growing number of doctors that simply refuse to prescribe any real pain medication for fear of being monitored (doctor’s words, not mine).

Are there people who abuse these medications? Absolutely! Does that mean that every patient that asks for some type of strong pain medication is a drug seeker? No! My wife had an ongoing prescription for Toradol injections for years. Then the manufacturer had manufacturing problems for a while and that medicine became scarce. Now the manufacturer is back up and running just fine, but the doctors are no longer willing to write prescriptions for it. Why is that, do you suppose? Toradol, in a simple non-medical definition is a liquid form of Ibuprofen, inasmuch as how it works. Same concept. Toradol is an anti-inflammatory medication that functions like Motrin, but functions more efficiently. It isn’t a medication a patient can get high with. It simply helps to break the cycle of a migraine. Its also used as an immediate pain medication for patients dealing with kidney stones.

The catch 22 of pain management

Neurologists here in Texas all seem to be one trick ponies. One will only use Botox. One will do no treatment other than trigger point injections, (which by the way is simply a fancy name for a nerve block). Insurance companies don’t like to cover nerve blocking treatments, so doctors found a way to beat the system by calling it something else so that it can be covered. Other doctors will only work by surgically implanting electrical wires subcutaneously on the skull. Otherwise known as a STEM. The one thing all of these different doctors have in common is that, once they are satisfied that their “one trick” did not work, they want to refer you to a ‘Pain Management” clinic.

I have taken my wife now to three different pain management clinics in the last 5 years. The one thing each of them had in common was that, not one of them prescribed medication for pain. They are also one trick ponies. Their trick is to throw anti-depressants at the patient, because some idiot somewhere along the way decided that was a useful treatment for incapacitating pain.

Caregiver’s frustrations

My frustration lies in the doctors themselves. I am a combat veteran. I understand all too well that I may have a way of viewing things that differs considerably from the way doctors view things. In my eyes, a doctor who is uncomfortable or unwilling to prescribe a medication simply because it may be a medication that is highly monitored, is a coward. I have had this exact conversation with my own doctor. While I try to remain as respectful as possible in doing so, I have told her on more than one occasion that if she is afraid to do her job, then perhaps she is in the wrong line of work. When she tries to throw the government monitoring back as an argument to defend her position, I pose a simple question to her. If you are a doctor licensed to practice medicine in this state and are writing the correct prescription for the correct symptom; why does it matter who is watching?

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

Comments

View Comments (15)
  • kelly banks
    6 days ago

    This article makes me sad. I understand the opioid crisis is real but even the treatment of migraine sufferers at the ER is terrible so maybe we should just video ourselves in a really bad migraine when we are dying in pain and vomiting until the point of dehydration and then go to the dr. Or pain management clinic and say I need something for these days and a preventative if I have one I haven’t tried. Also the survey at the end was also sad! I receive excellent car but my husband has to drive me 1.5 hours away for it. However 82% of those surveyed are looking for better care! Doesn’t bode well for drs. If 82% aren’t helping their patients my advice find a good neurologist that practices at a head ache center! Even if u have to go to a bigger city near u it’s worth it for proper care! My dr prescribes meds over the phone when I am stuck in a cycle and I just see him every 3 or 6 months to tweek my meds as needed! Good luck everyone

  • JPaula
    6 days ago

    Thanks for writing this and pointing out what people with chronic pain go through. Migraine is invisible and we shouldn’t have to fight for pain relief. My insurance company recently sent me s letter saying that they were no longer covering my Naratriptan. My doctor wrote a letter and it was accepted – fortunately. I don’t think we should have to fight so much for treatment.

  • lucylou
    3 months ago

    I am suffering today because my insurance decided to cut my triptans (only thing that work on my migraines), and I don’t have any so I am struggling big time! Sooo sick of fighting either the Dr. or insurance. Have had migraines for over 60 yrs. and Never been addicted but the fight continues and causes a huge amount of stress. This is so wrong, my neice committed suicide over the pain!!!

  • wendy
    3 months ago

    I went to a well known headache clinic in Chicago and it was almost impossible to get a strong medication. After 6 weeks straight of a migraine loop [one ending (stage 4 or whatever) while another was starting] I remember getting 4 soma. At that point it was so far behind “chasing the pain” that it helped out me to sleep but otherwise the equivalent of tictacs. They tried a cocktail of anti-depressents, anti-seizure and blood pressure medications and nothing helped [except promethazine for nausea]. Meanwhile I had more neck pain- probably because after being told to grit and bear it I did- enough to crack some teeth in half. “Luckily” I had 2 ankle surgeries during this time and got some pain meds from that – a refilled those to the max to hoard for later [my Mom say the stash at one point, asked me if I was selling drugs, for real]. They didn’t warn me of the side effects of all of them – major depression- so deep I didn’t realize how bad it was until one day I missed a dose and felt like another person. Add cognition issues- not sure what all I mentally missed or screwed up on but did leave the stove on once and walked away, nothing cooking…and I think it led to losing a job. Another I think caused major adrenal fatigue- like I could I let stay awake 6 hours a day, with a lot of caffeine and sugar at time of diagnosis [as my body barely produced cortisol, epinephrine, dopamine, etc.] Luckily the end I got an integrative doc – he has a MD and did all western medicine for years and then starting noticing some patients getting better out the woo-woo stuff. He did tests, showed a gluten sensitivity and while I have to get back the bandwagon again, that change alone was the best preventative ever. So I get real pain meds [which I actually don’t rebound on – unlike after 2-3 consecutive doses of Alleve], he watches my adrenal function [others would give steroids but never test natural steroid levels in the body], and has been open to a Cefally script (didn’t help me) and a newer triptan I hadn’t tried. For a while he also got me physically therapy/chripractic/with deep neck message covered by insurance [I stopped when I had a period of no insurance.] If you have had no luck and can find a good integrative doc I highly suggest that.

  • kimmersutphin
    6 months ago

    Narcotics do help some of us. I used to be able to go to er and they would give to me. No more. What they do now is leave me in the waiting room for hours and hours and then not help me. I used to only go when I couldn’t get rid of with all the other medicines I take. So that was about once every couple of months.

    Have not been in er in a year or more. I just lay in bed and pray as I am throwing up that time passes quickly and I get better with meds I have on hand.

  • TNmigGal
    7 months ago

    My last Pain Management Doctor got out of the ‘business’ because he couldn’t afford the extra staff needed to keep up with all the new insurance paperwork ‘exceptions’ he was having to process – he was one of the few that was willing to fight for the extra medicine if a patient truly needed it, and didn’t believe long-term, stable patients needed to be weaned back tp the the CDC ‘recommendation’ that all the insurance companies were treating like the end-all new, set-in-stone law it wasn’t. So I went to a newer, large Pain Management Group and was told that they only do one type of surgery on migraine patients and no medications – like you said, how is that managing my pain?? Plus, it wasn’t even covered by my insurance!! So, I went back to an old pain management doctor that I had seen years before and thankfully, he still practiced a multi-prong approach: medicines, procedures, etc. If no one knows what causes migraines and different things trigger migraines and different medicines help migraines, why do some doctors and the government keep thinking that there is one golden cure-all that is going to work for all migraine patients??? That doesn’t hold true for any disease or we wouldn’t have multiple medicines for each disease by multiple pharmaceutical companies.

  • darnapar
    1 year ago

    Unfortunately this lack of prescribing patients with adequate pain relief is leading to suicides. The other problem I see developing is more deaths from liver and kidney toxicity due to an increased reliance on over the counter meds. A third problem is it is increasing the cost of medical treatment was you are shuffled from dr to dr. This is just one more area of life falling to over politicalization.

  • Steven Workman moderator author
    11 months ago

    It is an unfortunate reality we live in today. Any loss of life is tragic, but it seems even more so when someone makes it to a point in their life where they feel that ending their life is the only way to find relief. It feels like we have come to a place where the pain has caught up to the technology, if that makes any sense. Even knowing that long-term use of OTC meds damages our kidneys and liver, we still use them because it is the only form of “control” many people feel they have. I can understand the government’s concern over potential opioid addiction and why they want to limit or remove its use. Speaking as both a patient and a caregiver however, it feels like there hasn’t been enough of a push to provide new alternatives. All we can do is keep fighting until new discoveries are made.
    Steven Workman (author)

  • chica22
    1 year ago

    Amen to that! I am 67 years old and have never been addicted to anything and have never even taken opiate pain medication for migraine. I have had migraines for over 50 years. I also have recently been diagnosed with a very painful disorder called cervical dystonia. To make a long story short…….no doctor will prescribed anything such as Xanax or a painkiller to help me even though I am in constant pain….the cervical dystonia triggers migraine and the migraines make the dystonia worse. They are more concerned with their DEA profile than with treating me properly. I live in Tucson, AZ. I am not sure what to do now. My doctors are not doing their jobs.

  • katdan1026
    1 year ago

    Unfortunately this us the new reality. I work with a family practice and as of January 1, 2018 the Fed’s really are monitoring the number of opiods being written by each practitioner. All medical records are electronic, especially at your pharmacy, so it is easy to track how many of each drug a certain prescribe writes. Write too many, your MD license is in jeopardy of being pulled. Problem is, no one knows what that magic number is, so they are afraid to write controlled substances except for extreme cases and then in limited amounts. Every one else goes to pain management. I don’t know why your pain management doc refused to write rx’s, that’s why we refer to them. Maybe because you asked for toradol which isn’t an opiod??

  • chica22
    1 year ago

    Interesting that doctors are not prescribing needed medications to those of us who need it and would use it appropriately…….BUT the addicts still get their drugs and the pain institute doctors still prescribe the majority of pain medications. The only ones NOT getting appropriate medications are the patients who actually need it. Let’s see, how effective is that?

  • chica22
    1 year ago

    The above was a response to katdan1026. Wasn’t sure how to do that.

  • Sil61
    1 year ago

    Fantastic article. So true! My family doctor stopped prescribing anything that could be abused. Even sleep medication. I was frustrated but this made me realize how wrong it is.
    Thank you.

  • Steven Workman moderator author
    11 months ago

    I have experienced medical professionals (both doctors and nurses), that had personal issues with one medication or another. I suppose those experiences are where my issues are. And while I disagree with the government or anyone else deciding to vilify a medication wholly based on what it is derived from, I do understand. Even my own doctor has explained the risks to her own medical license and how she has patients counting on her for their care. Sadly, my only response to that the last time this conversation came up was, “…So am I” Hopefully the doctors on the treatment side and the doctors on the research side can find ways to come together to find alternative medications or treatments that work better in the future.

  • debbieleq
    11 months ago

    I understand the frustration and I have too been told by the neurologist that I need to go to pain management. But from most information I have read as well as the videos of the Migraine World Summit, I think most of the narcotic drugs will make migraines worse. So I kind of understand the doctor, however there are other pain medications that he has told me to buy over the counter that was alarming. Like taking 600MG of naproxen every 3 hours as needed. Wow that sucked. Two days later I was completely bruised from head to toe and he was calling it an allergic reaction. Doing the math that was 4800 MG of Naproxen a day! That seems to me that was a little excessive. But I am not a doctor, so I don’t question it.

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