I know I can’t be the only one out there who’s doing it. Several times a month, I check my supply of rescue medications to be sure I have enough to make it to my next fill date. Between insurance-imposed limitations, medication-imposed limitations relating to allowed dosage, and the imposed limit my doctor writes for my prescription, I sometimes must ration my supplies to ensure I will have enough to last me to the end of the month.
IMPORTANT: All medication use and strategies should be set in consultation with your physician.
A hard choice
There are days, or times during the day, when I must choose whether or not to properly respond to escalating pain due to the fact that I’m running out of medication. I ask myself, “Do I really have to function right now or can I get by with severe pain? Can I get coverage for my responsibilities, such as transporting my children? Can I put off this or that deadline? Can I miss that appointment?” Choosing which days to medicate is an awful choice. Of course, given the option, we’d all like to be fully functional every day. But for migraineurs who are counting our precious medications, we don’t have that luxury.
For many of us, the insurance company limits the amounts of our most effective medications. While our physician might determine it is safe and effective to write for a higher number, the insurer only covers a minimal amount. You may wish to talk to your doctor about appealing the insurer’s decision to attempt to gain approval for a higher allowance of that medication. And, if you have an organized doctor, a responsive insurer, and perhaps a little luck, that may work. Others are left with the option of paying out of pocket for more medication than the insurer allows. Unfortunately, many different types of migraine medication are extremely expensive.
One of the medications that work best for me when I’m in the most extreme migraine pain is ketorolac/toradol injectables. However, there is a limit as to how frequently I can take these. Some triptans also have intake limits. This can pose another hurdle in relation to pain management.
A question of tolerance
There exists a fairly major judgment among those in the migraine community (both medical and patients), who feel strongly that opioids are not suitable for migraine management. There is significant research that shows that this type of medication causes rebound headache and there is a high risk of developing an addiction to these types of drugs. That said, for better or for worse, many migraineurs do take opioids as part of their treatment protocol.
For those of us who take opioids for migraine, we must consider the risk of building a tolerance to these medications over time. There is really no way to avoid physical tolerance to opioids. However, tolerance is different than addiction. Many people who take these medications for migraine have been taking the same dose for years. They are not drug seekers who are seeking a high. They are merely seeking relief from severe pain and for many of us, opioids provide the best pain relief. With opioids and some other medications, the more you take the more you need. Therefore, it is critical to maintain the recommended dosage - never more - even when the pain is out of control and not responding. It bears repeating here that you should always consult closely with your physician about use of all medications, most especially opioids.
A harsh reality
No one wants to be spending time focusing on pills or making choices about whether or not this is a day they can get by without functioning. However, for chronic migraineurs, ensuring that our supply of rescue medications lasts throughout the month is an important, responsible and essential part of managing this disease. The harsh reality is that many of us go many days without effective treatment in order to pace ourselves and our medications throughout the month. I feel certain that, if given the choice, we would all love to be medication-free.
Is this an issue for you? If so, how do you manage the challenge of ensuring you have enough medications to last you through each month? Please share in the comments section below so we can learn from each other.
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