Doc, please help my achin' head

March 29, 2010 2:59 PM

Do you think I could obtain a prescription for Marinol to treat my chronic migraine headaches? I am in NC.

I have suffered from terribly severe migraine with aura for 15 years now. In the past two years the headaches have transformed from sporadic to chronic. I spend days at a time debilitated in bed and generally miss 4-5 work days per month (luckily I am in academia and can easily make up this work by working extended hours/weekends at other times).

I have completely rearranged my lifestyle and work very hard to prevent my migraines from being triggered. I've also tried a lot of drugs (including heavy duty narcotics) to deal with the headaches. They don't work. The only thing that does relieve the pain is marijuana. Unfortunately, as medical marijuana is illegal in my state obtaining it is a nerve-wracking affair. Plus, it pretty much confines me to my home, because it's not like I can whip out a joint while I'm in the middle of work and, furthermore, I am hesitant to go on any vacation at all if I cannot drive to the location. Basically, it severely limits my life but provides me relief from disabling pain. It's a hard line to walk.

I hate having to feel like a criminal and an outcast because I want to manage my pain. I hate that I could potentially be arrested for something that I truly only use to manage my pain. These feelings are magnified by the fact that much more hardcore drugs - including opiates and barbiturates - are routinely prescribed for chronic migraine. I don't like the ways those drugs make me feel. I don't like their addictive nature, and they don't relieve my pain nearly as good as THC does.

So I've been debating bringing up the issue with my doctor and asking to try out a prescription of Marinol. The reason I have not done so yet is because I feel like I will be automatically rejected and then labeled a drug seeker. I guess my question is: does anyone have any suggestions for how to bring this sort of issue up with a doctor? Furthermore, does anyone think a doctor would actually work with me on this?

posted by anonymous to health & fitness (13 answers total)

I think it really depends on where in NC you are. I could see a doc in Charlotte/Raleigh/Asheville going along with you for a bit, and I could see a doc in, say, King immediately calling the police.

If this is really the only medicine that works for you, you may want to consider moving somewhere (say, CA or CO) that works better for your lifestyle.
posted by Oktober at 3:16 PM on March 29, 2010

This depends a lot on your doctor. If you have a positive and trusting relationship with your M.D., I'd say go for it, but if you don't, there is a very real risk of being labelled a drug-seeker. I think a positive approach in bringing up the subject is as an inquiry for information and perspectives on the treatment option, as opposed to asking for a prescription.

It's true, though, that if you lived in somewhere with a friendlier climate, this would not be a problem. I'm in Oakland and there are a lot of very open-minded doctors here who are well-educated on the subject and unlikely to pigeonhole you as a drug-seeker.
posted by doteatop at 3:35 PM on March 29, 2010

Marinol will probably knock you out or overwhelm you with side effects. This is why the medical marijuana movement remains strong-- most people can't tolerate the legal version because, ironically, it makes you too spacey. With smoking, you can titrate the dose, not with the oral cannabinoids now available. So, while it's worth a try-- and a good doctor will recognize you are not drug seeking because the drug is not actually popular-- it may not help much.

Btw, you shouldn't stigmatize opioids while glorifying marijuana: different things work for different people. And being physically dependent on opioids is *not* being addicted. Addiction is compulsive use despite negative consequences; dependence is needing something to function. So, we're all food, water and air addicts.

Though lots of people hate the effects of opioids acutely, if you do take them regularly in a steady dose, you tend to tolerize to the "high" and "numbness" but not to the pain relief. This is why I could hypothetically right now be on a dose of methadone or Oxycontin that would kill someone else-- but not be at all impaired and be totally safe to drive.
posted by Maias at 4:17 PM on March 29, 2010

"... The reason I have not done so yet is because I feel like I will be automatically rejected and then labeled a drug seeker. ..."
posted by anonymous to health & fitness

U.S. medical practice sucks donkey balls in the area of pain management, and so your fears are not unfounded. Given that your career course is in academia, I think you have additional long term professional risks if you continue to try to manage the condition, either with Marinol prescriptions, or street marijuana. Those include the possibility of peer awareness that you routinely take medication, or use street drugs with psychoactive properties, on off-label prescription, if you can even find a routine prescriber, and that, as an off-label user of an FDA approved drug, your results are outside the realm of scientific trial support of the mainline drug indications.

You also have related medical risks. First is that Marinol is not FDA approved for migraine pain control; you're asking a doctor for an off-label prescription, at best, with the effective doses and schedules to be determined in a clinical trial of 1, that being you. Second, because of the relatively long period (2 to 3 hours) between ingestion and maximum effect, Marinol may not be seen by many docs as effective in migraine treatment, where the general trend is to recommend behavioral avoidance or early intervention with targeted migraine meds. That's not to say that most docs presented with an acute migraine sufferer are going to be good at delivering effective pain control outcomes; indeed, the study evidence linked above is against you.

Perhaps you had best, and first, search about you for neurologists with a specialty in migraine management. Perhaps, after a full course of the mainline treatments for migraine, which you say are ineffective in your case, you could convince a neurologist with migraine specialty focus to go with you down a path of off-label prescription of a psychoactive drug, even if only in consultation with a pain management specialist.
posted by paulsc at 4:23 PM on March 29, 2010

I have no idea if she'd go for your idea, but if you are looking for an outstanding neurologist in NC with a specialization in migraines, I highly recommend Dr. Sara Sacco in Charlotte (actually based at Presbyterian Matthews) [phone]. She saved my life, a term I don't throw around loosely.
posted by Sweetie Darling at 4:47 PM on March 29, 2010 [1 favorite]

Have you tried beta blockers? I had severe migraines every 10-14 days and no migraine medication seemed to work for long. It was exhausting and upsetting. Finally, my doc prescribed atenolol twice daily, and it has been a miracle drug for me. I get maybe three migraines a year now, and I can always zap those ones with Maxalt.

Just wanted to put that out there in case you haven't tried it. I don't see any side effects from the atenolol, except my blood pressure is now a little low.
posted by vickyverky at 5:06 PM on March 29, 2010

You mention trying a lot of drugs, including heavy duty narcotics, but have you tried using the triptans (Imitrex, Relpax, Maxalt, etc.)? If you throw up, they have inhalable and injectable versions of Imitrex, and I find that a prescription of Compazine or Phenergan helps with my migraine-induced nausea. Also, they are now using Topamax for migraines. You can take the triptans and Topamax daily for prevention, I believe, or only when you feel a migraine coming on. I sympathize... when I get migraines if I don't get the meds down quickly I start vomiting. I personally take Relpax, Compazine, and Vicodin all at once, because the Relpax does not stop all the pain.

I'm not trying to discourage you from the prescription you want; I just wanted you to be aware of other options.
posted by IndigoRain at 8:36 PM on March 29, 2010

This seems like more than a regular GP can handle. It's really in your best interest to find a physician(s) who specialize in headaches and pain management. There are programs at Duke and UNC, and I'm sure others in the area. Here's the Duke's Pain/Headache Clinic - seems like a good place to start. You don't have to live in this kind of pain alone.
posted by barnone at 8:54 PM on March 29, 2010

I have completely rearranged my lifestyle and work very hard to prevent my migraines from being triggered.

Have you ever considered moving to a state where obtaining the painkiller you require wasn't such a drama?
posted by lalochezia at 10:41 PM on March 29, 2010

I'm starting this answer at 4:20 my time, so I suppose synchronicity is operating somewhere.

There are several problems with marinol as its currently manufactured and prescribed (in the US). (Please interpret the following as based on second-hand information):

-Variations in medication strength. Due, possibly, to quality control issues, users report strong pills commingling with weak in the same prescribed batch.
-Slow onset of the pain relief--you're ingesting, rather than smoking or vaping. Expect a half-hour to an hour or more.
-Lack of analgesic cannabinoids.
-Possibility of consuming more than an appropriate dosage, as is often the case with ingested cannabis.

All in all, smoked or vaped marijuana can be more effective for migraines, when you need relief from the headache, aura and nausea right now. You can't beat the immediacy.

I applaud your avoidance of opiates and barbiturates, both of which can lead to rebounds. I experimented recently with a 50 mg codeine prescription, but found that the pills led to a near-continuous daily headache that could only be relieved by more codeine. Nasty stuff (not for all migraineurs, but for me).

I've had good results with Fioricet, however. It's a mid-range-acting barbiturate called butalbital mixed with acetominophen and caffeine. Most people scoff at fioricet and its aspirin-laced sister, fiorinal, due to the rebound propensity, and prefer triptans. In fact, migraine treatment centers are averse to fioricet (and opiates) and take them away from new patients. They're correct in theory, but the sad reality is that triptans don't work for me, nor do daily prophylactics like Topomax. I control the rebounds by restricting myself to two or three fioricet pills per week. Spacing out the pills seems to cut down on rebound headaches, but YMMV.

Oh, and I'm told through my second-hand source that fioricet combines well with vaped cannabis. The cannabis hits the nausea, the barbituate and caffiene go to work on the headache. You also have the advantage of minimal odor due to the vaping.

In short, fioricet might work for you if you haven't had success with narcotics. Try the triptans first, and then experiment with a fioricet prescription, keeping in mind the dangers of rebounds and possibly addiction for overuse. And, once medical cannabis is legalized in your area, think of registering as a medical user.
posted by Gordion Knott at 12:45 AM on March 30, 2010

Good luck getting your insurance to cover that, so check the price before you go any further. You may be in for an unpleasant surprise.
posted by StickyCarpet at 1:36 AM on March 30, 2010

And, once medical cannabis is legalized in your area, think of registering as a medical user.

If OP is planning to stay in NC, ain't gonna happen in our lifetime.
posted by Sweetie Darling at 3:01 AM on March 30, 2010

follow-up from the OP "I appreciate all the responses. I didn't post this question looking for advice on migraine medications to try. I've tried all of them. I'm just looking for answers regarding my specific question on Marinol. Thanks!"
posted by jessamyn at 7:40 PM on March 30, 2010