8 months, no pain meds - long enough?

June 23, 2007 12:36 PM

Have I given the "no analgesics" strategy long enough to work on my chronic daily headache (CDH) AKA "coexisting migraine and tension-type headache"

I have a mild headache, EVERY day.

It became milder after I quit caffeine, chocolate, alcohol, Psudafed and all the foods listed in Buchholz's Heal your Headache.

It became milder still when I stopped using ANY painkillers (I've only ever taken OTC meds) for 3 months (on top of the things listed above).

I'd read that I could possibly get rid of the daily HA entirely, so I kept on with the plan to see if I could "break" the daily headache. I'm at 8 months now, but I also get migaines (mostly hormonal) and so I'm handling them without any meds. They aren't terribly severe, but tend to be long - 3 days. This is getting harder to do in the summer when I have more unavoidable triggers (weather, travel).

I am currently taking Nortriptyline as a preventative, I am also on magnesium, B-2, CoQ10 and fish oil.

Nortriptyline seemed to being helping this winter - I had 3 HA free days in a row; but it isn't doing as much for me this summer. Or perhaps I should say that it has a bigger job to do in the summer.

My neuro wants me to try Topomax, and I agreed, but I wanted to wait until I'd given the "no analgesics" strategy more time. I was hoping it would totally break and then I'd avoid the Topomax. I'm beginning to think this was a mistake on my part.

Now that I've read more about CDH, I'm beginning to think it is unlikely that this will totally break, and I'm beginning to wonder if I will even achieve the study's goal of 6 headache free days in a row.

What's the longest anyone ever tried avoiding painkillers? The longest I've seen is one year in this 2001 study http://www.neurologyreviews.com/oct01/nr_oct01_litmon.html

I'm trying to figure out what is a reasonable amount of time to devote to this strategy.

posted by egk to health & fitness (9 comments total)

This year, when my doctor (an internist) was trying to sort out a daily headache plus tension headaches plus increased migraines, she kept me off of analgesics for six weeks. She felt that was long enough to get over withdrawal headaches and rebound headaches both.
posted by headspace at 1:15 PM on June 23, 2007

Topamax was a miracle drug for me - I had a headache every day for more than ten years, then one day I started taking Topamax, and that was the day I stopped having headaches.

However, Topamax can have some serious side effects. I'm going to be talking about going off it and finding something else with my neurologist really soon. The big side effect is cognitive impairment. It makes you stupid. Really. Try googling 'dopamax' and you'll get some idea of what I mean. You'll often find yourself losing your train of thought in the middle of a sentence, forgetting everyday words ("could you put the milk back in the ... the, you know, the cold thing"), and in general being unable to form coherent thoughts.

It's a tradeoff. Mostly I found that my sum productivity is higher being a little stupider than I should be, but functioning, than being up to par, but knocked out with a headache every day. Lately I've started to have some headaches again, though, so I'm rethinking that tradeoff.

Side note: I've had really good luck in the last few months with Relpax for acute-use in stopping really intense headaches.

posted by dmd at 1:38 PM on June 23, 2007

This isn't what you asked, and it sounds like you're under the care of a doctor, but I had this problem until I started on medicine for my blood pressure. I had never had a problem before, and it's only mildly high. But its so much better now. Just a thought.
posted by dpx.mfx at 2:08 PM on June 23, 2007

Man.. I wish I could be you in a few months, having had the will power to actually try giving up the painkillers. I've had a CDH (or a migraine, whatever) for the last 8+ months, and I swear it's slowly making me crazy.

I'll second that you reconsider the Topamax... I tried it, but had to stop because it made my eyes hurt. Yes, it can also make you stupid, make your hands, feet and other extremities have pins and needles all the time, and can make everything carbonated taste like ass, but it does do wonders for the headaches. It was so bizarre... I could feel a headache starting, then 15 minutes later, it was just gone. Poof. I had literally forgotten what being headache free felt like until that point. However, glaucoma is also another side effect, and when I complained to my neuro that my eyes hurt, he made me stop taking it asap. You have to build up to (or down from) your dosage in small steps, so the sooner you start, the sooner you're likely to get some relief. As usual, everybody reacts differently to different meds, so I'd recommend you give it a try first, and see how it affects you. If it works without too many side-effects, then hot-diggity damn! You'll have a good idea if the Topamax works within a month. If not, then try the "no analgesics" strategy, or whatever else you can come up with.

Also, the blood pressure meds I'm on are supposed to help with my headaches, but so far, don't. They are lowering my BP tho, which is a good thing.

dmd - I'm gonna ask my docs about Relpax now tho, thank for the suggestion. (Sorry for the derail...)
posted by cgg at 4:05 PM on June 23, 2007

For me, Topamax started working within a few days. I remember it being a really weird feeling, just like cgg said - I could feel the headache starting, and then it was as if something reached in and clamped down on the headache and made it stop where it was.

Which, I think, is not a bad description of what Topamax does - or of why it causes cognitive problems. Topamax is an antiseizure medication - in very, very rough terms, it increases the threshold required for activity in one part of the brain to spread to another part. If you consider that thought is all about making connections between different bits of brain, imagine what happens if you make making those connections a little more difficult. Concept One is supposed to automatically trigger Concept Two, but Topamax gets in the way, and you're left wondering what that word is for a round red thing with a stem that you give to a teacher and keeps doctors away.
posted by dmd at 6:55 PM on June 23, 2007

You've lived with this for a long time, so you must already have tried keeping well hydrated and making sure your workplace has good ergonomics. But just in case you haven't, do both those things.
posted by flabdablet at 10:20 PM on June 23, 2007

Analgesics, especially the NSAIDs, can trigger rebound headaches when they're used constantly. But my feeling is that after 8 months, they're out of your system and that headaches which are still going on at that time are manifestations of a different phenomenon. In general rebound headaches tend to go away after 6 or 8 weeks maximum if the patient is really able to cold turkey off them.

Using this kind of analgesic as abortives, on a once or twice a week basis, doesn't seem to get many migraineurs into trouble. I can't speak to your own case, but I know that in my own case I take 650 or 975 mg of aspirin once or twice a month to abort an incipient migraine, with good success and no more ill effects than maybe an increased tendency to bleed the next day.
posted by ikkyu2 at 5:56 PM on June 24, 2007 [1 favorite]

So, it sounds like I am safely out of rebound and now dealing Chronic Daily Headache. Bummer... "The overall chances of true remission (eg, to less than one headache per week) in chronic daily headache are fairly slim, about 15%." But the chances that I can get to 14-15 HA a month with a preventative are pretty good.
http://www.neurologyreviews.com/oct02/nr_oct02_chronichead.html

Reading about Topamax has been really interesting. Many of the symptoms (forgetting words, in particular) are things that I occasionally have trouble with when I am about to get a headache (prodome). It sounds like the problem is a lot more pronounced with Topamax.
posted by egk at 5:34 PM on June 25, 2007

It sounds like the problem is a lot more pronounced with Topamax.

The Topamax effect you read about is an idiosyncratic side effect. It has nothing to do with migraine auras and it doesn't happen to everyone who takes it.
posted by ikkyu2 at 6:06 PM on June 25, 2007