From pill-free to migraine-free

January 24, 2008 4:16 AM

How long does it take to detox from pain meds, specifically those taken for migraines?

Inspired by Heal Your Headache, a book often cited on these pages, I'm trying to give the toss to analgesic migraine meds. The meds I've abandoned are Fioricet (a barbituate/caffeine derivative, used three times a week by me), Ibuprofen, and antihistamines. These meds (apart from Ibuprofen) are considered rebound-headache-producing by the book.

How long -- days, weeks, months? -- does it take to completely flush these pills and their effects from my system?

Also, again following the book's sage advice, I'm quitting dietary migraine "triggers," like chocolate. Is there a similar "get clean" period in effect for these things as well?

posted by Gordion Knott to health & fitness (7 comments total)

My worst dietary trigger is MSG. I will invariably develop a migraine within half an hour of consumption, but it is usually gone within a day. The main problem I had when I lived in the US was trying to avoid it since it is not required to be listed on ingredient labels. It's in most frozen meals, soups, sauces, salty flavoured snacks, and numerous fast foods. I found trying to keep from inadvertently consuming MSG far more difficult than trying to avoid rebound headaches.
posted by happyturtle at 6:05 AM on January 24, 2008

When my doctor was trying to sort out what headache pain was rebound, and what pain was just straight up pain, she had me stop all my painkillers of every flavor for six weeks.
posted by headspace at 6:21 AM on January 24, 2008

Is this something you can figure out by researching the drug in question and its half life? Also, here is a paragraph from this article in the NYT about rebound headaches and pain meds:

Once weaned from medicine, most patients show significant improvement after three months. They also learn their lesson and steer clear of overusing pain pills, research shows. In one study, 87 percent continued to report significant improvement two years after stopping overusing painkillers. Many headache sufferers have been praying for a miracle cure. Now it’s here, though it may not be what they expected.
posted by sneakin at 7:56 AM on January 24, 2008

As a pharmacologist I will chime in by saying this is a difficult question. First, there are multiple drugs with different behaviors and half-lives. Second, it is more than just a question of the drug effectively disappearing from your system, it involves your body resetting. Finally, you are asking multiple and somewhat vague (or colloquial) questions: When will I detox, completely flush out drugs and their effects?

So, to take a stab at the questions. Most of the drugs you've listed above have short half-lives. The general rule of thumb is that after 4 half-lives you have "virtually" eliminated a drug from the system. (In reality you have eliminated 94%.) That should be a couple of days. You probably don't have to worry about the effect of the remaining 6% which will continue to disappear.

Secondly, detoxing follows a similar course, usually slightly delayed. A junkie or alcoholic will detox in several days. Detoxing is removal of drug plus the acute phase of the body readjusting.

Third is the chronic phase of your body readjusting to not having the drugs. The drugs do a number of things including changing receptor numbers, neurotransmitter releases, etc. So how long does it take until your body restores to its "natural state?" I'm going to say the solid research on this is not available. As a rule of thumb I put this on the order of a month. I say that because in other dependencies, the physical addiction is strongest for the first month. If you can go nicotine free for a month you have a much better odd of staying free. This is kind of comparing apples and oranges, but I think there is no direct figure for the drugs you list.

Fourth is "when will I be healthy because I gave up these drug dependencies?" I am an anti-pharmacologist pharmacologist and skeptical of drugs. Nevertheless, there are some cases when the patient does better off with the meds than without. Which is your case? I don't know.
posted by dances_with_sneetches at 8:28 AM on January 24, 2008 [1 favorite]

FYI, Ibuprofen gives me rebound headaches (I call them hangovers).
posted by gjc at 8:45 AM on January 24, 2008

Just to put into my 2 cents, I've found Ibuprofen alone does not cause rebounds, but Ibuprofen with any sort of caffeine does. My neuro agrees with my hypothesis, as well. Basically, I can exist in a world that has either Ibuprofen or caffeine, but not both. Actually, now that I've found a preventative and a dosage that actually works for me (Verapamil) my world includes caffeine and the occasional (once every couple of weeks or so) double dose of Ibuprofen for the bad days, after which I stop the caffeine for the day.

Good luck - your solution is out there, it just takes time to find.
posted by cgg at 9:15 AM on January 24, 2008

cgg- Interesting! Thank you.
posted by gjc at 1:31 PM on January 24, 2008