Over the past few weeks, for some reason a question I’ve got a lot has had to do with what scares me most in this world.
I’ve probably given a different answer each time, but here’s the honest one that lives with me every single day: my medicine.
My medicine scares the absolute crap out of me.
There’s this question that is ever present in my mind, especially after having taken medication… Is my migraine coming back full fledged because of my medication?
I mean you can look at my chart above and see on days where my medication does give me some relief (medication use indicated by a star) such as on the 5th and again on the 8th, it seems that within 24 hours of taking that medication my migraine is back and has a vengeance.
This is when I start questioning myself. I doubt if I should have ever taken the medication in the first place. I wonder if it’s worth trying to take more medication prior to my “every three days” rule to just get the pain to back down.
But, I have to stop.
This time last year, I was in a horrible cycle of overusing my medication and experiencing rebound headaches like no other. So of course I’m terrified. I’ve been there. I’ve seen what this is like and I’ve experienced how out of control it can get.
I want to take the time to explain the difference. Mostly for me, to truly have in writing a justification for myself so I don’t have to be so scared, but also for you to understand where the fear comes from along with the differences and the importance of knowing it.
I’ll start by saying, I am using my medication at the proper rate and some days my medication lasts much longer than it’s supposed to. Meaning the physical migraine “pain” has stopped as well.
The thing about medication is that it is intended to relieve pain for around 12 hours. Typically, in severe migraine patients, medication is only ever intended to take the edge off, not even eliminate the pain. Fioricet – my abortive – gives me an average of 5 – 10 hours of relief, and I can feel when it wears off.
A while back, I broke down the “4 days” of migraine that is a typical cycle for me. This cycle has a changed a bit, but it’s still close to accurate.
Day 1 consists of feeling decent, perhaps I’ve got a bit of energy and may tackle a few tasks that I normally wouldn’t. I can usually leave my house, grab a coffee, see a friend without immediately recognizing signs of migraine coming on. Towards the end of the day, I’m a bit drowsy and may notice what I consider a 5-6 level pain creeping in. I define this as occasionally noticing discomfort in my head, sometimes dull pain, other times small jabs. It isn’t consistent and doesn’t interfere with any tasks. I may have other symptoms such as nausea or subtle jaw pain and stiffening of the neck.
Day 2 I wake up and can tell I have a migraine. Usually the pain will stay between a 7 and an 8, and I’m still fairly functional. The pain is constant and other symptoms make concentrating and completing tasks difficult. I occasionally will feel disoriented and often will get dizzy upon standing. Day 2 is when I should take my medicine, as this is the most effective time during the migraine cycle to reduce the pain.
Day 3 the pain is between an 8 and a 9. I typically can do only basic tasks and stay glued to the couch, managing to feed myself, stay as hydrated as possible, and perhaps be active on social media. I can’t watch TV or work on a project, because the noise and light required for these tasks are too aggravating. I can take medicine early on in this day and it has a 50% change of making an impact. I spend the day trying to nap, alternating between ice and heat and waiting for the pain to subside.
Day 4 the pain breaks. Sometimes this occurs late into Day 3, or in the early hours of Day 4. Day 4 is spent recovering, I’m often in a fog and struggle to complete tasks or understand what I need to do. My face and body is tender from the pain and noise sensitivities may still be heightened.
Sometimes the first and last days of a migraine are merged into one, especially if one large storm system is following the one that just came through.
These don’t always fit perfect 24 hour segments, and medicine can change how the cycle progresses.
If I take medicine on day 2, odds are the migraine will break and the days actually get all mixed up. I’ll suddenly have Day 1, Day 2, Day 1/4, Day 3 Day 4. The medicine forces the pain to take a break and suddenly the pain jumps back up to where it should have been had I not taken the medication.
This is where the difference between rebound headache and migraine progression is most clearly laid out.
When you take your migraine medication and it works to the point of you not feeling like you’re not having a migraine attack anymore, you believe your migraine has ended. At the end of the day, you’ve really just put an effective band-aid over the pain. The band-aid comes off and you’re back to where you would be regardless of having put the band-aid on or not.
Now, the obvious solution to part of the problem, is to take more medication. The half life of Fioricet is 35 hours, so as it wears off, technically I could just take more and potentially extend the period of relief. Except, I limit my medication to no more than every 3 days, so this isn’t feasible.
To look at natural “migraine progression” it’s important to understand that an intractable migraine, doesn’t really go away.
But, rebound headaches are a completely different story.
Rebound occurs when you’ve taken too much of a medication or have taken it often enough that your body has started to believe you need the medication in order to feel good so the regular hormones stopped being produced.
When it comes to migraine medications, the side effect of overusing them is “headache”, which is why the term “Medication Overuse Headache” is common among chronic patients. Why? We take the obvious solution of taking that second dose of medication.
Most likely, we haven’t been properly guided with our pain medication. We haven’t been told that even if it isn’t a Triptan, we still should limit the pills to 9-10 doses in month.
When I was first prescribed my fioricet, I had episodic migraines or migraines occurring less than 15 days a month. The chances of needing to take the second dose or even having enough pain days to worry about the limits on medication simply wasn’t an issue.
As my migraines became daily, my medicines didn’t change, I was informed which medicines were safe to use with each other and how far things needed to be spaced out. But not in terms of a month by month – more of a day to day instruction. If I take fioricet at 5 AM and it hasn’t worked I’m safe to take a different variety of medication before bed or around dinnertime. But, I can’t do that day after day after day.
So, I did. I played the guessing game with medications. Most days I took one or the other. Some days I took both. Half the time I took multiple doses. And, my dependency on the fioricet was born.
But how does one tell the difference between the medication either not working, not working enough, or it being a rebound type of situation?
For that, we have to look at the pain itself.
For my whole life, I’ve been able to feel my head pain and look at the radar and see that there is in fact a system moving through. As the system would pass, so would the migraine.
But last Spring, there wasn’t a single thing to indicate “why” my head was hurting so bad so often, and why nothing seemed to even touch the pain. The “why” was because my brain was demanding more medication, even when it didn’t need it.
When you are rebounding from medication, your typical migraine patterns won’t exist. Your treatments and go to’s will be ineffective. And you’re going to run out of medication before you qualify for a refill.
It’s the last one that really hurt me.
After I’d detoxed from my medicines and gotten on the track of managing my medications and limiting them, I ran out of my medicine and had to wait for weeks before getting a refill.
That was in June. I got the refill. That same bottle I got in June is under my sink and it looks like by next month I’ll need a refill.
So even though, I may constantly be questioning should I take my medicine, have I taken too much or medicine too close, having that same bottle and still having medicine left is valid proof that I’m simply experiencing the natural progression and return of my pain, not a rebound headache.
If you are concerned about the amounts of medicine you are taking or would like to better understand long-term use guidelines, contact your doctor or pharmacist.