09 May 2012

Migraines and medications and analgesic rebound

I've been taking narcotics chronically since October 2010, because of the residual back pain. I had taken them from Nov 2009 to May 2010, while I was on warfarin for the post-op DVT/PE. Because you are my adoring audience, you are well aware that I had a 2nd DVT (not yay) in Oct 2010, which required me to take rat poison forever (also not yay, but at least I didn't have another PE). NSAIDs (those lovely anti-inflammatory meds) also thin the blood and make bleeding ulcers and bleeding in worse places (like the brain. I'm fond of my brain as it is...) more likely when combined with warfarin. For this reason, my hematologist limited me to a total of 8 naproxen 220 mg tablets (Aleve) per month. I can't tolerate the majority of neuropathic pain meds (my brain is messed up enough and those meds make it even worse!), so they are out. Thus, I went back on narcotics to keep the chronic back pain under control.

I hate the idea of taking hydrocodone daily, so I keep it to the utter minimum -- one half of a 7.5 mg hydrocodone tablet daily, with some days requiring a whole one. It's a very small dose, and I haven't had to escalate the dose in the year and a half I've been taking it. Recently I've wondered if I could actually come off the daily hydrocodone. The back pain is tolerable though still present. I have no other ailments right now that require pain meds (hello, comminuted fracture of left wrist).

So I stopped taking the hydrocodone on Sunday. And I've had a migraine now for the past 2 days. The back pain has been manageable (!) but this headache is really annoying. I suspect that there is a component of analgesic rebound to this migraine, which is especially irritating.

Analgesic rebound headaches (ARH) are chronic headaches caused by overuse of short-acting pain meds (analgesics). They are notoriously tough to get through. They can take up to 2 weeks to resolve, and one has to be careful not to substitute another short acting analgesic medication for the offending one. I've supported many a patient through this process. I just would prefer not to have to go through it myself, to be honest. This morning, I was forced to use up one of my precious Aleves, as I woke with the same migraine I went to bed with (no, I'm not talking about TheHusband, you silly people). Aleve usually works for me to abort a migraine. Not today. I hate when I experience first-hand what I've treated patients for.

I will stop complaining and look on the bright side, now. Thanks for listening.

Update 5/11:

Migraine pretty much gone. The back pain is definitely worse, especially in the morning. I was hunched over quite a bit this morning, but moving better by the afternoon.


Random Michelle K said...


Wish I had something more.

Shawn Powers said...

Me too, headaches suck. :(

Phiala said...

Ugh. I hope the headache resolves quickly.

neurondoc said...

Boom-boom-boom. Still pounding. I'm a bit nauseated, too. But my back doesn't hurt more than usual, so I'm thinking positively.

Xine said...

{hugs} Wish I were closer and could do something to help.