Question: Chronic headaches, opioid rebound, caffeine?
Answer:
Full Question:
I am a 45 y/o male who has been suffering with
headaches about 10 years. They started out mild to moderate and I used OTC sinus
meds and Tylenol. Over the years they worsened and I saw several neurologists. I
have been on almost every anti-depressant know to man, I've had Botox, nerve
blocks. I've been on opioids (which have caused rebound headaches). I have been
diagnosed with atypical facial pain and chronic daily headaches. I am currently
taking naproxen no more than 3x/week, Migranal nasal spray (no more than 3x/week
and Compazine (also no more than 3x/week). I take amitriptyline every night and
Zyprexa occasionally for pain. I am at the end of my rope. The most relief I get
is from a "10" to possibly and "8". Do you feel that the rebound headaches will
eventually lessen and that I can expect some relief as long as I don't go back
to the opioids? In addition, how much of an role does caffeine play in this
cycle? I am down to 12 oz per day and 1 cup of tea. Daniel.
Answer:
Dear Daniel;
There are so many factors in perpetuating chronic headaches that it becomes impossible to sort out issues that may be operative in any one person. Caffeine and NSAIDs certainly can play a role. Have you seen a headache specialist? Many people think that the neurologist is the natural type of physician to see for headaches. This is simply not true, as many neurologists aren't overly interested in treating Migraines and headaches and doing intensive long-term management. You are on some "primitive" medications and there are a lot of newer items on the market. A sound sleep pattern is also very important.
Rebound lessens only when you stop the offending agent for a period of time, then limit acute treatment with meds in the same class to two or three days a week as you're doing with Migranal. (i.e. Treat with Migranal, other ergotamines, and/or triptans no more than two or three days a week and opioids limited to two or three days a week.)
How much a role caffeine plays in your cycle is something we really can't answer because it depends on the individual. For some people, even one cup of coffee will trigger a Migraine. For others, it's not a trigger at all.
Ultimately, the best would be to find effective preventives so you don't need acute treatment often enough for rebound to be an issue. antidepressants, Botox, and nerve blocks still leave you with more preventive options to try than all of those put together. Given your list of issues, seeing an actual headache and Migraine specialist should be your next step. If you need it, there's a link below to our directory of recommended specialists.
Good luck,
Teri Robert and John Claude Krusz
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