Wife has daily Migraines. Neuro wants her to quit Vicodin... Need Information.

Question: Wife has daily Migraines. Neuro wants her to quit Vicodin... Need Information.

Answer:

Dear Bob,

Bravo! It's great to see a spouse seeking help for their partner. You don't say how frequent your wife is taking Vicodin, but with nearly daily Migraines, I'm going to guess that it's several days a week. It's very understandable that her neurologist is recommending that she discontinue it. He's probably also recommending not replacing it with a similar medication because analgesics have a very high potential for causing rebound headaches if taken more than a couple of days a week. Here's some info on rebound:

Arghhhhh! Rebound Headaches!
You have a headache. Taking medications is one of the logical things to do. There is something to consider before you take that medication though -- the dreaded rebound headaches. They're caused by taking medications too often. Sometimes just taking a drug for two or three consecutive days can cause rebound.

There's also growing opinion in the medical community that the older triptans, including Imitrex, can cause rebound headaches. Put that together with the fact that Migraines are just plain hard on the body, and it makes really good sense to work hard to find an effective preventive regimen. If the Botox works, that's great, but Botox isn't the only way to go. There are over 100 medications being used with success to prevent Migraines today. Add all the possible combinations of those meds, and you have a situation where, with a good doctor, effective preventives can now be found for at least 98% of Migraineurs. When we do get a Migraine, abortives such as Imitrex are preferred over pain medications because they actually work to stop the process of the Migraine attack. Pain medications can't do that; they just mask the pain for a few hours. If Imitrex doesn't work well, there are now six other medications in the triptan family that are worth trying:

Triptans: Overview and Profiles
In 1992, the FDA approved the first of a class of medications that many Migraineurs call "miracle drugs." That drug was sumatriptan (Imitrex®, Imigran®), the first triptan. Here are both general information on triptans and detailed profiles of each.

One thing we all have to keep in mind is that Migraine is a genetic neurological disease, not a headache. A headache can be one symptom of a Migraine attack, but Migraine is a disease.

You don't say how long your wife has been seeing her current neurologist. If she's been seeing him for a lengthy time, but not making progress, you and she would do well to consider a reputable Migraine specialist with an established track record. Since headache and Migraine are all they treat, they get far more experience than general neurologists and tend to be far more up-to-date in the field. There's a link to our directory of recommended specialists below.

Bob, I could write page after page to you about Migraine disease and its treatment. Since I don't know specifically what information would be most helpful to you, I'll close here, but you're welcome to email with specific questions. You and your wife might also get a great deal from our forums where we share information and support each other. There's also a link to our forums below.

Good luck,
Teri Robert
(answer reviewed by Dr. Krusz)

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