Migraine - Rebound

Shaheen,

I've never used the medication you are using but found one study online where 2.5 was used as a preventative therapy. All other information points to medication overuse headache which actually causes a migraine type of headache. Early on in my migraine treatment I had a neurologist tell me to never take another over the counter pain medication, he explained MOH and said over the counter meds are too easy to use too frequently. I had been popping aleve and excedrin migraine like tictacs and stopping them sucked, so I'm sure stopping a triptan would be a lot worse. The problem with MOH is that the only treatment is to stop taking all pain medications. You are going to go through a withdrawal period, so things will probably get worse before they get better. Once you detox you can resume recommended use of the medication, and they can rule out MOH which will exclude you from other treatments such as botox. I read some people go into the hospital to detox, or taper the medication. I would discuss those options with your doctor since they want you not to take it daily.

Do you still experience headache frequently? If not I would bring up the study of naratriptan as a preventative. Did you change doctors? This would explain a differing treatment approach. If not, a conversation for your doctor should address what changed that they were ok with prescribing a daily dose for so long,allowing you to get to this point but now all of the sudden they want you to stop. If they are adamant you have MOH or other health risks, such as heart problems that brought on their change of treatment there few options. Your expectation probably should not be to continue triptan/pain medication daily, since it would not change anything with MOH. Instead maybe discuss an expectation of a taper in dose such as alternating 2.5 and 1.5 with a goal of 1.5 daily. Then lessen frequency, such as 1.5 every other day, then every three days etc until you are off. I know you mentioned tapering, was bad, but it will probably NOT be pretty. They should expect to be ready to admit you to a hospital if it comes to that if a taper isn't working, especially if they are the ones who allowed you to get to this point. I suggest possible trigger point injections and nerve blocks for temporary treatment. I had them and got worse before I got some relief but again some relief. If you want more detail on those PM me. I've also read about migraine treatment where people get a pic line in an inpatient setting where they administer lidocaine, not sure if it would contribute to MOH but wouldn't hurt to ask.

I recently tapered off of an antidepressant I had been on for 7 years on instruction of a new headache clinic doctor. Even tapering was rough, and it took about a 1 1/2 - 2 months. I was an emotional roller coaster the whole time, and for a while afterward. I was in h*ll. Though I haven't gone through your exact situation, I understand your fear.

Jenn

I agree 100%! But I don't have an answer. Find another Dr maybe? Rebounds are a great concern, but so is our real pain. It sad when we have to plan vacations around our medicine refill date. I hope you get to the point you don't need medicine, but until then just know you are not alone.

I don't know if this reply will be popular, but I have a very good doctor friend who knows a bit about migranes who says that rebound headaches DO NOT come from triptans, they come from paracetamol/ibuprofen (i.e over the counter meds).  He says you cannot become adicted to triptans as such - but I said I was addicted to them in terms of 'i am adicted to not having a migrane' if you get me?!

Anyway - it's obvioulsy not an ideal situation to be taking loads of triptans, but i know how it can happen....