Thursday, November 8, 2012

Migraine Myths: Opiates, Narcotics and Glutamate

Migraine factoid: 

One more reason opiates/narcotics can be dangerous for Migraineurs: they leave residual glutamate in the neuronal synapses, which may render other therapies ineffective.  

Glutamate is the working end of MSG and is an excitatory neurotransmitter which can be a potent Migraine trigger.  It has been placed at the top of a cascade that too often results in Migraine attacks.  Examples of these drugs include Tylenol 3, morphine, hydrocodone, oxycodone, Oxycontin, Dilaudid etc.

Here is a post I wrote some time ago re: glutamate and how it works in our brains, as well as a list of other names this nasty little neurotransmitter can hide under in our food, cosmetics and other products.  We need a balanced amount of glutamate to live, but keeping that balance is tricky indeed.

Anything that potentially renders our other therapies ineffective should be avoided if at all possible.  

It's sad, but many Migraineurs, especially those that are chronic, tend to think that their doctors refuse to prescribe opiates and narcotics for their Migraine pain because they don't believe how bad the pain is.  Please understand - this is untrue and those who perpetuate this lie are not helping patients get better!!  

   Silver Creek Falls, Oregon Photo copyright 2011 Ellen Schnakenberg

The truth is, having Migraine is bad enough, but can you imagine if it got worse?  That is what opiates/narcotics can do for us.  Yes, it helps the pain temporarily, but the damage it can cause can be long-lasting.  If it help an episodic Migraineur transform into a chronic situation, so much the worse. 

As an advocate, I do believe there are times when treatment with opiates and narcotics are appropriate.  This should be a last option however, not a first or second line drug to help with attacks.

If you suffer episodic Migraine or chronic Migraine, please talk to your doctor if you are still using opiates or narcotics.  These medicines are designed to help us feel better, but they do nothing to get to the root of the problem which is the Migraine process itself.  It's true, we want relief from the pain, but that's only the tip of the iceberg.  We don't need pain relief, we need something to abort the process or prevent it in the first place.  

Live your best life,
Ellen Schnakenberg
~patient educator and advocate


Anonymous said...

Thanks, Ellen for your helpful information! I have something to consider…

There are cases where chronic severe Migraine (or in my case Cluster Headaches) can only be treated with traditional long acting opiates. I have been suffering with Cluster Headaches AND Migraines for 22 years (since I was 18). I get the worst of both worlds. It's quiet unfair... kind of like a bald man with dandruff!  Neurologists have argued and disagreed on whether I get one or the other for too many years until an ER visit that lasted about 6 hours of treatment, witnessing the entire process, deemed I get both since I definitely have real Clusters but get aura hours after the initial attach starts. After 22 years and more doctors than I can count trying to treat me without success the ONLY relief I have ever received was with opiates. The pain gets so intense that I have lesions in my brain from stroking not being treated soon enough. I am now on Morphine Sulfate ER all the time and a short acting opiate for breakthrough pain. While nothing will make the pain go away this will at least bring the level of pain down to a 5-7. It saved my life. While I know the medical community has to be diligent to prevent misuse the stigma attached to opiates has caused me years (and years) of zero relief. ANYONE with genuine cluster headaches (or their loved ones) can tell you that this pain is so severe you cannot help but to ask the big question... why go through this everyday? Why stick around when even doctors can’t relieve your pain. With me it was more of a won’t for most than can’t but I digress. There is a reason this is nicknamed the suicide headache. I understand that long acting opiates should be a last resort BUT there needs to be supporting documentation out there stating the benefits with people like me who did not respond to traditional migraine meds. I went years and years trying the same meds over and over (that absolutely did not work) to the point I know more about these meds than most doctors. If you google opiates and migraines there are numerous sites stating that opiates will not help migraines/cluster headaches. Period. Most by doctors. This simply is not true for everyone. I don’t think it takes a FBI profiler, a behavioral psychiatrist, or a crystal ball to be able to tell the difference from someone with a legitimate history like mine and a drug seeking junkie (they never seem that smart…). So, yes for most opiates is not the option BUT… (especially you doctors out there) please don’t rule out the possible need. You may save a life.


Ellen Schnakenberg said...

Hi Damon! Thanks so much for your comment!

I do know that there are times when opiates are necessary, however that should be rare, which really is the point I want patients to take away from the post. Very rare indeed. And never unless everything else has been tried. Since opiates can cause the chronification of Migraine and MOH, they should be avoided until the bitter end.

I can't help but wonder by your comment though, if you are seeing a board certified Migraine and headache specialist? Here is a list of those currently certified and in practice in the US This could be key in helping your situation.

I ask because cluster headaches last seconds to minutes, not hours. Migraine can have symptoms that mimic cluster headache. Cluster headache is not treated with opiates either, but rather other methods such as injectable sumatriptan, oxygen, melatonin etc.

A good way to tell if it is cluster headache is how you act when you are having an attack. If you are banging your head on a wall (literally) and pacing and agitated, it's likely cluster headache or a related disorder.

A good way to discern Migraine is to stand up and put your head between your knees. If the Migraine worsens or pounds, it is most likely a Migraine. If it doesn't - and some non-Migraine patients find relief when doing this - then it is not likely it is Migraine.

Although opiates don't make cluster headaches worse, we know they sure can for Migraine. As a chronic Migraineur myself, I honestly can't imagine getting any worse.

I would really love to see you getting to a good specialist who will not only be able to very accurately nail down your diagnosis, but based on that, treat you with far better results than a neuro who has had precious little training in headache medicine <3

Anonymous said...

I am so glad to read this again. I grasp it better this time and also enjoyed the comments. thanks Ellen michele

Michael said...

I have had Cluster Headaches (CH) for 17 years which are a separate disorder from Migraines, but have certain similarities, including the effectiveness of Imitrex. Around 75% of CH patients can abort a CH in 5 to 10 minutes by inhaling pure oxygen! Doctors don't tend to recommend it because it has no patent and there's no advertising for it, and costs practically nothing to cure a headache. It's not as effective with Migraneurs, but it's absolutely worth a try.

The other thing Migraineurs need to take a look at is the new cure for CH verified in a In 2006, Harvard study which conducted tests using modest sub-psychedelic doses of either LSD or psilocybin ("magic mushrooms") on Cluster patients and found an 80% cure rate! I took the cure last Fall and have had only a few shadow headaches since. Taking the cure is a felony, but who cares when the only other cure available is suicide? And what jury anywhere would convict a person for curing a severe brain disorder? Since the government offers no guidance, I would urge anyone who takes the mushroom cure, to study the cure and know what you're doing. Cluster Busters, and EROWID are two web sites with lots of user info.

Anonymous said...

Hi Dr. Schnakenberg, thanks for sharing the info re the MSG. It's amazing that as research advances it actually reveals how complex, delicate and sensitive our brains our to countless chemicals we sometimes unknowingly put into our bodies.
Migraine headaches have plagued my family for two generation. My mom, aunt, sister and myself have suffered migraines for years. I like your "head between the knees" test but believe me that isn't necessary for me, I'm keenly aware when I've had a migraine.
Over a span of 7 years I've had six doctors, three neurologists and tried dozens of OTC and prescription meds. Aspirin, naproxen, ibuprofen, Tylenol, fiorecet (without codeine) imitrex, axert, cafergot, propanolol, verapamil, Elavil (which I continue to use for depression), botox and herbal teas, physical therapy, I even tried incense and aromatherapy! It smelled good but no relief LOL. Finally my last doctor prescribed opiates and for the first time in almost 8 years I had substantial pain relief and instead of a daily pain level of 10 to 12 it's now at 5 to 7. The quality and productivity of my life is better now, too.
I know good doctors will try the migraine specific medications first to treat migraine patients but if they don't work and all migraine meds and therapies have been exhausted opiates can be an option to help relieve the sometimes unbearable pain of migraine headaches.