Rebound/Medication overuse headaches

I am a 33 yr old female that has had migraines since childhood.  In the past two years, I have been taking fioricet, vicodin ES, Motrin 600, phenergan or a combination of these meds for my headaches and nausea. I am now up to approx 100 pills a month and 1 -3 ER visits a month, having anxiety attacks and when I have tried to gradually get off the meds, I end up in the ER with a killer migraine.  I am seeing a new neurologist who is trying to treat me with topomax (topamax), which has not worked, and after reading more about these types of headaches, I see that this type of medications rarely work when you are experiencing rebound headaches. Today, when I went in at the end of my rope, he suggested I up the dosage of topamax and add some more meds......He told me to keep taking my pain meds .....I WANT TO GET OFF OF THEM......they are causing the problem!!!  When I asked about detox, he told me it was only for people who are on morphine and stuff and dismissed the fact that I am missing out on half of my life right now due to pain.  What do you think? Thank you for any of your own opinions!

[DrRakeshMD]

Hi Dear

Sorry to hear about all this. You seem to be having pretty frequent and severe migraine attacks. Unfortunately there is no permanent cure for migraines. The patient can take medications only to reduce the intensity and severity of attacks, and to reduce the frequency of episodes. The medications that you have been taking in the past have been a combination of nonsteroidal antiinflammatory drugs (simple pain killers) which reduce and alleviate pain during the time of attack. However, because you suffer from frequent attacks of migraine, you are an ideal case of starting regular prophylactic therapy for the disease to reduce the frequency, severity and duration of attacks, and to increase the responsiveness to acute therapy given during an attack. The first line therapeutuc agents for the prohylaxis of migraine include propranolol, timolol, topiramate (topamax) or valproate. As your physician has begun treatment with topamax, i am sure it will benefit you in the long term. Hence, please continue on the advice of your physician.

Best..