Avoiding painkiller overuse

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Avoiding the painkiller-overuse rut in migraines

By n Neergaard, Ap Medical Writer – Mon Dec 22, 9:21 pm ET

WASHINGTON – Those pain pills you think help your migraines? Take too

many and you could make them worse. Overusing painkillers can spin

migraine patients into a rut, spurring more headaches that in turn

require more pain medication. A very unlucky fraction even get what's

called chronic migraine, where they're in pain more days than not, and

new research suggests certain prescription painkillers, including

narcotics, increase that risk.

Don't misunderstand: Treating migraines, properly, is important. The

bigger message is to try migraine-preventing medicines if the

tenacious headaches strike regularly — so that you don't fall into the

painkiller rut like Rena Cerbone did.

" It was a double-edged sword, " Cerbone, 41, of Montclair, N.J., says

of a period when only one pain reliever dulled her migraines and then

invariably triggered rebound headaches a day or so later. " I was

taking Fiorinal on a daily basis just to function. "

The caution is timely, as the estimated 30 million Americans who

suffer migraines — migraineurs, they're called — often find the

holiday season a time of increased pain. Lack of sleep, tempting

treats and the stress of travel are common triggers.

The head throbs, usually on one side, anywhere from a few hours to

three days. Nausea and sensitivity to light and sound are common.

Moving makes it worse. Some people can sense them coming with visual

disturbances like seeing pinpoints of light, although lacking that

classic " aura " doesn't mean you don't have a migraine.

Fortunately for most patients, migraines are every-so-often miseries.

Studies suggest that about a third of migraine sufferers have them

often enough to be candidates for prevention medications that can cut

the frequency in half. Yet only about 10 percent use them.

And depending on acute painkillers more than a few days a week can

signal overuse.

" Most people outside the specialty community are not aware of the

concept, " said Dr. Silberstein of Jefferson University,

a spokesman for the American Academy of Neurology. " I think there's an

epidemic in the U.S. of patients having frequent headaches, taking

their pain pills over and over again, " and winding up in more pain.

Overusing any pain medication, over-the-counter or prescription, can

cause a rebound headache once it's stopped.

But occasionally in frequent migraine sufferers, the brain gradually

becomes more sensitive to pain so they worsen even more. When they're

having pain a stunning 15 or more days a month, it's called chronic

migraine or " transformed migraine. " No one knows exactly how many

people get that bad, although migraine specialist Dr. Lipton

of the Albert Einstein College of Medicine says some estimates suggest

there could be as many as 5 million.

" Chronic migraine is a condition we should be trying to prevent, " says

Lipton, who also heads New York's Montefiore Headache Center and

studied whether particular medicines are linked to this worst-case pain.

The study tracked 8,200 episodic migraine sufferers for a year, and

found 2.5 percent worsened to a state of chronic migraine. Those who

took two classes of prescription medications — drugs containing

narcotics, such as Percocet, or drugs containing barbiturates, such as

Fiorinal — were most likely to worsen, Lipton and colleagues reported

in the journal Headache. Risk increased with higher doses.

Over-the-counter standbys, from plain acetaminophen to the

anti-inflammatories called NSAIDS — ibuprofen, naproxen and their

cousins — weren't linked to chronic migraine. The NSAIDS even showed a

hint of protection. Migraine-specific painkillers called triptans

likewise showed no risk at low to moderate use, becoming a risk factor

only after 10 pain days a month.

Some patients will need the stronger narcotics or barbiturates,

especially for severe attacks, Lipton acknowledges. But, " the reality

is they're overused " in migraines, he says, advising that patients who

truly need them limit weekly doses.

Chronic migraine aside, getting out of the medication-overuse rut is

hard. In New Jersey, it took Cerbone several tries before she found a

migraine specialist who cut her prescription painkiller cold turkey

and found a daily prevention medication that has worked since August.

Headache specialists advise:

_Ask about migraine-prevention drugs. Choices range from blood

pressure-lowering drugs called beta-blockers to epilepsy drugs and

certain antidepressants, all of which have side effects to be

considered. Some patients even try Botox injections, to quiet

overactive nerve endings.

_Quit the overused medication, but brace for painful withdrawal. A

doctor may advise different short-term medications to help.

_Use a headache diary to pinpoint migraine triggers and learn to

minimize them.

EDITOR's NOTE — n Neergaard covers health and medical issues for

The Associated Press in Washington.

http://news./s/ap/20081223/ap_on_he_me/med_healthbeat_migraine_rut_5