Drugs. How do they work?

I really know little about them and how they work.

I know they have a time to kick in, and they have a half life.
I was also told about the pain gate and not waiting until the last dose has totally dipped before taking more.

But, given we seem to be a bit different us miggies, with the threat of rebound/MOH.
Do the drugs perhaps behave differently in our brains? And if so why? Is it a clue as to why we have migraines?

Why do we seem more susceptible to rebounds?
Is it the drugs we take or the amount or way we take them?

If an OTC is every 4 hours and someone takes a dose at say 9am.
But doesnt take any more then for several days,
How does this make the brain seek more of the drug?
Seems a long time. Doesnt sound like an addiction...

Is MOH like addiction?
I know someone who got addicted to Syndol for headaches.
In fact she is still on them. She has daily headaches, but her sister, my neighbour, says she is addicted to the tablets.
Is that the same as MOH? Or is addiction different?
How does the brain decide....

I am fascinated by this. I know we have people on here far more erudite than I.
Should I tell my neighbour, who wants to help her sister stop the drugs that she is probably in rebound?
Or is she addicted to the drug (probably the codeine)?
How do we tell the difference if there is one.
How does the brain chose? It is the brain presumably.

I bow to your superior knowledge, but be gentle with my ignorance please.


Pen

Oh Darlin', I would stay far far away from this. My sister firmly believes that I am addicted, as do other people because they don't understand pain management. They hear the word vicoden and boom, they're off and running. Am I physically dependent? Yes. Very much like there are many drugs such as steroids that you have to taper off of, I would have to with narcotics also.

BUT, regardless of the conclusion that many people jump to, I do not walk around in a drug induced euphoria. I am always in some pain, usually about a 2/3. But, I can stay at work. When I'm hovering around and staying a 7/8 I can't even leave my room.

And, I do not crave my narcotics. I do not get a yearning, a "have to have it" feeling.

And we have discussed here numerous times that not everyone has MOH. In fact I think it's overrated.

If an intervention is in order for your neighbors sister, it would be up to her immediate family who LIVE with her and know her whole medical situation.

Dear Pen, I know your heart is in the right place, but I wouldn't touch this with a ten foot pole. If my sister, or sister's neighbor decided to mention something to me about my health and medications I would go ballistic and it would be a VERY long time before I spoke to my sister again (and that would be AFTER I chewed her up and spit her out! )

Count me in with Charlotte!

No really its okay. I can only suggest to Kate that her sister is in rebound rather than addicted.
But neither she or I really understand how they work.
Her sister is desperate to get off the Syndol, but her dr doesnt even know she is on them.
They are OTC.

I appreciate the sentiment, but its fine really.
We just hoped to understand the mechanism of drugs a bit better.
I wont be involved, just told Kate I would see if anyone can help.
Kate herself has migraines, but not as frequent as most of us.

Oh and her sister is single and lives alone.
No other family, parents dead.

But I really appreciate your concern for me Charlotte. Thank you.

There is no single mechanism for drugs. People complete entire PhDs without knowing how every drug out there works, and in fact the mechanism behind many migraine/central nervous system drugs is currently unknown.

That does change it somewhat, Pen, but, and it's probably because I'm so sensitive to this issue, I would still only get involved if the person with the actual problem, i.e. your neighbors sister, came to me for advice.

Yeah, I agree with Charlotte. I would not get involved under any circumstances, really. If the actual person with the problem came to me for advice I would tell them to discuss it with their doctor. I try to stay out of other people's affairs as much as possible unless they are actively hurting someone else.

I dont think this is coming across right. I am NOT involved at all.
Kate has migraines. Her sister has daily headaches.
Kate thinks her sister is addicted to the Syndol.
I explained about rebound. She had never heard of it.
When she asked what happens with drugs to do this, I couldnt answer.

So I thought maybe someone could.
Jayme I can understand your comment.
But do we know about codeine???
It is supposed to be one of the worst for MOH and is also addictive.

Aside from Kate's sister. I would like to know.
What is it about codeine that causes rebound and it is addictive.
How does the brain/body react in a way that causes either....

I cant take codeine at all. But I imagine aspirin behaves in a similar way.
But it isnt addictive I think,

Thanks

P

Pen, the only thing I've ever been addicted to is cigarettes. And I know I was because I craved them. If I was out I was trying to figure out how to get more. I've never felt that way in any drug or alcohol so I can't respond to that part of the question.

As for codeine, I personally can't take it as it does give me a MOH. BUT, the headache I get is not a migraine, it more of a hangover headache.

However, I know several on this site who have no problems at all with codeine. As we've said so many times before we are all so different. I'm sure what I take would knock some else on their tail.

Same with rebound, I think a person only knows for sure if the take a drug holiday.

Sorry I can't help more. I think Jayme hit the nail on head...we just don't know!

Thanks Charlotte, yes it does seem we dont know.
I find that a bit un nerving that even the people who make them dont know...
But, if they work, they work....

I will just tell Kate that if her sister cant stop taking them it could be addiction.
If she takes them because the headache comes back then it could be rebound I guess.

If anyone has anything to add, still reading.

Otherwise, thanks.,

P
PS: I have never been addicted to anything. Not even cigarettes. I just decided to stop and did.
Stillhad the occasional one socially for 20 years.....not a problem....we are all different,,..

The simplest explanation I could find was from a Mayo Clinic site that said:
It's not clear why rebound headaches occur. However, scientists suspect that regular use of headache medications alters the way certain pain pathways and receptors work in the brain.

But as far as why certain medications change the pain pathyways and receptors and others don't is a mystery to me.

This was taken from:

http://www.mayoclinic.com/health/rebound-headaches/DS00613/DSECTION=causes which really doesn't tell you anything more than you already know.

Don't forget the third option...she has chronic daily migraine or CDH and the only thing that controls the pain is the codeine.

It's so different for everyone....my son has CDH and codeine does nothing for his headaches (except make him sleepy) so there must be a reason why things work for some and not for others as part of this rebound/moh mystery. If you could figure this out, you could be very rich!!

Whilst I do not wish to enter the basic discussion on this subject, since it seems upsetting to some people, I wish to add comment to something in Paradox' post steroids that you have to taper off of,.
Actually, unlike Vicodin or codeine, steroid is not a drug but it is a hormone. If it needs to be tapered off it is not becasue of drug withdrawals symptoms, but to give your body time to start to produce it's own hormone, which stopped the moment you start taking steroids. The body needs to readjust before it can produce it's own hormone which is necessary for normal fucntioning of our metabolism.

Steroid is also a potent, and very effective antinflammatory. It is this action that can help to reverse the inflammation, and stop the migraine.

What is it about codeine that causes rebound and it is addictive.
Codeine is a narcotic, an opiate (this is why it makes some people sleepy, when they take it) . It originates from the same group of medicines like morphine - and this is why it becomes addictive quite quickly.

But steroid acts like the natural hormone - cortisol - produced by our bodies own adrenal system.

I hope this answers your question. And I do not mean to start WW3 by answering this!
This is not a comment, on anyone here taking any of the above.

However, anyone who takes Syndol or Solpadeine is in danger of becoming very quickly dependent on it. Syndol and Solpadeine were on top of the list of medicines which cause MOH, and the list was given to me by my neuro.
I hope this helps. BUt I agree even second hand interference in someone else's medical situation is not advisable.

Thanks for the comments Mini.
What about the second part of the codeine problem though.
You said it is addictive, but is this also what makes it cause rebound?
If that is the case then it suggests there is no difference between MOH and addiction does it not?

I know about Syndol and Solpadeine, I cant take Syndol.
it isnt the codeine it is the anti histamine...
I do steer away from Codeine as I only have one working kidney.

I must correct your last comment though Mini.
This is not interference of anyone's medical situation, not first or second hand by either myself or my neighbour.

I did think I have made it clearer, as I hadn't initially.
Kate is concerned and just wants to try to help her sister.
Her sister wants help. No one is interfering. Least of all me.
All I was asked to do was impart any information I could.
I don't see that as interfering. You misunderstand I think....but
Either way I am going to tell her what I have learned as I said I would.
And I try to keep promises....

Maybe I misundertood what you are saying, but so did all others people who read you, since we all have the same impression: you are getting yourself involved in someone else's business - and this is the reason why we all think that this is not a good idea, even if you have good intentions.

NO I am not Mini. And I explained that. I have been asked. It is then my business.
The lady wants to know, her sister wants to know, I said I would see what I could find from the good people of this forum.
I made a promise, I intend to keep it.

I appreciate the sentiments, but I am totally happy with what Kate and I are trying to do.
What on earth do we do when someone asks for help...walk away?
What are we all doing on this forum then???
Don't we all give opinions and discuss every single day....

I just dont have the same concerns I guess. I would hope someone would do the same for me.
Imparting information is hardly interfering. Especially when the information is solicited.
We have a sound knowledge/experience base here.
But if no one can say what the difference between addiction and MOH is, then one has to assume it is the same thing.
And I dont think, judging by previous comments on this forum, that it is....

I don't need any more warnings thank you, I am comfortable with what I am doing.
But if anyone has any more to add on determining addiction from MOH.
Please fire away. Regardless of Kate's poor sister, I am curious now.

Thanks.

Pen, I don't believe that addiction and MOH are the same thing. Addiction does not cause a headache. Addiction is a mental and physical craving for a drug.

MOH is a headache is that happens in some people. I don't know the mechanism of why it happens in some folks and not others, but it is a totally different critter than addiction.

I mentioned before that I am physically dependent. One time because of a pharmacy mix up I was out for three days. I did not have a headache. I had withdrawal...my nose was running, my body ached and I had terrible stomach cramps.

At least that's my take on it. Clear as mud?

Personal opinion is that rebound/MOH are highly over exaggerated. My only evidence for that is personal experience. When I was told to cut back on medication for fear of rebound, all that did was increase the number of days I was miserable. It did not reduce the days with headaches or severity of headaches. I think that doctors have latched on to this diagnosis when they see a chronically ill patient and don't know what else to try. Of course I can't say it never exists. Maybe some people get it. But it's one of those diagnoses that is just too easy to throw out there and too hard to disprove.

As for addiction. That manifests in many ways including cravings and physical dependence to feel 'right'. Withdrawl from not having the drug includes shakes and other manifestations, not just headache. But many people need a drug to function normally, such as a diabetic. We don't call them addicted. The question is, if the drug was withdrawn, and one got through the withdraw period, would the drug still be needed for normal health/functioning? If no, then it was an unnecessary addiction. If yes, then it is more likely an appropriate treatment.

Very good point, Migrainegirl!

Pen, this is an amazing website with lots of more detailed information you may find helpful in your quest for answers...................don't be put off by the name!! it has lots of great information - i have found it very useful over the years.

http://www.biopsychiatry.com/

Pen, you will have very heated opinions about MOH-addiction connection, this is why many people refuse to take part in this discussion for fear of fights.

What I suggest, is that if you are really serious and want to find out proper answers to your many specialist questions, why don't you make a list and try to ask Dr Robbins who visits this website and he will point you in the right direction.
Anything else you will find, is just guesswork and scientifically unreliable opinions.

I dont see anyone even contemplating getting into a heated discussion about MOH on this thread Mini?
This thread is about trying to determine how drugs work.
It was to try to discern the difference between addiction and possible MOH.

It seems no one knows, but I have been sent a useful thread.

We dont tend to have heated discussions on this forum Mini.
We dont always agree, but we generally get along.
You will find us very friendly.

P

I am glad to hear that, but I was trying to explain why people are reluctant to enter into this discussion, since certain subjects can lead to strong differences of opinion, and if you genuinely want to find out, it is best to ask somone who is a doctor with specialist knowledge, otherwise you might never know the correct answer.

mini, i just have to chime in here, because i don't see how you can assess "people are reluctant to enter into this discussion". there are 2 pages of posts already.

asking doctors with "specialist knowledge" is often very unproductive. but our dr. robbins may be able to explain this better. my personal experience with at least 100 doctors over the past 40-plus years has been that if one asks one question, one is likely to get 100 different answers. there just aren't any hard-and-fast rules in medicine which is, after, all, a "practice". dianne