MOH. If you medicate daily, can you have it??

This is not controversial. Just picked up on something linda said.

If we get this from drugs. If we take the drug every day, does that negate the possibility?

Some of you have had it I believe.
Were you taking the offending article on a daily basis?

Dianne takes a daily Triptan and is sure she doesn't rebound.
Many take daily abortive I believe.....

So I am not arguing for or against.
Just wondered if that makes sense.
Or, not understanding drugs at all, is that too simplistic?

Yes, the only MOH that I have ever had was when I was taking Ibuprofen daily, as prescribed, for pain in my neck and foot, not headache!

The prescription stated: Take 4-6 teaspoonfuls by mouth three times daily. At 100 mg/5 ml, that translates into 400 to 600 mg X 3 = 1200 to 1800 mg per day.

The headache would start about an hour, or so, before the next dose was due to be taken. About another hour after taking the dose the headache would be gone, only to return as the time for the following dose approached.

The Ibuprofen did absolutely nothing to relieve the pain in my neck or foot. The only pain that Ibuprofen has ever reduced is the MOH that it caused in the first place!

No, I do not suffer from MOH. I went on a four month drug holiday and did not take anything not even OTC. All I had was four months of daily migraines. So I take daily narcotics now that MOH has been ruled out.

There are some drugs that WILL give me a rebound headache, slightly different from my migraine (more of a hangover headache). These include codeine, stadol and clonopin. Codeine is the worst so I steer away completely, the clonopin and stadol I use ONLY as a last resort.

I think while MOH may effect some people, it is vastly over rated and cause some people to needlessly suffer.

This is obviously highly emotional subject, but if you want certainty and more definite answer, you need to consider a current scientific definition of MOH, and take it from there:
http://www.answers.com/topic/rebound-headache

http://headaches.about.com/od/allheadpaintype1/a/med_overuse_ha.htm

It sounds as if you are unsure about MOH, and perhaps suspect that you suffer from MOH. But no doctor will be able to answer that question, unless you are prepared to follow MOH guidances exactly, since only then you will have a definite answer to the question: either you headache/migraine is caused by MOH, or not.
Anything else is speculation, a guesswork. NO one of us can tell you if you have MOH, or not. YOu need to go thorugh the whole procedure, to discover for ceratin if you have been affected by MOH, or not.
It is quite simple - but to any of us who might be worried about MOH, this is indeed a very scary prospect and this is perhaps a reason, why it is sensitive subject.

Hi Mini,

You are right it does seem to be a sensitive subject. Probably because we get such conflicting advice and opinion.
No I dont have it. I dont fit any of the criteria and my Neuro has told me I definitely dont have it.
It was something said on another post that if it is the rise and fall of the drug that causes it, if you take something constantly,
Can that occur? Seems even that isnt cut and dried.

Mulekick
What happened to you is pretty text book I think, with the "need" for the next dose.
BUT as you were on it constantly, I guess that rules out Linda's theory that consistent dose rules it out.
I trust when you stopped the Ibuprofen this went away. Its good that it wasnt for your head pains though.

Charlotte.
I cant decide about it. I am told I am just not a candidate and take far less than I used to anyway.
I guess it exists, good people on here say so. But at 1 in 50 of us, yes it is overblown, and many of us just have daily pain.

To be honest I dont know how I could take nothing anyway. I have fibro as well and constant myofascial pain.
I never get headaches, unless I get sick. It is the stabbing nerve pain that drives me nuts.
I have it this morning. I havent taken anything yet. I feel no headache from the two I took yesterday at 2pm.
I never do. Most of the time I take OTC and they work or they dont, but I dont need any more.
2 Anadin/Excedrin in any one day is all I ever take. Not every day, just when I need to.
This suggestion of Linda's, well I was curious. Few posts as yet, but looking as if daily makes no difference to the way these drugs hit.

P

"But at 1 in 50 of us, yes it is overblown

1 in 50, of us? What is that reference applying to? Please explain further.

It is quoted from several sources Mini.
I think it you google it, it will show up.
Sorry I have a gut bug and migraine today so cant find it.

P

Opps, see below....I managed.

Mini.

Here you go

http://www.patient.co.uk/health/Headache-Medication-Induced.htm

And also your own link that you posted. Says right near the top 1/2% of the population.

http://www.answers.com/topic/rebound-headache

Hope that helps.


Others....Charlotte....what did you go through for nothing...Did you get the withdrawal?
I would suppose if you didnt, then you didnt have a problem??

I thought Goadsby's comments on getting off med were interesting...
How do we stop MOH?
Immediately discontinuing the medication causing the MOH is the preferred plan of action. It's obviously the quickest, and it doesn't add more medications to an already confused body. According to Goadsby, et al, withdrawal symptoms usually last two to 10 days. Those symptoms may include: withdrawal headache, vomiting, arterial hypotension, tachycardia, sleep disturbances, restlessness, anxiety, nervousness. In some cases where the MOH is being caused by medications such as butalbital compounds that have been taken daily in large amounts, seizures can occur if the medication is abruptly withdrawn, so a tapered withdrawal or supervised detoxifications is necessary. The best approach is to ask your doctor for help and advice.

I was not sure what you meant, and if this reference 1, 50 was about MOH incidence (or cure?), since many if not most cases of MOH go undiagnosed.

As we know statistics can be used in so many different ways, this is why I said that the only way to be sure if you might have a MOH problem is to do the testing yourself by stopping all/any listed suspected medicines, and that if after two month from stopping you still have the same frequency of h/a as before, then you have definitely not been suffering from MOH.

It takes guts to go thorugh with it of course, but some people who did try have benefited greatly, and some do not.
But I doubt if anyone can tell if you have MOH, otherwise.
Thanks for the link.

Hi Mini,
You misunderstand the thread. I dont need anyone to tell me if I have it. I know I dont.
The question was, someone asked, if you medicate every day, can the medicine still rebound.
Can you get over use if you dont allow that fall in the chemicals that is said to cause it.

We already have one poster saying yes, she got it from daily Ibuprofen, and she wasnt even taking it for headaches.
i would imagine there would be more.

The 1 in 50 2% is most definitely in regard to the percentage of the population that might be effected.
This isn't based on diagnosed or undiagnosed, it is the projected figure put out by some of the top neuros on both sides of the Atlantic.
That is how it has been explained. I think the suggestion is that the percentage may rise a little in headache patients.
Given that they cant often agree on much, this seems to be the accepted figure among many of them.

However, as I said, that has been discussed on here many many times. I was just picking up on the constant medication theory.
I am also now further confused by Peter Goadsbys comments about the time taken for withdrawal. Makes the 2 months off all meds seem excessive does it not.>

Pen

Yes, when I stopped taking the Ibuprofen the rebound headaches went away, once it was completely out of my system.

Keep in mind, though, that this was not OTC Ibuprofen, but rather was prescribed; so that I needed to get my PCP's permission before discontinuing it. I told him that it was giving me rebound headaches, which I had learned about at Ronda's previous forum.

well done mule, agree with your post
pen it is not the drop in the between the meds that gives the moh, there are those as you know that take triptans everyday and have moh so yes ibuprofen everyday will without question give you moh.

This was exactly what I wanted to mention, Dawn. I absolutely agree.
It is taking medicine that can cause moh, not stopping it. The more often you take it, the more likely you will get moh. So if you take it daily, you are simply increasing the chance of getting moh.

I am still confused abiout those figures that 1-2% of general polulation get moh? But what proprotion of people who suffer with migraine get moh - what is the figure of people with migraine who get moh?

After all most people in general population do not depend on frequent use of painkillers and triptans and these are the main causes of moh. It would be more interesting to know that figure.
However, I still think that most in that group are not diagnosed since as I said above; until you go through the whole process you might not know for sure if you have moh or not.
Well done MK for going trhough the process and getting such a great result. Great news.

Hi Dawn,

I am going to call you on this in the nicest possible way.....
How do you know that, given we are told so many different things, and that the drs admit that many of us could take meds all day forever and not get MOH.....How do we know the mechanism that causes it?? Is it the taking, the amount, the gap in between???
How do we know that people that medicate every day have rebound??? Linda obviously thought that it is the sort of rise and fall of the medication that causes it. ~Seems to be some confusion.

My husband is sitting here asking this. He is interested in the science behind it.
He was with me when the neuro told me I do not have it and my history of medication suggested I was not a candidate.
What is it that causes it? I took 4 times as much OTC 10 years ago than I do now. I took it every day.
One day I decided it wasnt helping so much so I cut it down. My headaches were the same with or without it.
Well they are not headaches. They are the same pain, exactly the same pain, none of this, different pain they describe.
Just the same myofascial pain/migraine. The neuro looked back at my notes. I spent 20 years on Dihydrocodeine for IBS.
No rebound, no addiction (you will know it is addictive). He said it seems to be some people get it some dont....
I hate drugs. I bear as much pain as I can. No preventatives have done anything other than give me lousy side effects, I am off them.
I could not endure my life with no pain relief. I have come close to the edge before. I am too old to balance quality with quantity. I choose quality. Not a choice I should have to make...

Is Ibuprofen particularly bad Dawn? My mother in law is on it for arthritis, on prescription, quite a whacky dose. She hasn't gotten any headaches from it. My neighbour has been on them for ages. She has migraines, but not chronic. She has had no headaches on them.
I went to ask her before writing this. It seems such a hit and miss thing...I dont take Ibuprofen. I might as well eat a box of Smarties.
Useless things...Same with Paracetamol. I only respond to Aspirin.....

But that is just me. To get back to the original post. What is it in the drugs that causes the rebound? Why are headache patients the worst effected? Is there something different about us and if so shouldnt this help them to find a cure? Help us understand Dawn.

Mule Kick, it is great that you made that step and got rid of the daily headaches. Thank goodness you found out about it from Ronda's
How long did it take to get it out of your system? Have you had the same problem with anything else since? Well done.....

Anyone else made that big step and got off the medication to find their headaches are better?

Interesting, thank you all.

it comes down to whether the drug are for preventative use and therefore long term rather than an acute treatment ie painkillers and triptans. the way they all work on the brain i cant remember but they work differntly and if a drug is designed for acute treatment it is just for that, as to ibuprofen i dont think it is any worse than the rest. the codeine drugs are the worse. it isnt a case that headache pts suffer the worse from it. it is possible to get moh from taking the painkillers for other ailments.
noone is saying you have moh pen but you have to detox from the drugs to start again in order to get rid of the moh, not just reduce the meds and this was discussed at the migraine conference.

as a previous post said if you(anyone) do detox then you can find out for sure if you do have it and if it makes no difference then you werent and if it does, great and you have your life back. only by doing the detox can you prove it.

they said at the conference that the first 2 weeks you will need off work and i know my neuro offers to admit pts to hosp during that time if they want to, as did the neuro that taught the detox last year and helped the pts through with it. 2 months off meds is hard but the best results are got from the pts who do detox the best.

While I think MOH is over-rated, I also believe it exists in some people. And, I think the only way to find out is to go off ALL meds for a prescribed amount of time. In my case it was four months. It goes back to the horrible reaction I had to topamax and the side effects I had to all the other drugs. In a hospital setting I went off all meds at once. I did not have withdrawal, I just still had the same stinkin' headache.

I went 4 months because at that point I was afraid of all meds. However at the end of four months I could not stand the chronic daily migraine.

That's when I felt comfortable knowing that I did not have MOH.

At that point I decided to go with strictly a pain management regime (yes, narcotics) and I got my life back.

Hi Dawn,

I am glad someone understands how drugs work better than me. I just swallow the horrible things...
So Dr at City of London put me on long term Ibuprofen as a preventative......(needles to say it didnt work).
She wanted me off aspirin and convinced me that daily Ibuprofen would prevent the migraines.
This was to be for 2 to 3 months.

So is the Ibuprofen then an acute or preventative? Why would she put me at risk of MOH if it is the former?
Also I am confused as to how the drug knows how to do this. If you take these meds sometimes, and not others.
ie: I had a bug a few weeks ago and took Anadin for the headache it gave me (I only ever get headaches when I am ill).
Every day for about 5/6 days. After that I took none for 8 days, then has them as usual (2/3 times a week).
Assuming I was prone to have MOH. Would that mean having taken them so much I was pushing my luck?
And myself, who now takes a quarter of the OTC that I used to.....
One last thing. Do they experts have any idea why some people get it and others never do?
Surely this might be a clue as to the mechanism of our problems....

It is something personal to us I suppose....metabolism or whatever.

Thanks Dawn, appreciate your comments.

Charlotte:
I would have imagined that if there is no withdrawal then the drugs are not the problem.
I also wonder if those that feel anything of that sort, might have a clue that they have MOH
What did being in hospital do for you. How did they help you manage it?
Four months wow, I admire your courage....

So tell me about the narcotics Charlotte. We dont seem to get this kind of treatment here.
Yet it evidently works....What do you take and how come this kind of drug doesnt cause rebound?
Or maybe it can, but you at least have the satisfaction of knowing, not to you...


Thanks
Pen

Dawn, you are making several valid points. I think what is missing in this discussion is more clarity like you and MK provide.
Pen, I am sorry, but the picture of your moh that you draw is rather confused, so I am not surprised that you find it difficult to get any definite answers. One thing seems to be clear so far is that you do not believe that moh exists, and this is fine. So, why keep torturing yourself with doubts?
However, I must say that I have somes difficulty with your following statement:

tell me about the narcotics Charlotte. We dont seem to get this kind of treatment here.

Thiss statement is misleading because of course we have narcotic treatemnts in this country. We can actually buy some of them otc in any chemist. What you say is also unfair since you keep speaking (incorrectly!) in the name ofr the whole country again. Once again creating wrong and negative pictures of UK. I am talking about statements like:
"we dont get this treatemnt here",
"we do not have it here", or that
"we cannot get it on NHS" and many others.

I am sorry but this ist not helpful and therefore can I please ask you in the name of other UK residents who have different experince, that in the future you only speak on the basis of your own experience rather then making general statements for the whole country. I hope you don't mind my mentioning it, I am sure you are not aware you are doing this. Thanks.

Mini,

Pen didn't say that you couldn't receive them in the UK, just that it wasn't a common practice in her experience. I know you are new to the board but in the past she has not been able to get anything for pain beyond OTC (perhaps at prescription strength and I want to move to the UK if you can get narcotics OTC, not so in the States). She has clearly stated this in the past.

Everyone on this board knows that each of us has their own battle with the health care system. What happens in one part of a country, even within doctors, depends on preference. I could go to different doctors here. One would refuse narcotics and the other glad to prescribe them. It depends on their philosophy. Same with MOH - some doctors don't even mention it while others harp on it.

Hi Mini,

Boy we do seem to have a problem understanding each other dont we...
First point. I am not interested in discussing "my'" MOH. Because, as I have said.
I have been told I dont have it.

I dont think I said I dont believe it exists, in fact I refer to the experience of Mule Kick and applaud the success of getting over MOH.
So I will state it here so that there is no further confusion for you...
I do believe it exists for some people.
I have been told I dont have it and have no wish to discuss my situation any further and am NOT torturing myself.

If you search on here it was Estre that made the point that she felt that daily consumption of drugs would mean one would avoid it.
I was curious and that is where the thread started. I am learning, with the help of Dawn.
I am still curious. Who knows what we might learn about migraine individuals if we could discern why some get it and others never do.

Now as for the NHS. You have, with respect taken some of my comments out of context.
But first I must say Mini, I speak for myself and my own experiences. Not the whole country.
I think that is an unfair criticism of what I have been saying. I dont imagine anyone made that assumption and I will check, but I cannot imagine why you would think that anything I have said represents this country. Indeed I could make that same mistake about your comments.

Now you picked up these points:
"we dont get this treatemnt here", I think this is in reference to the narcotics. I am not aware of being offered any.
"we do not have it here", or that ' Cant find where I wrote that, sorry,
"we cannot get it on NHS" and many others. Again, please show me where I wrote this, on this thread, I cant find it.

Of course I don't mind you pointing this out to me Mini, but I hope you don't mind me telling you that you are misunderstanding me
So to clarify:
1: I am English, I was born here and have lived here my whole life, I have never had any private treatment only NHS.
Most of the time it works pretty well, there is a lot of room for improvement. This comes from the Government and the management.
My two nieces that are nurses are strong defenders of the NHS, but they know where things could be done better.
I know my own GP and neuro feel there is far too much bureaucracy and unnecessary delays due to it. they have expressed their frustration to me.

2: I write of my own experience and express my own opinions.
I have never had anyone else who lives in England think otherwise of me.
I am sorry you think otherwise. You have me wrong.

3. I have no interest in creating a negative image of England (cant speak for the UK; I live in England).
And I don't believe that I have.

I am sorry you feel I am negative. I am not, but neither will I praise something if it has disappointed me or let me down. Who would?
Mini why dont you post your own experiences, presumably you feel they are more positive than my own.
This should give a balance to anyone who feels England needs supporting.

I hope we are clear now.
I enjoy your comments, they make me use my brain.....

P

This is precisely why I asked to speak only about personal experince, so we can all share what we know. I can only comment about what I see here and now, and not about any past stories HeelerLady.
And yes, you can most definitely get certain narcotics otc in this country, and you are of course most welcome in our country it is very beautiful here.

There you go Mini. Now we are on the same page.
I write of my personal experiences.
I imagine we all do. Some are good some not so good, but.....
Thankfully I do not represent England......
Not got a good enough head for that...

In case there is any confusion about what narcotics are available in UK country, you might find this list helpful when you next visit your doctor:
http://www.patient.co.uk/doctor/Opioid-Analgesics.htm

As to other points, maybe it is best to leave this discussion since I am sure we have not time, nor inclination to go over the same ground again, and again.

Fine with me Mini. You are right, no point in repeating ourselves..
But, thank you for the link, and just to say I have never had, nor been offered any of those drugs for migraine.

I did have dihydrocodeine for 20 years for IBS, but for Migraine none.
I will keep the link, thank you.

pen