Methadone for Migraines??

This is the latest idea from New Neuro. Anyone have an opinion?

Perhaps I'm bias'd, having

Perhaps I'm bias'd, having spent a month jail with a doc who got himself addicted to it, and got busted writing his own scrips.

Methadone's toxic side is longer than it's analgesic power.

If your head aches are anything like my nitroglycerin induced skull buster, then I have some understanding.
Pain in the head is all consuming.

You have to keep looking for the source.


Titled: The pain you never know i felt
18x24 Acrylic & watercolor & ink

I've heard of low-dose

I've heard of low-dose naltrexone for pain including migraine, which would have the opposite effect as the methadone with the same anticipated result. It's fairly controversial from what I've read; I'm sure Chris has an opinion.

barbiegirl wrote: I've heard

barbiegirl wrote:

I've heard of low-dose naltrexone for pain including migraine, which would have the opposite effect as the methadone with the same anticipated result. It's fairly controversial from what I've read; I'm sure Chris has an opinion.

Why would methadone have the opposite effect of naltrexone? While methadone displaces opioids from receptors, nullifying their effect, it has many other properties and actions.

While I was under the care of a pain management physician in the US southwest, I was prescribed methadone in place of a morphine-benzodiazepine combination and it worked fairly well, though not as well as the combination it replaced, in my opinion.

The greatest problem I found with the methadone was the inconsistent manner in which it acted in my system. It felt as though the dose was being varied every time I took it.

Morphine does not help me with the occasional migraines which I suffer; in fact, it tended to worsen them. However, the methadone didn't have that effect, and may have benefited me, though I had no way of comparing or evaluating it.

Using opioids for treating

Using opioids for treating chronic daily headache when all else has failed is definitely an option.

You just need to keep in mind that even if this class of medication is successful, it
won't completely eliminate the pain, but reduce it to a more tolerable level.

Methadone has been used with some success in chronic headache when other opioids have failed. This
medication has unique properties (that other opioids do not), and is used occasionally in treating nerve
related pain.

I personally don't use it, as it requires special permission to prescribe it for pain purposes in Ontario. Methadone can be tricky to prescribe, as it's pharmacology is unusual. In treating chronic pain it is usually dosed 2 - 3 times a day, compared to that used in treating opioid addiction (i.e. once daily).

Chris do you not RX it, cuz

Chris do you not RX it, cuz it is tricky or cuz you have to ask momma?

Funny ya can ladle this stuff out to junkies, all day long, but Granny's bad back needs permission.

2 countries, 2 governments, 2 peoples all doin the same stupid shyte...

Tell your children, to pray for any disease process other than pain, cuz if it be pain, you be screwed.

Hang in there Rockstar!

I picked up the methadone

I picked up the methadone today. I'm still not sure if I'm going to use it. I'm afraid of it.

chrisaldridge wrote: Using

chrisaldridge wrote:

Using opioids for treating chronic daily headache when all else has failed is definitely an option.

You just need to keep in mind that even if this class of medication is successful, it
won't completely eliminate the pain, but reduce it to a more tolerable level.

Methadone has been used with some success in chronic headache when other opioids have failed. This
medication has unique properties (that other opioids do not), and is used occasionally in treating nerve
related pain.

I personally don't use it, as it requires special permission to prescribe it for pain purposes in Ontario. Methadone can be tricky to prescribe, as it's pharmacology is unusual. In treating chronic pain it is usually dosed 2 - 3 times a day, compared to that used in treating opioid addiction (i.e. once daily).

New Neuro has me taking it once a day (at bedtime). I don't want to be too high to work.

rockygirl wrote: I picked up

rockygirl wrote:

I picked up the methadone today. I'm still not sure if I'm going to use it. I'm afraid of it.

Eeek. Good luck. If you do decide to take it, I hope it helps. But if you don't, I can't say I blame you. Not one bit.

rockygirl wrote: New Neuro

rockygirl wrote:

New Neuro has me taking it once a day (at bedtime). I don't want to be too high to work.

Rocky, methadone's half-life (see graph at http://forum.opiophile.org/showthread.php?t=22744) is around 12-59 hours, even though the analgesia usually lasts only 4-6 hours. This means that you may feel increased effect over the first three to five days as the blood serum level increases until a steady state is established.

As you would be taking it at bedtime, the analgesia wouldn't last until your awakening, though with each nightly dose, the effects will be stronger for those first few days.

I don't think morphine and methadone are cross-tolerant, but you still aren't opiate naive, and I can't see your neurologist prescribing something for you to start during the work week which would leave you feeling like a zombie in the morning.

Of course, Chris can speak to this whole issue much better.

I can only really tell you that I've been switched to it for a month or so, and while it was "an adjustment", it didn't hamper any of my daily functioning.

New Neuro told me to start

New Neuro told me to start taking on a weekend, so I wouldn't miss work if things went awry. I was too sick last week after the appointment to pick up the methadone to try it on a weekend. (I was in bed from Wednesday night until Sunday morning.)

rockygirl wrote: New Neuro

rockygirl wrote:

New Neuro told me to start taking on a weekend, so I wouldn't miss work if things went awry. I was too sick last week after the appointment to pick up the methadone to try it on a weekend. (I was in bed from Wednesday night until Sunday morning.)

Every patient responds differently to opioid medication; some will have a significant reduction in pain, some won't. Some will have lots of side effects (i.e. sedation, nausea, constipation, etc.), some won't.

Unless a person has received a trial of opioids before, you can't predict a response to opioids ( or side effect profile ).

I have only had 1 patient experience a dramatic reduction in head pain with long acting opioids (i.e. 70 - 80 % reduction).

The only opioid that has been

The only opioid that has been tried and even touched the migraine is Dilaudid (I'm pretty sure I didn't spell that right). Morphine made me not care about the pain, but I couldn't get out of bed on it.

rockygirl wrote: The only

rockygirl wrote:

The only opioid that has been tried and even touched the migraine is Dilaudid (I'm pretty sure I didn't spell that right). Morphine made me not care about the pain, but I couldn't get out of bed on it.

I think starting with a low , single daily dose of Methadone is a wise thing to do.

rockygirl wrote: The only

rockygirl wrote:

The only opioid that has been tried and even touched the migraine is Dilaudid (I'm pretty sure I didn't spell that right). Morphine made me not care about the pain, but I couldn't get out of bed on it.

Usually the nauseating and sedating effect of an opioid resolves on a STABLE dose with time (2-3 weeks).

The constipating effect does not.

chrisaldridge

chrisaldridge wrote:
rockygirl wrote:

The only opioid that has been tried and even touched the migraine is Dilaudid (I'm pretty sure I didn't spell that right). Morphine made me not care about the pain, but I couldn't get out of bed on it.

I think starting with a low , single daily dose of Methadone is a wise thing to do.

I'm supposed to titrate up slowly.

Four days on methadone so

Four days on methadone so far. Vomiting, rebound headaches, wooziness, exhaustion, and a doctor who can't be reached. Priceless.

rockygirl wrote: Four days on

rockygirl wrote:

Four days on methadone so far. Vomiting, rebound headaches, wooziness, exhaustion, and a doctor who can't be reached. Priceless.

When you feel nauseous, Rocky, try laying down for fifteen minutes, if you can. Ginger, which has been mentioned here numerous times, should help, too.

As of yesterday, I'm off

As of yesterday, I'm off methadone.

rockygirl wrote: As of

rockygirl wrote:

As of yesterday, I'm off methadone.

Not everyone does well or can tolerate this opioid. It can make for quite the adjustment.

Rocky, what happened? Did you or your doctor make the decision?

Was it not helping the pain, or were side effects making it not worth it?

New Neuro made the decision.

New Neuro made the decision.

I was vomiting, woozy, sleepy, and getting rebound headaches when the meds started to wear off.

He decided it wasn't worth it.

rockygirl wrote: New Neuro

rockygirl wrote:

New Neuro made the decision.

I was vomiting, woozy, sleepy, and getting rebound headaches when the meds started to wear off.

He decided it wasn't worth it.

Every person tolerates opioids (and not just methadone) differently.

Rocky, A mutual friend asked

One of my triggers is

One of my triggers is cleaning products, too. I've eliminated them for years, in favor of unscented and/or green products. Now that the school has to eliminate those products, too, I rarely have migraines triggered by those odors. The only time I have problems is if I'm in an office or something when they're cleaning.

MicOnTheNorthShore

This story gives a pretty good description of post-traumatic headache , migraine subtype.

The usual conservative approach is just that: stress management, avoiding triggers, etc. Patients are counseled to
perform regular aerobic exercise, which can be helpful in reducing the number / frequency of migraine days. Acupuncture
can be helpful for some people.

Some people will use/ overuse over the counter pain meds and make their migraines worse.

I can speak as someone who

I can speak as someone who takes methadone for pain....and chris is right when he says that a stable dose is something very important when trying methadone or any strong opioid. My advice would be to do some reading on the subject . Try.....Dr Webster methadone(googling) he seems to be a good touchstone for this medication. Hope you feel better ... cheers

I just want to find something

I just want to find something that works. I'm so tired and at a lower point than I've ever been. It's been seven years since my headaches started evolving into what ended up in the constant head pain I have now. I've seen so many doctors in every specialty and have done all the tests and tried all the treatments that they recommended. I'm on a medical treadmill. I just want someone to help me.

rockygirl wrote: I just want

rockygirl wrote:

I just want to find something that works. I'm so tired and at a lower point than I've ever been. It's been seven years since my headaches started evolving into what ended up in the constant head pain I have now. I've seen so many doctors in every specialty and have done all the tests and tried all the treatments that they recommended. I'm on a medical treadmill. I just want someone to help me.

I wish I could. Constant pain takes the joy (no pun intended) right out of life.

chrisaldridge

chrisaldridge wrote:

This story gives a pretty good description of post-traumatic headache , migraine subtype.

The usual conservative approach is just that: stress management, avoiding triggers, etc. Patients are counseled to
perform regular aerobic exercise, which can be helpful in reducing the number / frequency of migraine days. Acupuncture
can be helpful for some people.

Some people will use/ overuse over the counter pain meds and make their migraines worse.

Hi Dr A......can caffeine help with headaches? I have a friend that takes over the counter pills with codeine and caf ..me thinks they also have tylonol . I am wondering if he can try a caf pill instead , the cod is hurting his stomach ..cheers

I know people who get

I know people who get Migraines when they don't take their Methadone for a few days! So, yeah it makes sense to give Methadone for migraines. Exclamation Mark

I also have migraines/chronic

I also have migraines/chronic daily headaches/whatever level of hell you'd like to call it. I've been here before but it's been a while.

I wonder if you could have taken phenergan with the methadone to avoid the nausea/vomiting and other sides. I personally cannot take opoids without phenergan.

At any rate, I did years of opoids for my headaches and then my family got all queasy about it even though I took as directed, etc. The thing that worked best for me was demerol tabs with phenergan. I had a certain number per month, which I took with phenergan, no harm no foul. Enter the family - and I quit all opoids cold turkey. Which was fine, except for the pain. I didn't have withdrawal, believe it or not.

So anyway, three years later, I do notice that this seems to be related SOMEHOW to my vascular system (I know, duh). My blood viscosity is thicker. I do have high blood pressure. I tried staying on warfarin for a while, but nobody was super excited about that either (the doctors).

So. Finally, I'm on nadolol. With my normal blood pressure pill (micardis hct). That does seem to help. But I still take FAR too much aspirin to try to mute the residual pain. And I have the gastro problems to prove it. But I don't want to go back on opoids because my family is SO against it. And frankly, they do take some of the joy out of life (the family and the opoids). But I haven't found a particularly great option either, so for now I'm stuck taking way too much aspirin.

obliqueone wrote: At any

obliqueone wrote:

At any rate, I did years of opoids for my headaches and then my family got all queasy about it even though I took as directed, etc. The thing that worked best for me was demerol tabs with phenergan. ......

But I don't want to go back on opoids because my family is SO against it. And frankly, they do take some of the joy out of life (the family and the opoids). But I haven't found a particularly great option either, so for now I'm stuck taking way too much aspirin.

Obiqueone, Meperidine (Demerol) is not indicated for long term treatment. It produces a metabolite, normeperidine, which accumulates and is toxic.

You might find that you would do better with an SR formulation of an opioid. As they are prescribed with a view of maintaining a static blood plasma level, the total daily dose is often less (than PRN prescribing) and the side effects relatively minimal.

delete duplicate post

delete duplicate post

Well, I'm not going to be

Well, I'm not going to be taking ANY opoids for chronic pain because my family just can't deal with it. The pain from the headaches and from my stomach from taking the aspirin is excruciating but is STILL easier to deal with than the constant bellyaching from my family.

The deal is that we genetically have these headaches in my family. My mother and I live in different parts of the country. I think my mom felt she was a little addicted to her own pain meds. So... when she went off of hers (unwillingly, because her doctor retired), all of a sudden, I was an addict. And she's a little (twirls finger by head) bpd. But... Since we have a large family and its so much easier just to keep her, and by extension them, happy - I just stopped taking mine too. Otherwise, she is like the World's Fair of drama.

Also, there is this magical thinking I have that some day I'll be able to figure out how to stop the headaches somehow. It's nothing holistic, because I've tried all of that. Anyway, I was wondering if low-dose naltrexone or sub-oxone works for anyone with headaches. That's literally the opposite of an opoid isn't it?

obliqueone wrote: I also have

obliqueone wrote:

I also have migraines/chronic daily headaches/whatever level of hell you'd like to call it. I've been here before but it's been a while.

I wonder if you could have taken phenergan with the methadone to avoid the nausea/vomiting and other sides. I personally cannot take opoids without phenergan.

At any rate, I did years of opoids for my headaches and then my family got all queasy about it even though I took as directed, etc. The thing that worked best for me was demerol tabs with phenergan. I had a certain number per month, which I took with phenergan, no harm no foul. Enter the family - and I quit all opoids cold turkey. Which was fine, except for the pain. I didn't have withdrawal, believe it or not.

So anyway, three years later, I do notice that this seems to be related SOMEHOW to my vascular system (I know, duh). My blood viscosity is thicker. I do have high blood pressure. I tried staying on warfarin for a while, but nobody was super excited about that either (the doctors).

So. Finally, I'm on nadolol. With my normal blood pressure pill (micardis hct). That does seem to help. But I still take FAR too much aspirin to try to mute the residual pain. And I have the gastro problems to prove it. But I don't want to go back on opoids because my family is SO against it. And frankly, they do take some of the joy out of life (the family and the opoids). But I haven't found a particularly great option either, so for now I'm stuck taking way too much aspirin.

As you probably know, a migraine has a whole lot of related discomfort that does not necessarily accompany a headache.

I was on phenergan when I was taking the methadone.

obliqueone wrote: Also, there

obliqueone wrote:

Also, there is this magical thinking I have that some day I'll be able to figure out how to stop the headaches somehow. It's nothing holistic, because I've tried all of that. Anyway, I was wondering if low-dose naltrexone or sub-oxone works for anyone with headaches. That's literally the opposite of an opoid isn't it?

Naltrexone is an antagonist (opioids are agonists), so yes, you think of it as being the opposite of an opioid in terms of its being used as a counteractive measure. It is used to rid the body of the effect of opioids where a patient overdoses. I think it displaces opioid molecules from their receptors.

Suboxone is a formulation which includes an opioid agonist and an antagonist. If I remember correctly (Chris can give an accurate explanation), the idea is that the antagonist dose is insufficient to counteract the full effect of the agonist, but if the patient takes an extra dose, the blood plasma level of the antagonist reaches a level sufficient to counteract the agonist, defeating the user's intent.

Suboxone is one tool used by some pain management physicians with patients whom they have a concern about regarding opioid abuse.

yeah, I figured you didn't

yeah, I figured you didn't get this far without knowing about phenergan, but thought it was worth a shot. My migraines were like yours. They started as migraines and evolved into the chronic daily thing.

obliqueone wrote: Well, I'm

obliqueone wrote:

Well, I'm not going to be taking ANY opoids for chronic pain because my family just can't deal with it. The pain from the headaches and from my stomach from taking the aspirin is excruciating but is STILL easier to deal with than the constant bellyaching from my family.

The deal is that we genetically have these headaches in my family. My mother and I live in different parts of the country. I think my mom felt she was a little addicted to her own pain meds. So... when she went off of hers (unwillingly, because her doctor retired), all of a sudden, I was an addict. And she's a little (twirls finger by head) bpd. But... Since we have a large family and its so much easier just to keep her, and by extension them, happy - I just stopped taking mine too. Otherwise, she is like the World's Fair of drama.

Also, there is this magical thinking I have that some day I'll be able to figure out how to stop the headaches somehow. It's nothing holistic, because I've tried all of that. Anyway, I was wondering if low-dose naltrexone or sub-oxone works for anyone with headaches. That's literally the opposite of an opoid isn't it?

Suboxone is an opiate. It is made differently than other ones, though. You cannot take any type of "regular" opiates with it. I know some people get headaches while taking suboxone, while others do not. I do not get headaches from taking it, and I've had no bad effects at all. Suboxone is very difficult to get off of. It has a long half life, and in my experience, the withdraw is worse than regular opiates.
What if you simply do not tell your family about what medications you're taking? Do they really need to know? I think you should do what you need to do so you can be healthy, pain free, and have a good quality of life. There is a difference between being dependent on a medication and being addicted to it. Does your family know the difference? Whatever you choose to do, I do hope you get the help you need so you can be free of your headaches.

The naloxone is added to the

The naloxone is added to the buprenorphine so the patient cannot dissolve the tablet and shoot it up. If they do so, the naloxone will displace the buprenorphine from the opiate receptors and the patient will go into immediate withdraw. It's just added so the suboxone cannot be abused. When dissolved under the tongue, the naloxone has no effect really.

So... has low dose naltrexone

So... has low dose naltrexone been tried with chronic headaches? Willing to TRY anything that I haven't already tried and I've tried all the standard stuff.

Did I mention that my mother has borderline personality disorder? It's been three years since I just stopped taking opiates one day, and if I just sound tired, she assumes I'm taking pain medication - even though I'm not. So no, I could not take opiates and hide it. She's very canny and hyperacute that way. And she thinks she's doing it for my benefit, but she probably has subconscious ulterior motives. She's not well mentally.

And I'm just not good with subterfuge. I'm a very straightforward person. My family is so absolutely opposed to any opiates for anyone (its a dogma and they all buy in - they used to be in a religious cult, and they are prone to a group think mentality) that if at some point my health requires me to do that, I will have to cut ties with them and do my own thing. For now, I'm trying to find a way around it. Because it's not like I particularly WANT to spend the rest of my life on opiates either. Even apart from them.

I was like you in that I was

I was like you in that I was to the point I would do anything to get help, I suffered from migraines for over 30 years and it had come to the point that I had a headache all the time.... After trying everything and I mean everything from Botox on down to every pill you can imagine my doctor decided to try methadone, 5mg three times a day and at first I was pretty sick but I hung in there and now I have days where I have no headaches and I can actually able to enjoy life. I am on disability because I was unable to work because of so many headaches, so to me it is worth taking as long as it is monitored by my doctor, what scares me is he is getting older and I am afraid he will retire and I would have to start over again!!!!!

AdamAustin wrote: Methadone

AdamAustin wrote:

Methadone can be taken if required. If your doctor has told you to take methadone regularly, take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. But do not take a double dose to make up for a missed one.Although side effects from methadone are not common, but it does occur, like.
dizziness
lightheadedness
drowsiness
upset stomach
vomiting
constipation
stomach pain
rash
difficulty urinating

If anyone has got the above symptoms, withoout wasting further time, let your doctor know about the complicity, one is facing & get your medicine changed.

Out of curiosity, why did you resurrect this thread?

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