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Opioids (Narcotics) for Migraine & Headache Disorders: Two Specialists Weigh In

Opioids are highly controversial in the world of headache medicine. Beyond the obvious issues of dependence and addiction, there are risks specific to headache disorders. In this short video, two headache specialists address some of the issues, including:

  • Taking opioids more than eight times a month puts a person at risk for rebound headache (also called medication overuse headache or MOH).
  • Opioids can reduce the efficacy of other migraine medications, including abortives and preventives.
  • Migraine is an inflammatory condition. Opioids may increase inflammation, counteracting any migraine relief they might provide.
  • Opioids aren’t particularly effective for head pain to begin with. The receptors of the brain associated with head pain have few opioid receptors, so there’s not much for the opioids to work on.

This is a huge, controversial topic, but the more I learn about it, the more convinced I become that opioids should be of limited use in treating headache disorders. Opioids have a place, but that place is small and specific. They shouldn’t be a front line treatment, which they too frequently are.

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Directories of Headache Specialists for Adults, Children

The Migraine Research Foundation has released updated lists of doctors certified in headache management, including a list of doctors who treat children. Anyone can hang a shingle saying they are a headache specialist, even without any special training. MRF’s lists only include doctors who have passed a certification exam verifying their knowledge of headache medicine. Check out this excellent resource if you’re looking for a specialist to treat your (or your child’s) migraine or headache disorder.

 

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What Do You Think of Your Doctor?

I need your input. I’m forever being asked what I know about particular headache specialists or clinics. I know the ones I’ve seen and that’s about it. You’re the expert on what you’ve experienced. Please share your opinion by commenting on the doctor who treats your headaches.

Fine print: You may identify the doctor or clinic by name, but be nice even if you didn’t think much of the doctor. You can point out what you disliked without trashing the person. Please keep in mind that people have differing opinions about particular doctors. I will delete inappropriate comments.

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Happy Anniversary!

Yesterday marked the first anniversary of The Daily Headache (here’s my first post). I can’t believe it’s been a year. At the same time, it has become such a part of my life that it feels like I’ve been doing it forever.

Hart suggested many times in the two years before I started the blog that I should become a headache blogger. I resisted, thinking that I didn’t want to complain about how I felt and didn’t have much else to offer. Besides, I didn’t think it would have any readers.

Then I tried to make an appointment with a headache specialist in Seattle. She’s the kind of neurologist that you go to when no other treatments work. You have to send your records and “apply.” There was a six month wait to see her.

I couldn’t believe that there were so many people in the Seattle area who have headaches bad enough to “qualify” to see this specialist that her schedule was so backed up. Realizing that many other people suffer like I do was heartbreaking.

Then I recognized what I have to offer: the knowledge that none of us are alone. Turns out that almost everyone who e-mails tells me that they appreciate the blog for that very reason.

Thank you for being a reader. Even though I don’t personally exchange messages with all of you, know that each of you is the reason for The Daily Headache. If I had a magic wand to cure you all, I’d use it in a heartbeat. Since that’s not possible, I’ll focus on the healing power of shared experiences.

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Finding a Headache Doctor in Your Area

Finding a doctor you like is hard enough. The additional requirement that the provider be is well-educated and up-to-date on headache seems unattainable.

Instead of immediately narrowing the pool to well-known headache specialists or clinics, consider looking for a doctor who is dedicated to treating headache, no matter what his or her medical specialty is. With a wider selection, you’re much more likely to find a doctor that you connect with. And will be saved the hassle of having to travel far from home or wait six months for your first appointment or both.

A good resource for finding such providers is the National Headache Foundation’s list of headache management-certified docs. According to the NHF, these are the requirements to get the certificate:

“…[T]he physician must have a practice which involves a substantial case load related to headache research or patient management, must have published an article in a peer reviewed journal, have completed 50 Continuing Medical Education credit hours in the area of headache in the past five years, presented at scientific meetings or published articles and been involved in teaching, lecturing, publication or research in the past seven years.”

If you don’t have luck with the list, ask around. Don’t know anyone to ask? Keep your ears open. People mention headache and migraine a lot more than it seems like they would — a coworker, neighbor or barista may give you a terrific lead. If there’s an active support group in your area, go! The folks in the group are an amazing resource. Asking on an online forum might help, but there’s a good chance that members who live close to you won’t see your post.

Other resources include member lists from the NHF (call (888) 643-5552) and ACHE, as well as About’s headache section. The list is comprehensive and well-managed. To be included in the directory, doctors have to be recommended either by other doctors or by patients. The source of the recommendation — doctor or patient — is noted.

I found one doctor by looking in the Yellow Pages for neurologists with ads that listed headache as one of their interests. She was a great doctor and I loved working with her, but her knowledge of headache was basic. She was still willing to treat my headaches aggressively.

With any of these sources, you should do your own research. When you call to schedule your first appointment, it’s a good idea to ask if that doctor sees a lot of headache patients. If the answer is no, you may want to follow another lead. Some other questions to ask at your appointment will help narrow down the field even more.