Theories that become realities

In the headache and migraine community there is this generally accepted theory that there is a thing called Medication Overuse Headache (MOH).  There’s a lot of science about what could be happening to cause this but in laymans terms, if you take too much medication too often it will cause you to get more headaches instead of less.  And there’s limits for how much of certain kinds of medication you should take.  Different doctors and pharmaceutical companies seem to disagree on what these limits should be, so it’s kind of confusing for patients really, but generally it’s believed that you shouldn’t take triptans, opiates, nsaids, or barbiturates more than a few times a week.  If you take them too much for three months demonstrable changes in your brain occur and you actually experience a new kind of headache: Medication Overuse Headache.

Doctors go around a lot telling patients that they are in a MOH cycle and they need to stop taking medication and just go through a bad period and then they will have less headache days.  For some this works, but for many it doesn’t.  It just means that people wind up living in pain without anything to help them for a few weeks or months or however long it takes until they can find someone who is actually willing to help them again.  That’s becoming less and less too as doctors become more timid about prescribing pain management medications.  The pressure is so great.  The pain management tools are so inadequate.

Now, the nsaids, opiates, or barbiturates may in fact mask the symptoms of this MOH at any rate so the argument occurs.  If I am going to have a headache/migraine every single day anyway, what difference does it make if I’m just masking the pain.  Abortives don’t work for some, preventatives are a long-term crap shoot that often only ends in short term relief.  It’s a frustrating game we play and then we are villainized for wanting to use whatever is available that will make the suffering less.

But maybe there is a price for using these medications every day?  Nsaids are really hard on organs after a while, as are barbiturates.  Triptans will make your heart all explody and that’s not preferable.  Opiates though…as long as you don’t take too much you are pretty okay, other than maybe constipated.  For me opiates have never been a good choice as I react to them poorly.  Itchy, vomiting, and dizzy is not my idea of how to make my head feel better when I’m already vomiting and dizzy from the migraine.  It’s like fuel for the fire, but it’s not like that for everyone.  For some, it’s just a few hours of peace in an otherwise darkness filled day.  Why not?  Because they might get addicted?  Somewhere I think there’s probably a statistic that shows that people who are in pain have a lower incidence of addiction than others.  I’m sure I’ve read it somewhere, but I’m not looking it up right now and this is my highly unscientific Eileen-blog of just thoughts and stuff so I think it’s okay.  Everyone has Google.  I think I’m right on this though.

So since we don’t have treatment options and opiates are the devil and MOH is a think what we do have popping up is treatment centers that focus on learning to manage your pain without medication.  They use techniques like cognitive behavior therapy to learn to reduce stress and learn relaxation techniques,  learning to avoid pain behavior, and encouraging resumption of normal daily activities regardless of pain.

I need to take some issue with this.  Some of these programs are geared specifically toward migraine and headache patients and they seem to forget that A MIGRAINE IS NOT JUST A HEADACHE.  It’s not just about the pain.  Second of all, it’s victim blaming.  Why can’t you just learn to live with your pain?  Honestly I do function pretty well for a person who is in chronic pain.  I’m not tooting my own horn here, I just know that I do.  I still have my shortcomings and it kills me.  So for someone to say to me or anyone like me or worse off than me that we aren’t coping well enough pisses me off.  Sure, we could all stand to learn some new coping skills every so often or get a refresher course, but I’m sorry, I don’t give a damn who you are, if you are vomiting and dizzy and in immense pain, you are not resuming normal daily activities.  I’d like to see the people who developed these programs try it.

And you can relaxation technique me into oblivion if you want.  I’d like to see someone relaxation technique their way through a busy work day.  You can’t just stop and be like “hey, I know I have an important meeting but my head is bothering me so I’m just gonna go do some meditation instead, okay?”

Seriously, if we want to end the stigma surrounding migraines and headache disorders, and for that matter chronic pain altogether, we are going to have to stop this.  We can’t keep minimizing what this is.  It’s serious.  You wouldn’t go up to a person in a wheel chair and tell them they weren’t trying hard enough or meditating enough or that they are just too stressed and depressed to walk, or that the medication they take every day to not be in pain is causing them to walk less.  So why are we doing this?  And it isn’t even coming from outside the community.  We are doing this to ourselves, and I’m not sure why.  It seems we are creating more problems while trying to solve them.  Perhaps it would be responsible to consider that.