Ask an Expert: Are Opiates the Only Option for My Daughter's Migraines?

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Ask an Expert: Are Opiates the Only Option for My Daughter's Migraines?

By Dr. Richard Juman 08/22/16

Our expert discusses options for migraine-sufferers who can't take opioid medication safely.

Image: 
girl contemplating pills
Does she need them?

My 19-year-old daughter has had debilitating migraines since childhood, and doctors and specialists have never found a medication that works as effectively as opiates. But since she has addictive tendencies, she goes through her month’s medication within one week. Then she goes and buys more from friends. Do you think that she will ever be able to just use the medication the way it's prescribed? Do you have any suggestions? She has said that the pain is so bad she cannot live with it.

Dr. Richard Juman: For many reasons, opiates are rarely the best choice for the treatment of chronic pain. One of the problems is the potential for addiction, a dynamic that seems exemplified in your daughter's situation. In the not-too-distant past, physicians limited opiate prescriptions to the treatment of cancer pain and terminal conditions. Changes in prescribing patterns have led directly to the opioid epidemic that the U.S. is now trying to come to grips with.

Although some people do manage to use opioids for chronic pain without misusing them, if she's using a month's supply in a week, she is obviously struggling. What's required is a solid long-term strategy for helping your daughter manage the underlying issue—migraines—as well as her misuse of the opioid pain relievers. With respect to the opioids, one option would be for her to have a consultation with an addiction treatment program that has a physician who prescribes Suboxone, an opioid-based medication for opioid addiction that may also provide the pain relief that your daughter is seeking for the migraines. If she were in a treatment program that offered not just the Suboxone but also counseling and group support, she might be able to establish a solid recovery from her opioid medication misuse while also achieving relief from the migraine pain.

At the same time, I would strongly recommend that she explore all possible evidence-based treatments for migraine, of which there are many. I'm not a physician, but a literature review reveals several medical options, including medications for migraine pain and others that are prescribed with the goal of preventing migraines from occurring in the first place. TMS (Transcranial Magnetic Stimulation), which uses magnetic energy to address the pain, and Transcutaneous Vagus Nerve Stimulation are other available treatments. Botox is another prescription treatment that is often used for chronic migraine. Additionally, there are many other treatments for chronic migraine that have proved successful for many people, including acupuncture, supplements and herbal remedies, biofeedback, stress management, massage therapy and dietary changes.

One, or several of these therapies in combination, may give your daughter the relief that she is seeking. I hope that she can establish a sustainable long-term strategy for managing her migraines, while at the same time getting herself into recovery from opioid pain pills.

Richard Juman is the editor of Professional Voices, a weekly feature on The Fix designed to provide a forum for addiction professionals to discuss critical issues in addiction theory, treatment, policy and research. He is also a former president of the New York State Psychological Association and a longstanding member of its Addiction Division Executive Committee. Full bio.

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