plus ça change

04.23.12
Sigh of relief. My appointment with the attractive, young, and aloof Dr. “Manhands” went well. Even though he knew I would be seeing Dr. T in August, he still asked questions and put some thought into my situation. He asked whether I’d ever tried Lamictal, which is a mood-stabilizing anti-seizure med used off-label for migraine. (Most migraine preventatives are off-label – only Depakote and Topamax have been officially approved, which is just another weird and unfortunate characteristic of migraine treatment.) I told him I had, that I didn’t remember having terrible side effects with it, but it must not have worked too well. He said, “I don’t have any new ideas, you’ve tried every available treatment.” I appreciated this, because it indicated to me that he understood the frustrating position I’m in. No “answers,” no hope of any real improvement. Knowing that in order to work and play and just live, I have to treat my headaches with some sort of abortive medication almost daily, which creates more pain. Pain (+living) = medicine = more pain. He said, “I have no problem continuing with these meds, but you *will* have rebound.” I know, right? As they say.

I prefer the term “rebound headache” to the more in vogue “medication overuse headache” because “overuse” implies fault on the part of the sufferer. I hear it as a stern, scolding voice in my head, not unlike the distinct condescending cadence of Dr Gotohell in the ER: “You are taking too much medication. Your history of narcotics use is 8 pages long… I could lose my license for giving you dilaudid, and I should know, I was head of the DEA for five years…” and the sinister implication underneath: “you are an addict, you are a drug seeker… you are an anxious, over-dramatic hypochondriac.” Meanwhile I’m curled up fetal on the hospital bed, sobbing and chewing my lips, pounding my forehead with my fists, knowing that without dilaudid I will go home and start vomiting and will just have to return. The biggest insult of all: a Toradol IM injection.

Another thing I like about the term rebound as opposed to overuse: it focuses on the action of the drug, not the patient. I picture a black bouncy ball ricocheting off of a brick wall: throw it and it bounces back, throw it again, harder, and back it comes, harder, hitting you in the face. Thwack. Rebound. But sometimes you have to throw the ball anyway.

I am supposed to get Botox treatment for migraine on Friday. 31 injections in the face, forehead, temples, neck and shoulders for 10% reduction in pain? Really? Not much evidence of efficacy, yet the FDA approved Botox for migraine treatment in 2010. For some reason. I’m nervous and excited and feel I might get a good 2 – 3 weeks out of it. Even two relatively pain-free weeks would be a huge gift. My fingers, toes, and the misbehaving, constricting veins in my head are all crossed.

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