My neurologist said since my migraines had increased I’d should stop taking the triptan pills for a month. He called it a “triptan holiday.” He told me not to use over-the-counter pain relievers such as aspirin, ibuprofen, naproxin (Aleve), acetominophen and prescription drugs such as ergotamines, opioids and combination pills like Vicodin as they too cause rebound headaches and migraines.

It was the day I feared. It’s hard to endure a migraine for 24 hours let alone a month.

I wondered if there was a better way. To find out how other people dealt with rebound migraines I posted a notice on the Headaches/Migraine forum web site (www.forums.about.com) under the title “Triptan Detoxification.” I said:

 I’m 55 and have had migraines for 15 years. I’ve tried a number of preventative medications including Elavil 25 mg and Topamax 200 mg, each for a year, without success.

My migraines shot up to 20 and my triptan (Amerge, Imitrex and Maxalt) use to 21.

My neurologist says I should take a 30-day triptan holiday. This means no triptans or painkillers for a month. He does not recommend being hospitalized.

Is there a gentler way to detoxify from triptans? Has anyone been successful, what was done and how long did it take?

Thanks for your help.

The responses were encouraging. The first responder recommended tapering off the medication into the drug holiday and using a different class of medication like Midrin. She said just riding the medication holiday out would be miserable.

Dr. John Claude Krusz said there are no addiction issues with triptans but there are potential rebound issues. Specialists in the field recommend limiting triptan use to three days a week. (My average is four.) He recommended reducing the migraines and triptan use by using one, or a combination of, the over 100 medications that can be used as migraine preventatives.

The third responder suggested I get a second opinion and that the migraine specialist should have a back up plan for the pain.

Another responder said she’d asked a number of hospital detoxification programs to help her get off the triptans. The medical staff all said they have no means to detox triptans only alcohol and painkillers.

One responder said going cold turkey is not good, fair or right that that cutting back is the way to go. She said except for a muscle relaxer, her new neurologist took her off all pain medication for six weeks and it was hell. She lay in her recliner in the dark feeling nausea, couldn’t function, see well, or think straight the pain was so excruciating. After three weeks she found another doctor who helped her reduce her pain medication more slowly.

People also sent me links to articles about rebound migraines. One article, to my surprise, on www.headaches.about.com said that rebound headaches have a name. The International Headache Society Classification of Headache Disorders, second edition, defined a headache caused by painkillers as Medication Overuse Headache (MOH). They said MOH results from an interaction between the medication and a susceptible patient. The headache associated with MOD is a new type of headache that has a peculiar shifting pattern of migraine-like and tension-type characteristics. Other differences include the absence of nausea, vomiting, phonophobia, photophobia, and hotflashes and that the MOH is not worsened by activity like a migraine.

An article titled “Medication Overuse Headache (MOH): When Meds Cause the Problem” by Teri Roberts said specialists in the field of migraine disease say a patient has MOH when they take more medication and get less relief.

She said a totally different drug or treatment regiment that includes more than one abortive/relief drug can help minimize rebound headaches. There are seven different triptans ( Imitrex, Maxalt, Zomig, Amerge, Axert, Frova, and Relpax) and each or them bind to a different receptor. However, pain relievers should not be taken more than two or three times a week. Ultimately, the long-term answer for migraine relief is an effective preventative regiment as patients rarely respond to preventative medications while overusing acute medications.

Peter Goadsby the author of “Chronic Daily Headache for Clinicians” said, “There is now substantial evidence that all drugs used for the treatment of headache may cause MOH in patients with primary headache disorder.” He says the way to stop MOH is to immediately discontinue or to taper the offending medication. Medications such as butalbital compounds need to be tapered or the detoxification supervised.

According to Goadsby withdrawal symptoms usually last two to 10 days. The withdrawal symptoms may include headache, vomiting, arterial hypotension, tachycardia, sleep disturbances, restlessness, anxiety, and nervousness.

One study reported that 82% of patients significantly improved four months after withdrawal.

The new knowledge about a triptan holiday, the support from others and not having a migraine for five days helped ease my fears.

When a migraine hit on day six I had a new plan. I’d just read about Kimba Arem, a sound therapist, that offers sound therapy to treat health challenges including chronic pain. Her CD titled “A Rejuvenating Journey through Sound and Music” with Andrew Weil, a best selling author, combines indigenous healing traditions with scientific breakthroughs in brain wave study to produce expanded states of consciousness that promote healing.

Since I did not have their CD I listened to the peaceful flute music by Robert “Tree” Cody for an hour on my CD player. I also did deep breathing, meditation and tensed and relaxed my shoulder and neck muscles.

I discovered the pain could be lessoned or even eliminated with gentle music most of the time.

On day seven of the triptan holiday the music therapy did not work. After enduring eight hours of agony a Reiki healer did a two-hour session. To my amazement, the migraine pain decreased. Three hours later I was back to normal and felt great the next day.

At the Reiki healer’s suggestion I started weekly hour-long deep tissue massages for three weeks. She said I had a great deal of tension, sadness and emotional pain stored in my body.

The three massages did help decrease my number of migraines. I went from an average of four to two migraines a week. However my low-grade migraines did intensify in two out of three massages.

When the music therapy did not work and the Reiki therapist was not available I took my first triptan on day 15 of the triptan holiday. Because I was hoping to complete the 30-day triptan holiday I was disappointed. However, the next month was an improvement as I only had 12 migraines and used 6 triptans versus the 20 migraines and 21 triptans I used before.

For six months I averaged 12 migraines and 12 triptans a month versus 20 migraines and 20 triptans.

My 15-day triptan pill holiday showed me that medication overuse does cause chronic migraines and that discontinuing the pills can be helpful and empowering. The triptan holiday was a success as it forced me to learn new things about myself, my migraines and the power of alternative healing.

A 2009 Rebound : Medication Overuse Headache Update 

In early 2008 I was back to more than 20 migraines and using more than 20 triptan pills a month. The triptan pill limit is no more than 12 a month.

My new neurologist was horrified. She told me to immediately stop taking the migraine medication for 30-days.

I tearfully told her about my 2005 15-day triptan pill holiday where I spent much of the time sleepless, throwing up and in agony for hours. I did confess that it had resulted in four less migraines and six less triptan pills a month for five months.

I agreed to do another triptan pill holiday because I knew she was right, and unlike my previous neurologist, she prescribed a narcotic to deal with the pain.

Although the first week was difficult I was stunned when I only had three migraines and took three narcotics the first month.

It's been 18 months since I did my 37-day triptan holiday. I now average eight migraines and eight triptans a month as opposed to 20. The migraines respond more rapidly to the triptans and their intensity has decreased. 

I’m grateful for my neurologist’s help. To read the complete story go to “Eckhart Tolle and Migraine Management.”

Eckhart Tolle and Migraine Management
http://www.authorsden.com/visit/viewshortstory.asp?id=34133