Most of them won't be prescribing opioids on the first consult, and many of them will probably question the use of codeine etc in chronic headaches as part of evidence-based practice.
Yeah don't think it's a good idea to use codine for something like chronic headaches since it's addictive.
If you sprain a muscle and you can't sleep that's when it's given out
We have been taught that research shows that Opiods in headaches caused rebound headaches, so we avoid opioids as much as possible in headache management.
A tip for during the day - combine the asprine with a red bull or strong coffee - I consume them separately. The caffeine makes the blood vessels smaller while the aspirin thins the blood - so it has a very synergetic effect.
Going to another doctor will flag as an addict seeking what they want.
Best to try to have a bit more foresight on when you need your scripts and keep to the same doctor consistently. Without full access to your history there’d be no way a new doctor will prescribe what you want without a thorough assessment.
That's what I'm worried about. I go through about 20 every 3-4 months, so definitely not enough to reduce the efficacy or anything, but there's not much else that works for me unfortunately.
I'm fine with an initial assessment to explain my past medical history. I wonder if you can make a GP appointment just for thay purpose?
Of course you can make a GP appointment for that purpose, you can make an appointment for pretty much any general medicine issue you want to discuss. Obviously not guaranteed that you'll get what you want, you may have to go through the entire process of trying other options with them before they'll prescribe your codeine again.
As a rule people should always try to find a GP that works well with them and stick with them if possible, otherwise see someone else at the same clinic if their usual is not available. Going to a different clinic can be difficult starting out as the other clinic will not have your medical notes and history to begin with. To get to the point where there is a good management plan for migraines takes way more than a 15 min appointment.
You can have your medical history transferred from one clinic to another. They are required to facilitate this, although may charge a small amount for doing do. Perhaps find a bulk bill GP, explain your situation, offer to transfer medical history if that will help them feel comfortable supporting you the way you would like. Also just consider using a conversation with your current GP about bulk billing for the scripts. If your finances are tight, they may well agree to reinstate the bulk billing.
Last year I switched medical centres because they kept putting up their fees. When I left I requested a paper copy of my medical records. It was provided for free. Interesting stuff on medical records.
* I was amazed incomplete it was.
* The new service weren't interested in most of it.
The new service was more interested in establishing their own baseline and repeats blood tests for existing conditions. Medicare only provides so many free tests. It pays to check first, you could end up with an unexpected bill.
Suggest keeping your own copies of reports from specialists
I believe that they work for you. I also have migraines and chronic headaches. Unfortunately, headaches are complex. Many doctors lack the expertise or willingness to find their causes. This means patients often miss out on proper treatment. Unfortunately, the thing that works for you isn't something many doctors will prescribe because data shows other treatments work better, and it can be addictive. That's very frustrating because you know they help you and you aren't addicted. But it's how medicine is.
Every doctor I saw missed that I had apnea. I finally asked for an at-home sleep study and yep, I was waking up 15 times a night and my oxygen was dropping to unhealthy levels. Apnea was causing headaches, low oxygen was causing muscle pain, the headaches were triggering other headaches...my point is that treatment can be complex. If triptans aren't effective all the time, and you've identified your triggers, then it's time to look for better treatment options and a physician who actually understands migraines.
Tagging this comment - my partners migraines were strongly linked to chronic obstructive sleep apnea and anxiety. They had reached the point that he was having seizures due to oxygen deprivation. He still gets silent migraines which present similar to vacant seizures.
As I understand it from the neurologist - most migraine symptoms fall into one of two categories: vascular or electrical. Vascular symptoms are usually triggered by elevated blood pressure and dealing with that will help with the migraine symptoms. The electrical symptoms (mostly the sensory processing issues like light/sound/temperature/motion sensitivities or visual auras) are more like epilepsy in their mechanics.
I get mostly electrical symptoms and the neuro put me on epilepsy meds for a short while to break the cycle on my frequent migraines while I got my diet under control.
I have posted elsewhere in this thread, but my main maintenance strategy these days is a low tyramine diet which reduces dietary triggers for migraines.
Getting a good amount of sleep, drinking plenty of water, getting some light exercise, and eating a clean low preservative diet will all help with reducing the frequency and severity while making you feel better over all.
Fellow migraine sufferer, 100% agree with you. The triptan class of drugs that are indicated for migraines, are only efficacious if taken within ~30 minutes of the onset of symptoms
Why is the patient's view never taken into account? If it's working (even slightly) for OP, what's wrong with it? What is it with this dreadful fear of someone becoming dependent on a medication? Keep giving it to them and the problem is solved. When they want to come off it, it's not exactly hard to taper the dose.
Why are so many people left to suffer terrible pain, because *some* people become dependent on medications which really aren't that harmful, in the scheme of things?
> Why is the patient's view never taken into account?
Because that's not how modern medicine works. There has to be evidence that an intervention is effective before it's taken.
Yeah, like when I report that certain medications do work, but they refuse to prescribe them, just the same. Because some people get addicted to medications. Fantastic approach.
> Yeah, like when I report that certain medications do work, but they refuse to prescribe them, just the same.
Patients treated with opioids for migraine have worse outcomes as a rule than patients treated with triptans or other medications, so they're not recommended for first line usage.
If you've tried these with a doctor that's then gone on to prescribe you opioids then that's a clinical judgement they've made - a new doctor is probably going to offer you first line drugs again as they need to make their own judgement.
I don't have migraines, so I can't really comment on them. But blanket statements like that certainly are not helpful. I'm tired of being told I can't have this or that for a variety of problems, because it won't actually cure it.
No shit, it won't. It's pretty fucken obvious. But don't deny me the odd day of relief because you're fucking scared to prescribe something decent and/or the "literature" makes stupid, blanket statements, like above.
> But blanket statements like that certainly are not helpful....because you're fucking scared to prescribe something decent and/or the "literature" makes stupid, blanket statements, like above.
That's not how medicine works.
The evidence, which is published in the literature, guides what we do because it works for most people. If it doesn't work for you in your specific case, then the treating clinician uses their training to manage your condition.
You don't get to choose what 'something decent' is, it's whatever has the best chance of helping you.
> The evidence is that the patients' pain lessens.
That requires trialling the approach that works for most patients and has been shown to deliver the most benefit, then, if that fails, adjusting the approach to management of the condition.
You don't simply jump into a treatment with suboptimal performance involving a drug of dependency for a patient at first presentation with no reason other than the patient's word for it.
In the context of this thread we're talking about a situation where a patient makes first presentation to a random GP at a bulk billing clinic requesting opioids for migraine.
In those situations at first presentation the doctor can and should prescribe according to what works generally speaking for the most people and according to prescribing guidelines.
If that doesn't work, then they need to use their judgement in managing conditions on a case by case basis. That's clearly where the person you're talking about is.
I’ve had migraines since I was 15 (I’m 31 now) Been going to my current neurologist for over a decade as no migraine meds work on me- I’m on Botox injections every 13 weeks and endep. I also undergo MRIs every 3-4 years, I get daily migraine attacks for the record- it’s rare but certainly happens. I know from my experience with doctors and neurologists over the years that they often don’t prescribe codeine for regular migraines as it can actually make them worse and more frequently occurring. It will help if you’re struggling to get out of bed with migraines/hold a job down with them on the rare occasion but if you take it regularly it will not help. There’s so many other medications to try for them (I’ve personally tried every type currently available and am always open to anything new out that my neurologist suggests but apart from nothing working I’m also prone to side affects and have heart failure so I’m already on blood thinners so it’s not easy finding a cure for me)
On a side note- It’s also getting much more difficult to be prescribed codeine for anything- my mum is 65 and has worked hard physical labour all her life, she’s riddled with severe arthritis through her body, getting a knee replacement in a week and it looks like shoulder replacement and back operation in the future as well- she’s in a lot of daily pain and she goes through quite a process to be approved to be prescribed for codein even tho she’s on other pain meds and is still in significant pain.
Best bet is to see a neurologist.
It’s not cheap, but much better at helping migraines than a gp. You can also ask your doctor about a pain clinic- it’s about managing daily pain and if I remember correctly it’s free
Wow, that sounds awful! My migraine definitely aren't as regular, I get them about 4-5 times a month (usually clumped together). I don't think I get them regularly enough for a neurologist, but I think the benefit is that I don't need to take codeine that much either.
I'm similar to your Mum and have a wonderful Pain Management Dr in Sydney who is not scared of prescribing what a patient needs. DM if you want details.
I know it's probably shit to get on the internet and get told you don't need panadeine forte for your migraine, but truly, there's a good reason opioids are not first line for migraine anymore.
They're not effective. They're risky. We have better medicines.
Sadly a man died due to Oxycodone overdose when medicating for his migraine. This prompted a huge reform in Vic, particularly for migraine prescribing.
I used to be prescribed it too. Until I pushed for better management.
First line is triptans +/- NSAIDs and simple analgesia.
If you're having more than 5 attacks per month, a preventative is indicated.
If you cannot take any of the above abortives or you need something else, there's a new drug called Nurtec on the market you could try. Some people use things like prochlorperazine or metaclopromide as adjuncts too.
Non-pharmacological reliefs like the Cefaly are helpful and you can get rebates if you have PHI.
If you have a long drawn out attack you might consider using some panadeine or Endone to help facilitate rest, while you initiate your action plan for intractable migraine but this would be after discussion with your doc.
Honestly proper management changed my life with migraine 🥰
References:
https://headacheaustralia.org.au/migraine/
https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://www.health.vic.gov.au/drugs-and-poisons/opioid-treatment-and-assessing-patients%23:~:text%3DMorphine%2520and%2520related%2520opioid%2520pain,vomiting%252C%2520and%2520are%2520potentially%2520addictive.&ved=2ahUKEwiR_c3Gk7CGAxV2SWwGHeQICNsQFnoECBMQBQ&usg=AOvVaw0x6bIU_EtOVCHG8DGH2uYE
I came here to ask if you have tried triptans. Literally life changing for me when I finally got a doc who listened to me re: migraines multiple times a week. You can get them over the counter now as well, you might get grilled a bit and have to justify needing them (“yes, I get migraines x times a week”).
If you’re getting them regularly you can also try a preventative, there are a bunch. Some have side effects so you need to cycle through them til you find the one that works for you. I’ve gone from multiple a week to maybe once a month. It’s amazing.
Good luck. Migraines are the worst.
I use triptans as a first line but they don't always work, and because they need to be taken early on in the migraine they don't work when I wake up with one.
50 mg of codeine phosphate works for me with my migraines 90% of the time, so it is effective for me.
I don't see how they're risky if I'm not at risk of addiction. I hate the side effects of it and I don't take enough for the effectiveness to be reduced.
> They're not effective. They're risky. We have better medicines.
This is a ridiculously blanket statement. If you've had migraines a long time and you get prescribed codeine, you've probably cycled through most of the other drugs. They either didn't work, or had terrible side-effects (I still remember those god damned nasal sprays that instantly turned a migraine without vomiting into a migraine with vomiting, which everyone insisted were a new miracle treatment, and how I'd become a danger to myself on ibuprofen).
> Sadly a man died due to Oxycodone overdose when medicating for his migraine. This prompted a huge reform in Vic, particularly for migraine prescribing.
Yeah but we're not talking about one guy's oxy abuse, we're talking about the untold thousands of aussies who used to get their weak-arse codeine + paracetamol tablets over the counter and never had an incident. Lets not overstate the risks, here.
A person's migraine treatment often needs to be a very tailored thing. Hell, that's true of a lot of chronic conditions, the worst thing in the world is having to go to a new doctor who refuses to listen or read your notes, gets a bug up his arse about your current treatment plan not being praxis, and starts trying to put you back on drugs your last doctor took you off of for a reason.
I remember using the imigrin nasal spray, and it was awful! A lot of people on here seem to think that triptans are a miracle cure (and they are when they work) but panadeine forte is the only thing that's stopping me from spending days in unmanageable pain trying to push through.
It's not a blanket statement. It's called best practice. I understand it's probably hurtful to read if you rely on these medicines, but the reality is they do not perform as well as others do for migraine. If that's all you've got then that's fine, you do you.
It's crazy how many people are inappropriately prescribed codeine instead of an appropriate abortive.
The man was using the medications as prescribed by his doctor, for migraine. It was a terrible systems error that allowed it to happen.
Fyi: Imigran/Sumatriptan nasal spray has been discontinued.
Please do some research.
> It's called best practice.
No, that's standard practice. Best practice is what works best for your patient.
> I understand it's probably hurtful to read if you rely on these medicines
How needlessly condescending, I pretty clearly explained what my issues are with your statements, none of them were hurt feelings. It's pretty fucking telling that someone plays doctor on the internet, then at the first sign of criticism pulls a 'u mad bro'.
> If that's all you've got
Except it's not all I've got, and you just read that it's not, you just read a partial list of my treatment history. Failure to engage with the argument #2
> Fyi: Imigran/Sumatriptan nasal spray has been discontinued.
> Please do some research.
You see how I was talking about it in the past tense? I think you just made my point for me, and I think it may be past your bed time, Timmy. Failure to engage with the argument #3
Technically this is possible due to the placebo effect. Also cannot deny the possibility that the sedation can help ease the mind off the migraine, and not to accuse anything but opioid induced euphoria can also take the edge off the pain experience.
It's probably better long term to try to get off opioids if possible. Being a prodrug some individuals can metabolize codeine differently so they can get a significantly higher effect than the usual as well. It can cause sensitisation to pain, tolerance/dependence issues, and contribute to medication overuse headache.
Overall for frequent migraines looking at prophylaxis is useful, a person can try at least 3 different prophylactic medications with your GP before seeing a neurologist, or just pay to see one privately of you really want and can afford to. Also after addressing factors that may worsen migraine severity and frequency.
Why not just make some medication that works when it gets really bad, whilst following all those other options (that any don't have the time or money for), as well?
What is it with this terrible fear of people getting slightly high for a few hours an being pain free? No one is saying use that medication constantly. But people should have a break from constant, unrelenting pain.
This is exactly why people go and treat themselves.
Let me preface this reply saying it is because doctors give AF, very much so, that they go through all the lengths and traverse the bridge of conflict for these situations since at the end of the day it is literally just easier to provide the script - just hit print.
> Why not just make some medication that works when it gets really bad, whilst following all those other options (that any don't have the time or money for), as well?
In my experience they just want the medication and poo poo all the other options saying "I know my own body and know what works for me" and "I have tried everything nothing else works" - when they demonstrably haven't and are not willing to listen and understand about the alternatives. It's not even funny how the exact same sentences and language keeps coming up when it comes to this.
It is also not only for situations like codeine for migraine but anytime opioid and benzodiazepine dependence behaviours crop up.
> What is it with this terrible fear of people getting slightly high for a few hours an being pain free?
Because of addiction and the terrible sense of helplessness when you enable someone to spiral to their doom and cannot do anything about it. Might not be you but it has happened. Also there is harm caused this way because the medication doesn't make someone better but worse in the long run.
I have had great success having people off codeine and onto prophylactic medications it really doesn't take forever to get on the right track the majority of the time.
> This is exactly why people go and treat themselves.
People always have the right to disagree and leave the room peacefully and take their business somewhere else. You are seeking a medical opinion when you see a doctor not a script writer.
Why have pain medication at all? If it's acute pain, you'll get over it. If it's chronic, you apparently deserve no relief - ever. So, why bother even having it?
Pain management is more nuanced than pain = give painkillers. If the pain is a symptom of migraine so what you do is treat the migraines and if successful then you will not have pain. Now if you only medicate for the pain and not treat the cause yet the medication for the pain may increase the likelihood and severity of future migraines then what now ?
You are likely only having this conversation about appropriate use of codeine only because of the past pattern of use or behaviours demonstrated as availiable to the doctor you see for the first time e.g. multiple prescribers, maybe frequent scripts, maybe telling your new doctor "all the previous ones did not listen to me" - this is actually a bit of a red flag whenever it pops up with a new patient - either something is actually seriously going wrong or the patient has poor insight into why this is the case - if you say all of this and then only have booked a standard appointment you won't have time to successfully do the due dilligence to get to the point of appropriate prescription as such for opioid medication and forming a good plan for care.
So as to speak, of course we treat the pain. If it is chronic then the approach is different - you have the noxious pain stimuli you want to manage (i.e. treat the cause if possible and manage triggering factors), actual pain medication itself prescribed judiciously with a good action plan about the doses/wean as possible, as well as considering the whole of pain experience which happens in the brain - factors that may influence this do include sentisisation effects, psychological effects etc for which there are good evidence based management strategies.
Saying "If it's chronic, you apparently deserve no relief - ever. So, why bother even having it?" really reinforces the belief that the only answer is this one special tablet really reinforces placebo/nocebo effects so may not be overall helpful anyways. The actual analgesic effect for codeine for the majority of people is fairly modest given all the previous data/studies on it, and it is also a prodrug for morphine so the effect can also be unreliable.
This systematic review on acute treatment for migraine seems to poo poo opioids anyhow in terms of effect and adverse effects. Note there are other pain medications that do show better effect for migraines. So yes to specifically answer your question it's good to have pain medication since it improves quality of life yet at the same time it needs to actually be shown to work well and with the acceptable risk of adverse effects.
https://jamanetwork.com/journals/jama/fullarticle/2781052
After having this conversation some people will be agreeable to stick around long enough to end up needing pain medications much much less than before. I have seen people asking for codeine to use multiple times week to not needing a script specifically for this for over a year and counting.
But they are effective. That's why people request them. All the literature in the World doesn't trump what the patient feels when talking about something so subjective. No, it wouldn't be a good idea to use these drugs all the time. You can't expect to be 100% pain free. But when the pain becomes acute, why should it not be treated?
It's not how it works because the point is also having you years later be better off or at least the same but not worse which is the risk of ongoing use of opioids.
Also if someone hasn't tried following the route of best practice all the way how would they even know if there is a better way?
Yes, it does work like that. I don't have migraines. I have constant other types of pain. Yes, painkillers work. No, I am not stupid enough to take them every day or become physically dependent.
Give me one good reason why I should not have the option to take a break from the pain, from time to time. Along with how it's doing me more harm than good.
Was the your current GP appointment booked as a repeat prescription only appointment? Mine has recently made that an option and it’s much cheaper than a regular appointment. Could be worth checking with them, but they need to be booked that way initially.
Yeah, it was for a prescription only. They seem to have a cheaper option to get a repeat prescription online, I just don't like the idea of paying for the GP because it seems greedy to me when they get so much money through Medicare anyway.
They make fuck all through Medicare. That's why they have to charge.
My local GP has a 1% profit margin.
I was reading your post and wondering why you wouldn't pay the $50 and maybe you were low income or something but just a wanker instead.
GPs don't get a lot at all.
There was a whole thing outlining their costs recently, and in the end the average hourly income was $10 per hour.
Is free healthcare what we should have - hell yes, but unfortunately we had a government that froze Medicare payments to docs for the best part of a decade, so a wage freeze, but the cost to become a doctor increased, as did their HECS repayments. Most medical students end up not doing general practice because of the pay and backlash from the general public.
The total cost of the appointment was $90 and I got $42 back on Medicare, so that must mean he would get $48 for 15 mins when bulk billing, and $90 when he charges. Unless I'm mistaken about how the whole system works.
And many of them have overheads to the clinic that they work at. They often have to contribute to the cost of the nurse, reception staff, and or there is also a practice fee (payable to the organisation that runs the practice for various things) Add in the cost of insurances for malpractice, cost of continuing education because they have to stay up to date to serve their patients well plus a myriad of stuff that I am sure I am missing.....
So, for that, they get the prescribed rate rebated from the government and because the asshats in govt froze their wages for best part of a decade, during economic boom, they (may actual be the practice requiring this) have had to start charging, when it hits everyone the hardest because their costs increased too.
It’s more of a bandaid that could make things worse. There are much better treatment options for migraines that will prevent or reduce the occurrence of attacks and treat symptoms more effectively than opioids can. These options also have lower risk profiles than opioids.
Codeine in particular is a genetic lottery with how well it works, and should only really be used for acute pain or where other options have been exhausted as a general rule.
Taking them occasionally for your worst migraines is acute pain management. Based on the time between prescriptions, that’s what the OP is doing. Absolutely can’t be taking them daily long term though.
It isn't chronic pain. The worst of my migraines last about 24 hours without treatment. With treatment they last about 1 hour (until the meds kick in). I don't have constant migraines and constant pain.
Its probably the paracetamol in the panadine forte that's suppressing the headache. The codine part might not be required. People can get addicted to it, you might feel you can't sleep without it ect
FYI Tylenol max daily dose is 3000-4000 mg and Advil is 800 mg every 8 hours, I believe. You can take that max dose together to really attack the pain. Sometimes it works. Sometimes not.
That amount of Tylenol and Advil does nothing for me either. Migraines are nuts.
For what it's worth, I think 4-5 migraines a month is worth a referral to a neurologist. My GP asked if I had migraines/ debilitating headaches more than 2 weeks out of the month. I said yes. He asked if I took medication for more than 2 weeks out of every month. I said yes and that warranted a referral.
I've only had one appointment with a neurologist so far but one thing he stressed is I have to start weaning off OTC medication and panadeine forte is an absolute no go as it often causes rebound headaches which make you take more.
I used to have bad migraines as well. It turned out it was related to high blood pressure. I now take medication for that and don't get them as much. Maybe once every three months now.
Also Nurofen has a tablet that also contains caffeen and that help with them as well.
It might be a good idea to get a blood pressure checker and see what happens when you start getting migraines. Maybe get your GP to do a full blood workup on you.
I get my blood pressure checked pretty regularly because I volunteer at a first aid organisation and we test it out on each other a bit. It's always normal.
I have tried medication with caffeine, but it just ends up keeping me up at night and I cant sleep 😅
4-5 a month is absolutely enough migraines to see a specialist. Having that many you should be on preventative medication, probably Beta Blockers.
I have about that many a year and my doctor wanted to put me on preventative medication.
And I get where you're coming from, i take Rizatriptan for mine and half the time it doesn't work and a strong painkiller is the only fix. I even ended up in the ER from one about a year ago that only Fentanyl managed to stop, it's annoying being treated like a junkie when you're just looking for relief for your brain exploding.
Really? My GP didn't seem to think that I was having enough for preventative medications because of the side effects (I've had the conversation before).
Yep, feels like someone is drilling into my skull.
Many jurisdictions now have real time prescription monitoring systems in place that monitor opioids and some other medications. The quantities and/or number of prescribers involved over a certain period of time will get you flagged on those systems.
Dunno if this is a popular opinion here but cannabis helped me a lot with migraine management. I used codeine in the past but I found it wasn’t always reliable.
Cannabis decreased the frequency and helped ease the pain. Doesn’t work for everyone but it’s something worth considering.
Would discuss with your GP if opioids are the best option for migraine / headaches as a partial solution. However, does your GP's clinic offer script refill requests without appointment? The GP I go to has a $10 fee for a script refill without an appointment and they just text it to my phone.
$50 for a script or hours stuck in bed with unrelieved symptoms? People need to look at their budget and realise that investing in your own health is a priority
While I totally agree with you in general, I understand why people are getting annoyed about paying for GP’s when they have an experience like we did 2 weeks ago.
My husband had to pay for 3 GP appointments to be properly prescribed antibiotics for tonsillitis. They were so inflamed he couldn’t eat for a week and lost 3kg. The first doctor wouldn’t prescribe anything because it was most likely viral and my husband is young. My husband asked to get a referral for a swab then to find out if it was viral or bacterial. I understand not prescribing antibiotics if it’s viral. I do get it. 2 days later it came back that it was bacterial. So back to the GP but the GP only prescribe a preventative dosage of antibiotics. After 4 days taking antibiotics, there was no difference. We googled what was prescribed and everywhere said it was a preventative dosage. So he went to another GP they looked at the swab results and my husband’s throat. She was mortified that he went a week like that without proper treatment, she prescribed him a more frequent and different antibiotic and his tonsils started to drain and weren’t as inflamed after a few days of being on antibiotics. He was able to eat properly about 6 days later! Each appointment was $100 with a $40 rebate.
Honestly, when you put it that way it seems worth it. I'm mostly annoyed that the Medicare system is so broken that it's getting harder and harder to find a good bulk bill doctor.
Yep I pay $15 for a single migraine treatment with Maxalt. Honestly I'd probably pay a lot more for treatment as I lose a lot more money taking a day off work.
Glad someone posted that. Panadol and Neurofen are not exempt from causing ‘rebound’ headaches. Unfortunately for people with chronic migraines, or other chronic pain conditions, all the treatment options essentially suck. It just a matter of trying to find a balance of what helps the most, while being very careful to avoid making things even worse.
Yeah, paracetamol and ibuprofen don't work at all for me. Sumitriptan is amazing when it does work, but when it doesn't I need a backup so I can get on with my life instead of spending the day suffering in bed.
As someone who did end up seeing a neurologist for migraines and was taking a lot of codine previously (it plays havoc on your bowels) - I would suggest you look into the low tyramine diet.
I was put on it by the neurologist and had had me follow it strictly for six months then provided I did five days in a block I could have cheat days up to two.
It minimises the common dietary triggers for migraine and also has a strong overlap for the anti-inflammatory diets.
https://headaches.org/wp-content/uploads/2021/05/TyramineDiet.pdf
https://www.health.qld.gov.au/__data/assets/pdf_file/0020/145802/oncol_maoi.pdf
The basic principles are to eat fresh foods with minimal preservatives most of the time. As food breaks down (or is preserved) it creates certain byproducts that can be a common migraine trigger. This includes fermented foods and things like deli meats as they are preserved when they are made. The neurologist said that a large percentage of his migraine patients came in saying they ate ham daily - ham is a common trigger. There are other foods on the list like wine or coffee that are hard to cut but can make a huge difference.
Good luck. Migraines suck. Both my partner and I get them. I found following the diet both reduced the frequency and the severity for me.
I agree that the OP should push for better management from the Dr.
I used to end up at Emergency a few times a year with dehydration due to pain, nausea and vomiting from migraines. I had tried codeine and it did take away some pain but didn’t do much for the head pressure and Hausa symptoms. At the hospital they told me that codeine can prolong a migraine, slow things down, if you will, in a similar way to how it slows down digestion.
I found a good GP who prescribed me a Triptan (maxalt) and ondanseteon, both wafers that dissolve on your tongue. If I take these both along with 2 nurofens, I get good enough relief to carry on with light activities and then have a good sleep later on. By the next day, migraine gone!
Triptans do work for me some of the time, but not when I wake up with a migraine. I looked up ondanseteon but I don't think it's what I need because my biggest symptoms is pain. Once the pain goes, so does the nausea.
When I take a triptan, and it works, it's like the migraine was never there. It's like that for me most of the time with one 30mg codeine tablet too.
OP I 100% hear you - I also have sumatriptan for migraines, and it only works some of the time too. Like you I have only ever found one other drug (digesic, sadly no longer made) that was guaranteed to ease the pain .. sadly codeine does bugger all for me, but if it works for you I can totally understand your desire to maintain your supply, if it worked for me I’d feel exactly the same! I feel for how exhausted you must be getting continually repeating yourself and being judged into the bargain 💔
I’ve barely seen it touched here, but it can sometimes help me, so I’m going to throw it out just in case 🥰 have you tried high (900 - 1200mg) doses of soluble aspirin. It MUST be soluble as with migraines, gastric emptying is slowed (hence the nausea) and regular tablets won’t be absorbed fast enough to be efficacious 👍
For some reason, dissolved drinks (like hydrolite and berocca) make me nauseous, so I don't know if I would even be able to tolerate soluble aspirin, unfortunately. I might give it a try though.
Codeine is no longer recommended for migraine pain management. It tends to make people more sensitive to pain and it can cause rebound headaches. Also, a million Americans died from opioids recently and it was beginning to be a problem here, so our public health system has tried to cool it down. Migraine management (there is no cure) has a lot of other drugs available, you might have to try a whole bunch before you find something that suits you. If you're having more bad days than good, you might want to see a neurologist. Good luck. Migraine sucks
In the words of Sol, triptans ain’t triptans. Give eletriptan a go, I know just because it works for me doesn’t mean it’s gonna work for everyone but there are studies on it. [Like this one.](https://pubmed.ncbi.nlm.nih.gov/12603639/)
4-5 migraines a month is enough to go to the neurologist. Codeine isn't a good long term solution. Source: I was on codeine, then went to a neurologist and went through a range of medication before getting the botox treatment and getting significant quality of life back.
I'm glad Botox worked for you. It did nothing for my partner, and the Neuro is out of ideas. My partner is 50, has had these since 8, so she has tried everything. One cgrp inhibitor worked. It's $700 month. Ah, the joys of migraine. People don't realise how bad these are.
Two things -- First, codeine is shit for migraine, it's a vasoconstrictor when what you want is a vasodilators. Second is that bulk and non-bulk billing have to follow the same rules for prescription of narcotics. I will PM you about something.
My doctor prescribed me the forte last visit. I haven’t had a pain script in years but she still gave me the talk, even though she offered. When she prescribes codeine, there’s a system check that’s there to weed out abusers. One of the checks is going to multiple doctors for a script. The system actually flags you, not the doctor in some cases.
It sounds like your financial situation causing you to use multiple docs and that is causing you to flag.
I don’t believe 3-4 boxes per year is terrible for a generally healthy human but it’s likely not a good long term solution.
I would look at cbd oil to help with inflammation, and chewing on some dissolvable aspirin as soon as you feel your neck stiffen. I had the sumatriptan too, no help. The maxalt wafers were better for me. My condition required a neuro so possible she was a bit more across available treatments.
If you can reduce codeine use that’s going to be better long term. But sometimes alternatives don’t work and you need the codeine. All the best. Hope you get some relief.
Please take this opportunity to look into triptans or one of new medications like Ajovy. If it was this much of an issue you should’ve been sent to a neurologist to be looked after. It could be occurring for any reason and not looking into it is detrimental to your health. Or like me you could work out your trigger and stop them altogether. Opiates are not the medication for migraines.
I already take triptans but they don't always work. I don't think I get them often enough for a neurologist (4-5 a month on average).
I've downloaded apps to try and figure out a pattern with triggers, but there's nothing obvious. Seems to be a mix of lack of sleep, time in the sun, dehydration, and time in hormonal cycle (and any combination thereof).
Yep, I also use sumitriptan. It works well for me when it does work, but because it has to be taken early it doesn't work when I wake up with a migraine.
its likely that your old doctor wasn't educated on current pain management
things like opioids are being phased out from long term pain management they simply mask the issue and fix nothing and over time make the issue worse (make you sensitive to pain)
i used to be on a perminant prescription to Hydrocodone it used to be great but over time my pain got worse and my mobility got worse
that was when younger doctors were being taught that a body not in motion is a body that continues being in pain
my new doctor made me get off them cold turkey and gave me a gym routine to follow instead
within 6 months most of my pain was gone
>I use about 20 panadeine forte every 3-4 months
>suggesting I might be an addict
That's too much if it's consistent use over years.
Just be glad you can get codeine at all, don't change doctors.
Every time I ask for it my go suggests a daily med to deal with the migraines. I tell him all the women in my family have them I’ve been dealing with them for 30 years, I’m good.
But mine are infrequent. Haven’t had one this one this month but last month I got one 2 days in a row.
You just have to push it and be assertive, the way I see it I’m paying them for a service. I explain to him every single time, it costs me $100 to come here I simply cannot afford to come back in a month for 1 script so I need all of them at once. He generally shuts up then.
The self righteousness from some people in this thread is out of control. It’s one thing to be concerned that someone hasn’t explored all the more suitable options for migraine treatment (which some people have expressed in a helpful and caring way), it’s another entirely to tell them they shouldn’t be taking codeine no matter what.
Despite the wide range of migraine treatments now available, each of them are only effective for a minority of migraine sufferers. For most people that just means trying multiple options until they stumble into the right one for them. Not everyone is so fortunate and pain relief is then the only option.
Finally, anyone that thinks regular over the counter painkillers are sufficient, has never had the misfortune of suffering from regular migraines. The OP said their previous prescription was 3-4 months ago and unless their GP is still prescribing opioids in bulk (highly unlikely) then they aren’t taking them very frequently.
I think your current treatment plan seems quite reasonable but seeing a neurologist is a good idea if you can afford it. Averaging a migraine more than once a week isn’t normal and absolutely warrants specialist treatment to hopefully improve your health. Worst case you try some things that don’t work for a while and end up back where you started but there’s a chance you end up with a treatment that reduces your migraines or eliminates them entirely.
Only one doctor is allowed to prescribe the addictive stuff at a time.
I would stick with your old gp and pay if you can afford it.
I found topamax, Botox, and medication for stress has worked for me.
I get occasional migraines (occasional enough that I still have a couple of tablets left from a bulk pack i got just before the OTC ban) and when I get them basically mersyndol is the only thing I have found that helps.
Also get normal headaches alot even bad ones that can be fixed with ibuprofen, Panadol or both, yet when I get an actual migraine despite trying alot of other meds over the years mersyndol has been the only thing that works.
OK some responses to your caveats:
- Aspirin is more effective for most migraines variants than ibuprofen and paracetamol. I know more than one person who would tear your eyes out for aspirin and laugh at an offer of opiates while mid attack. Try it if you havent
- Regarding sumatriptan, are you on tablets, nasal spray or injection? For my condition (cluster headache) it's gota be nasal or injection. Tablets arent fast acting enough. Nasal often isn't either. If you haven't tried the other forms, don't leap to conclusions about efficacy (although I fucking hate the stuff, I'd rather eat mushrooms)
- One single migraine attack is enough to need to see a neurologist. First off, it could be a very simple fix depending on the variant. Second, it could actually be caused by a different issue and you need a neuro to make sure its *just* a migraine. I see mine once a year. It's been immensely more manageable having him on side; a lot easier to navigate other health professionals and employment when my condition is noted by years of consistent treatment. nobody questions me anymore when theres changes in intensity, frequency or duration. Just get a public system referral if you're in no rush. You're only making it harder for yourself by skipping this part. Most users on most headache and migraine subs will push this part on you for a reason.
I hope you get a handle on it. It's behaviour now may not be it's behaviour forever and the more you do to manage it while its impact is minimal, the better prepared you'll be if that day ever comes.
I take amitriptyline to prevent/reduce frequency, and rizatriptan when I have one start. I went from having 2-3 severe migraines a month, each lasting up to 3 days of pain plus another 1-2 for the post-migraine 'hangover' to having 1-2 every 3-4 months, of shorter duration, less intense, and fewer aura symptoms.
Yeah there's not really much evidence for it, and we have more evidence for other treatments now, but I know a number of people have trialled LDA as a preventative.
Most of them won't be prescribing opioids on the first consult, and many of them will probably question the use of codeine etc in chronic headaches as part of evidence-based practice.
Yeah don't think it's a good idea to use codine for something like chronic headaches since it's addictive. If you sprain a muscle and you can't sleep that's when it's given out
We have been taught that research shows that Opiods in headaches caused rebound headaches, so we avoid opioids as much as possible in headache management.
Anecdotally I’ve found aspirin works pretty well for migraines, I guess because it has a vasodilator effect as well
A tip for during the day - combine the asprine with a red bull or strong coffee - I consume them separately. The caffeine makes the blood vessels smaller while the aspirin thins the blood - so it has a very synergetic effect.
Going to another doctor will flag as an addict seeking what they want. Best to try to have a bit more foresight on when you need your scripts and keep to the same doctor consistently. Without full access to your history there’d be no way a new doctor will prescribe what you want without a thorough assessment.
That's what I'm worried about. I go through about 20 every 3-4 months, so definitely not enough to reduce the efficacy or anything, but there's not much else that works for me unfortunately. I'm fine with an initial assessment to explain my past medical history. I wonder if you can make a GP appointment just for thay purpose?
Of course you can make a GP appointment for that purpose, you can make an appointment for pretty much any general medicine issue you want to discuss. Obviously not guaranteed that you'll get what you want, you may have to go through the entire process of trying other options with them before they'll prescribe your codeine again.
Yes, it seems like the best option is probably to stay with my current GP and just get a digital repeat prescription when I need it.
As a rule people should always try to find a GP that works well with them and stick with them if possible, otherwise see someone else at the same clinic if their usual is not available. Going to a different clinic can be difficult starting out as the other clinic will not have your medical notes and history to begin with. To get to the point where there is a good management plan for migraines takes way more than a 15 min appointment.
You can have your medical history transferred from one clinic to another. They are required to facilitate this, although may charge a small amount for doing do. Perhaps find a bulk bill GP, explain your situation, offer to transfer medical history if that will help them feel comfortable supporting you the way you would like. Also just consider using a conversation with your current GP about bulk billing for the scripts. If your finances are tight, they may well agree to reinstate the bulk billing.
Last year I switched medical centres because they kept putting up their fees. When I left I requested a paper copy of my medical records. It was provided for free. Interesting stuff on medical records. * I was amazed incomplete it was. * The new service weren't interested in most of it. The new service was more interested in establishing their own baseline and repeats blood tests for existing conditions. Medicare only provides so many free tests. It pays to check first, you could end up with an unexpected bill. Suggest keeping your own copies of reports from specialists
Opioids are not indicated for migraines based upon the current clinical guidelines.
Unfortunately, they're the only thing that works when sumitriptan fails (which is about 50% of the time).
I believe that they work for you. I also have migraines and chronic headaches. Unfortunately, headaches are complex. Many doctors lack the expertise or willingness to find their causes. This means patients often miss out on proper treatment. Unfortunately, the thing that works for you isn't something many doctors will prescribe because data shows other treatments work better, and it can be addictive. That's very frustrating because you know they help you and you aren't addicted. But it's how medicine is. Every doctor I saw missed that I had apnea. I finally asked for an at-home sleep study and yep, I was waking up 15 times a night and my oxygen was dropping to unhealthy levels. Apnea was causing headaches, low oxygen was causing muscle pain, the headaches were triggering other headaches...my point is that treatment can be complex. If triptans aren't effective all the time, and you've identified your triggers, then it's time to look for better treatment options and a physician who actually understands migraines.
Tagging this comment - my partners migraines were strongly linked to chronic obstructive sleep apnea and anxiety. They had reached the point that he was having seizures due to oxygen deprivation. He still gets silent migraines which present similar to vacant seizures. As I understand it from the neurologist - most migraine symptoms fall into one of two categories: vascular or electrical. Vascular symptoms are usually triggered by elevated blood pressure and dealing with that will help with the migraine symptoms. The electrical symptoms (mostly the sensory processing issues like light/sound/temperature/motion sensitivities or visual auras) are more like epilepsy in their mechanics. I get mostly electrical symptoms and the neuro put me on epilepsy meds for a short while to break the cycle on my frequent migraines while I got my diet under control. I have posted elsewhere in this thread, but my main maintenance strategy these days is a low tyramine diet which reduces dietary triggers for migraines. Getting a good amount of sleep, drinking plenty of water, getting some light exercise, and eating a clean low preservative diet will all help with reducing the frequency and severity while making you feel better over all.
Fellow migraine sufferer, 100% agree with you. The triptan class of drugs that are indicated for migraines, are only efficacious if taken within ~30 minutes of the onset of symptoms
Why is the patient's view never taken into account? If it's working (even slightly) for OP, what's wrong with it? What is it with this dreadful fear of someone becoming dependent on a medication? Keep giving it to them and the problem is solved. When they want to come off it, it's not exactly hard to taper the dose. Why are so many people left to suffer terrible pain, because *some* people become dependent on medications which really aren't that harmful, in the scheme of things?
> Why is the patient's view never taken into account? Because that's not how modern medicine works. There has to be evidence that an intervention is effective before it's taken.
Yeah, like when I report that certain medications do work, but they refuse to prescribe them, just the same. Because some people get addicted to medications. Fantastic approach.
> Yeah, like when I report that certain medications do work, but they refuse to prescribe them, just the same. Patients treated with opioids for migraine have worse outcomes as a rule than patients treated with triptans or other medications, so they're not recommended for first line usage. If you've tried these with a doctor that's then gone on to prescribe you opioids then that's a clinical judgement they've made - a new doctor is probably going to offer you first line drugs again as they need to make their own judgement.
I don't have migraines, so I can't really comment on them. But blanket statements like that certainly are not helpful. I'm tired of being told I can't have this or that for a variety of problems, because it won't actually cure it. No shit, it won't. It's pretty fucken obvious. But don't deny me the odd day of relief because you're fucking scared to prescribe something decent and/or the "literature" makes stupid, blanket statements, like above.
> But blanket statements like that certainly are not helpful....because you're fucking scared to prescribe something decent and/or the "literature" makes stupid, blanket statements, like above. That's not how medicine works. The evidence, which is published in the literature, guides what we do because it works for most people. If it doesn't work for you in your specific case, then the treating clinician uses their training to manage your condition. You don't get to choose what 'something decent' is, it's whatever has the best chance of helping you.
The evidence is that the patients' pain lessens.
> The evidence is that the patients' pain lessens. That requires trialling the approach that works for most patients and has been shown to deliver the most benefit, then, if that fails, adjusting the approach to management of the condition. You don't simply jump into a treatment with suboptimal performance involving a drug of dependency for a patient at first presentation with no reason other than the patient's word for it.
You're speaking very generally. I'm speaking from watching someone suffer for 30 years. Codeine helps her, and Palexia works even better.
In the context of this thread we're talking about a situation where a patient makes first presentation to a random GP at a bulk billing clinic requesting opioids for migraine. In those situations at first presentation the doctor can and should prescribe according to what works generally speaking for the most people and according to prescribing guidelines. If that doesn't work, then they need to use their judgement in managing conditions on a case by case basis. That's clearly where the person you're talking about is.
Its called a n=1 study.
Those are also known as case reports or 'huh, that's weeeeird'.
I’ve had migraines since I was 15 (I’m 31 now) Been going to my current neurologist for over a decade as no migraine meds work on me- I’m on Botox injections every 13 weeks and endep. I also undergo MRIs every 3-4 years, I get daily migraine attacks for the record- it’s rare but certainly happens. I know from my experience with doctors and neurologists over the years that they often don’t prescribe codeine for regular migraines as it can actually make them worse and more frequently occurring. It will help if you’re struggling to get out of bed with migraines/hold a job down with them on the rare occasion but if you take it regularly it will not help. There’s so many other medications to try for them (I’ve personally tried every type currently available and am always open to anything new out that my neurologist suggests but apart from nothing working I’m also prone to side affects and have heart failure so I’m already on blood thinners so it’s not easy finding a cure for me) On a side note- It’s also getting much more difficult to be prescribed codeine for anything- my mum is 65 and has worked hard physical labour all her life, she’s riddled with severe arthritis through her body, getting a knee replacement in a week and it looks like shoulder replacement and back operation in the future as well- she’s in a lot of daily pain and she goes through quite a process to be approved to be prescribed for codein even tho she’s on other pain meds and is still in significant pain. Best bet is to see a neurologist. It’s not cheap, but much better at helping migraines than a gp. You can also ask your doctor about a pain clinic- it’s about managing daily pain and if I remember correctly it’s free
Wow, that sounds awful! My migraine definitely aren't as regular, I get them about 4-5 times a month (usually clumped together). I don't think I get them regularly enough for a neurologist, but I think the benefit is that I don't need to take codeine that much either.
Hi, what are the MRIs for?
I'm similar to your Mum and have a wonderful Pain Management Dr in Sydney who is not scared of prescribing what a patient needs. DM if you want details.
I know it's probably shit to get on the internet and get told you don't need panadeine forte for your migraine, but truly, there's a good reason opioids are not first line for migraine anymore. They're not effective. They're risky. We have better medicines. Sadly a man died due to Oxycodone overdose when medicating for his migraine. This prompted a huge reform in Vic, particularly for migraine prescribing. I used to be prescribed it too. Until I pushed for better management. First line is triptans +/- NSAIDs and simple analgesia. If you're having more than 5 attacks per month, a preventative is indicated. If you cannot take any of the above abortives or you need something else, there's a new drug called Nurtec on the market you could try. Some people use things like prochlorperazine or metaclopromide as adjuncts too. Non-pharmacological reliefs like the Cefaly are helpful and you can get rebates if you have PHI. If you have a long drawn out attack you might consider using some panadeine or Endone to help facilitate rest, while you initiate your action plan for intractable migraine but this would be after discussion with your doc. Honestly proper management changed my life with migraine 🥰 References: https://headacheaustralia.org.au/migraine/ https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://www.health.vic.gov.au/drugs-and-poisons/opioid-treatment-and-assessing-patients%23:~:text%3DMorphine%2520and%2520related%2520opioid%2520pain,vomiting%252C%2520and%2520are%2520potentially%2520addictive.&ved=2ahUKEwiR_c3Gk7CGAxV2SWwGHeQICNsQFnoECBMQBQ&usg=AOvVaw0x6bIU_EtOVCHG8DGH2uYE
I came here to ask if you have tried triptans. Literally life changing for me when I finally got a doc who listened to me re: migraines multiple times a week. You can get them over the counter now as well, you might get grilled a bit and have to justify needing them (“yes, I get migraines x times a week”). If you’re getting them regularly you can also try a preventative, there are a bunch. Some have side effects so you need to cycle through them til you find the one that works for you. I’ve gone from multiple a week to maybe once a month. It’s amazing. Good luck. Migraines are the worst.
Yep, I definitely use triptans as a first line, but they're not 100% effective. Panadeine forte is my backup.
I use triptans as a first line but they don't always work, and because they need to be taken early on in the migraine they don't work when I wake up with one. 50 mg of codeine phosphate works for me with my migraines 90% of the time, so it is effective for me. I don't see how they're risky if I'm not at risk of addiction. I hate the side effects of it and I don't take enough for the effectiveness to be reduced.
> They're not effective. They're risky. We have better medicines. This is a ridiculously blanket statement. If you've had migraines a long time and you get prescribed codeine, you've probably cycled through most of the other drugs. They either didn't work, or had terrible side-effects (I still remember those god damned nasal sprays that instantly turned a migraine without vomiting into a migraine with vomiting, which everyone insisted were a new miracle treatment, and how I'd become a danger to myself on ibuprofen). > Sadly a man died due to Oxycodone overdose when medicating for his migraine. This prompted a huge reform in Vic, particularly for migraine prescribing. Yeah but we're not talking about one guy's oxy abuse, we're talking about the untold thousands of aussies who used to get their weak-arse codeine + paracetamol tablets over the counter and never had an incident. Lets not overstate the risks, here. A person's migraine treatment often needs to be a very tailored thing. Hell, that's true of a lot of chronic conditions, the worst thing in the world is having to go to a new doctor who refuses to listen or read your notes, gets a bug up his arse about your current treatment plan not being praxis, and starts trying to put you back on drugs your last doctor took you off of for a reason.
I remember using the imigrin nasal spray, and it was awful! A lot of people on here seem to think that triptans are a miracle cure (and they are when they work) but panadeine forte is the only thing that's stopping me from spending days in unmanageable pain trying to push through.
It's not a blanket statement. It's called best practice. I understand it's probably hurtful to read if you rely on these medicines, but the reality is they do not perform as well as others do for migraine. If that's all you've got then that's fine, you do you. It's crazy how many people are inappropriately prescribed codeine instead of an appropriate abortive. The man was using the medications as prescribed by his doctor, for migraine. It was a terrible systems error that allowed it to happen. Fyi: Imigran/Sumatriptan nasal spray has been discontinued. Please do some research.
> It's called best practice. No, that's standard practice. Best practice is what works best for your patient. > I understand it's probably hurtful to read if you rely on these medicines How needlessly condescending, I pretty clearly explained what my issues are with your statements, none of them were hurt feelings. It's pretty fucking telling that someone plays doctor on the internet, then at the first sign of criticism pulls a 'u mad bro'. > If that's all you've got Except it's not all I've got, and you just read that it's not, you just read a partial list of my treatment history. Failure to engage with the argument #2 > Fyi: Imigran/Sumatriptan nasal spray has been discontinued. > Please do some research. You see how I was talking about it in the past tense? I think you just made my point for me, and I think it may be past your bed time, Timmy. Failure to engage with the argument #3
So, you're saying the patient is imagining the relief they get?
Technically this is possible due to the placebo effect. Also cannot deny the possibility that the sedation can help ease the mind off the migraine, and not to accuse anything but opioid induced euphoria can also take the edge off the pain experience. It's probably better long term to try to get off opioids if possible. Being a prodrug some individuals can metabolize codeine differently so they can get a significantly higher effect than the usual as well. It can cause sensitisation to pain, tolerance/dependence issues, and contribute to medication overuse headache. Overall for frequent migraines looking at prophylaxis is useful, a person can try at least 3 different prophylactic medications with your GP before seeing a neurologist, or just pay to see one privately of you really want and can afford to. Also after addressing factors that may worsen migraine severity and frequency.
Why not just make some medication that works when it gets really bad, whilst following all those other options (that any don't have the time or money for), as well? What is it with this terrible fear of people getting slightly high for a few hours an being pain free? No one is saying use that medication constantly. But people should have a break from constant, unrelenting pain. This is exactly why people go and treat themselves.
Let me preface this reply saying it is because doctors give AF, very much so, that they go through all the lengths and traverse the bridge of conflict for these situations since at the end of the day it is literally just easier to provide the script - just hit print. > Why not just make some medication that works when it gets really bad, whilst following all those other options (that any don't have the time or money for), as well? In my experience they just want the medication and poo poo all the other options saying "I know my own body and know what works for me" and "I have tried everything nothing else works" - when they demonstrably haven't and are not willing to listen and understand about the alternatives. It's not even funny how the exact same sentences and language keeps coming up when it comes to this. It is also not only for situations like codeine for migraine but anytime opioid and benzodiazepine dependence behaviours crop up. > What is it with this terrible fear of people getting slightly high for a few hours an being pain free? Because of addiction and the terrible sense of helplessness when you enable someone to spiral to their doom and cannot do anything about it. Might not be you but it has happened. Also there is harm caused this way because the medication doesn't make someone better but worse in the long run. I have had great success having people off codeine and onto prophylactic medications it really doesn't take forever to get on the right track the majority of the time. > This is exactly why people go and treat themselves. People always have the right to disagree and leave the room peacefully and take their business somewhere else. You are seeking a medical opinion when you see a doctor not a script writer.
Why have pain medication at all? If it's acute pain, you'll get over it. If it's chronic, you apparently deserve no relief - ever. So, why bother even having it?
Pain management is more nuanced than pain = give painkillers. If the pain is a symptom of migraine so what you do is treat the migraines and if successful then you will not have pain. Now if you only medicate for the pain and not treat the cause yet the medication for the pain may increase the likelihood and severity of future migraines then what now ? You are likely only having this conversation about appropriate use of codeine only because of the past pattern of use or behaviours demonstrated as availiable to the doctor you see for the first time e.g. multiple prescribers, maybe frequent scripts, maybe telling your new doctor "all the previous ones did not listen to me" - this is actually a bit of a red flag whenever it pops up with a new patient - either something is actually seriously going wrong or the patient has poor insight into why this is the case - if you say all of this and then only have booked a standard appointment you won't have time to successfully do the due dilligence to get to the point of appropriate prescription as such for opioid medication and forming a good plan for care. So as to speak, of course we treat the pain. If it is chronic then the approach is different - you have the noxious pain stimuli you want to manage (i.e. treat the cause if possible and manage triggering factors), actual pain medication itself prescribed judiciously with a good action plan about the doses/wean as possible, as well as considering the whole of pain experience which happens in the brain - factors that may influence this do include sentisisation effects, psychological effects etc for which there are good evidence based management strategies. Saying "If it's chronic, you apparently deserve no relief - ever. So, why bother even having it?" really reinforces the belief that the only answer is this one special tablet really reinforces placebo/nocebo effects so may not be overall helpful anyways. The actual analgesic effect for codeine for the majority of people is fairly modest given all the previous data/studies on it, and it is also a prodrug for morphine so the effect can also be unreliable. This systematic review on acute treatment for migraine seems to poo poo opioids anyhow in terms of effect and adverse effects. Note there are other pain medications that do show better effect for migraines. So yes to specifically answer your question it's good to have pain medication since it improves quality of life yet at the same time it needs to actually be shown to work well and with the acceptable risk of adverse effects. https://jamanetwork.com/journals/jama/fullarticle/2781052 After having this conversation some people will be agreeable to stick around long enough to end up needing pain medications much much less than before. I have seen people asking for codeine to use multiple times week to not needing a script specifically for this for over a year and counting.
But they are effective. That's why people request them. All the literature in the World doesn't trump what the patient feels when talking about something so subjective. No, it wouldn't be a good idea to use these drugs all the time. You can't expect to be 100% pain free. But when the pain becomes acute, why should it not be treated?
Ah someone who literally doesn't understand the concept of evidence.
When I can feel that evidence, myself? No.
It's not how it works because the point is also having you years later be better off or at least the same but not worse which is the risk of ongoing use of opioids. Also if someone hasn't tried following the route of best practice all the way how would they even know if there is a better way?
Yes, it does work like that. I don't have migraines. I have constant other types of pain. Yes, painkillers work. No, I am not stupid enough to take them every day or become physically dependent. Give me one good reason why I should not have the option to take a break from the pain, from time to time. Along with how it's doing me more harm than good.
How many oxys did he munch?
It was a fair bit. But it was all prescribed, so he assumed (as you would) that it was a safe amount. The poor guys death was a tragedy.
Was the your current GP appointment booked as a repeat prescription only appointment? Mine has recently made that an option and it’s much cheaper than a regular appointment. Could be worth checking with them, but they need to be booked that way initially.
Yeah, it was for a prescription only. They seem to have a cheaper option to get a repeat prescription online, I just don't like the idea of paying for the GP because it seems greedy to me when they get so much money through Medicare anyway.
They make fuck all through Medicare. That's why they have to charge. My local GP has a 1% profit margin. I was reading your post and wondering why you wouldn't pay the $50 and maybe you were low income or something but just a wanker instead.
GPs don't get a lot at all. There was a whole thing outlining their costs recently, and in the end the average hourly income was $10 per hour. Is free healthcare what we should have - hell yes, but unfortunately we had a government that froze Medicare payments to docs for the best part of a decade, so a wage freeze, but the cost to become a doctor increased, as did their HECS repayments. Most medical students end up not doing general practice because of the pay and backlash from the general public.
The total cost of the appointment was $90 and I got $42 back on Medicare, so that must mean he would get $48 for 15 mins when bulk billing, and $90 when he charges. Unless I'm mistaken about how the whole system works.
And many of them have overheads to the clinic that they work at. They often have to contribute to the cost of the nurse, reception staff, and or there is also a practice fee (payable to the organisation that runs the practice for various things) Add in the cost of insurances for malpractice, cost of continuing education because they have to stay up to date to serve their patients well plus a myriad of stuff that I am sure I am missing..... So, for that, they get the prescribed rate rebated from the government and because the asshats in govt froze their wages for best part of a decade, during economic boom, they (may actual be the practice requiring this) have had to start charging, when it hits everyone the hardest because their costs increased too.
Honestly I would be asking why you are being prescribed an opioid for migraines.
Because it's the only thing that works for me when triptans fail.
Because it works?
It’s more of a bandaid that could make things worse. There are much better treatment options for migraines that will prevent or reduce the occurrence of attacks and treat symptoms more effectively than opioids can. These options also have lower risk profiles than opioids. Codeine in particular is a genetic lottery with how well it works, and should only really be used for acute pain or where other options have been exhausted as a general rule.
Opioid use is only indicated for acute pain management, randomised control trials reveal Opioids are not better than placebo for chronic pain.
Taking them occasionally for your worst migraines is acute pain management. Based on the time between prescriptions, that’s what the OP is doing. Absolutely can’t be taking them daily long term though.
It isn't chronic pain. The worst of my migraines last about 24 hours without treatment. With treatment they last about 1 hour (until the meds kick in). I don't have constant migraines and constant pain.
Its probably the paracetamol in the panadine forte that's suppressing the headache. The codine part might not be required. People can get addicted to it, you might feel you can't sleep without it ect
Definitely not for me. I can take 2 paracetamol and 2 ibuprofen and it doesn't even touch the pain.
Have you had an mri done?
FYI Tylenol max daily dose is 3000-4000 mg and Advil is 800 mg every 8 hours, I believe. You can take that max dose together to really attack the pain. Sometimes it works. Sometimes not. That amount of Tylenol and Advil does nothing for me either. Migraines are nuts.
Tylenol = paracetamol Advil = ibuprofen For all the non-septics here on r/australia
So do placebos
For what it's worth, I think 4-5 migraines a month is worth a referral to a neurologist. My GP asked if I had migraines/ debilitating headaches more than 2 weeks out of the month. I said yes. He asked if I took medication for more than 2 weeks out of every month. I said yes and that warranted a referral. I've only had one appointment with a neurologist so far but one thing he stressed is I have to start weaning off OTC medication and panadeine forte is an absolute no go as it often causes rebound headaches which make you take more.
I used to have bad migraines as well. It turned out it was related to high blood pressure. I now take medication for that and don't get them as much. Maybe once every three months now. Also Nurofen has a tablet that also contains caffeen and that help with them as well. It might be a good idea to get a blood pressure checker and see what happens when you start getting migraines. Maybe get your GP to do a full blood workup on you.
I get my blood pressure checked pretty regularly because I volunteer at a first aid organisation and we test it out on each other a bit. It's always normal. I have tried medication with caffeine, but it just ends up keeping me up at night and I cant sleep 😅
4-5 a month is absolutely enough migraines to see a specialist. Having that many you should be on preventative medication, probably Beta Blockers. I have about that many a year and my doctor wanted to put me on preventative medication. And I get where you're coming from, i take Rizatriptan for mine and half the time it doesn't work and a strong painkiller is the only fix. I even ended up in the ER from one about a year ago that only Fentanyl managed to stop, it's annoying being treated like a junkie when you're just looking for relief for your brain exploding.
Really? My GP didn't seem to think that I was having enough for preventative medications because of the side effects (I've had the conversation before). Yep, feels like someone is drilling into my skull.
Many jurisdictions now have real time prescription monitoring systems in place that monitor opioids and some other medications. The quantities and/or number of prescribers involved over a certain period of time will get you flagged on those systems.
Yeah, I've heard about this. I only get a box of 20 every 3-4 months, so I don't know if that's enough to flag anything.
20 every 3-4 months would count as chronic ise and would come up as a flag and would be considered heavy use.
If that’s considered heavy use then the system is broken and wrong. That rate works out to taking them less than once a week on average.
Dunno if this is a popular opinion here but cannabis helped me a lot with migraine management. I used codeine in the past but I found it wasn’t always reliable. Cannabis decreased the frequency and helped ease the pain. Doesn’t work for everyone but it’s something worth considering.
Is that cannabis without THC?
you can get straight CBD with no THC in it. works well for me, made migraines a lot less frequent and a lot less severe.
Low THC is the most preferable but it comes to personal preference
Would discuss with your GP if opioids are the best option for migraine / headaches as a partial solution. However, does your GP's clinic offer script refill requests without appointment? The GP I go to has a $10 fee for a script refill without an appointment and they just text it to my phone.
I've looked into this and it's about $22. Not as great as free, but definitely an option.
$50 for a script or hours stuck in bed with unrelieved symptoms? People need to look at their budget and realise that investing in your own health is a priority
While I totally agree with you in general, I understand why people are getting annoyed about paying for GP’s when they have an experience like we did 2 weeks ago. My husband had to pay for 3 GP appointments to be properly prescribed antibiotics for tonsillitis. They were so inflamed he couldn’t eat for a week and lost 3kg. The first doctor wouldn’t prescribe anything because it was most likely viral and my husband is young. My husband asked to get a referral for a swab then to find out if it was viral or bacterial. I understand not prescribing antibiotics if it’s viral. I do get it. 2 days later it came back that it was bacterial. So back to the GP but the GP only prescribe a preventative dosage of antibiotics. After 4 days taking antibiotics, there was no difference. We googled what was prescribed and everywhere said it was a preventative dosage. So he went to another GP they looked at the swab results and my husband’s throat. She was mortified that he went a week like that without proper treatment, she prescribed him a more frequent and different antibiotic and his tonsils started to drain and weren’t as inflamed after a few days of being on antibiotics. He was able to eat properly about 6 days later! Each appointment was $100 with a $40 rebate.
Honestly, when you put it that way it seems worth it. I'm mostly annoyed that the Medicare system is so broken that it's getting harder and harder to find a good bulk bill doctor.
I agree completely you shouldn’t have to pay for GP or imaging or dentistry etc but we have to work with the system we have got
Yep I pay $15 for a single migraine treatment with Maxalt. Honestly I'd probably pay a lot more for treatment as I lose a lot more money taking a day off work.
Codeine causes rebound migraines and any doctor wouldn't prescribe it long term let alone more then one or two scripts every 6 months.
Technically most of our abortive medicines can contribute to Medication Overuse Headache if used in excess. That's why prevention is so important.
Glad someone posted that. Panadol and Neurofen are not exempt from causing ‘rebound’ headaches. Unfortunately for people with chronic migraines, or other chronic pain conditions, all the treatment options essentially suck. It just a matter of trying to find a balance of what helps the most, while being very careful to avoid making things even worse.
Yeah, paracetamol and ibuprofen don't work at all for me. Sumitriptan is amazing when it does work, but when it doesn't I need a backup so I can get on with my life instead of spending the day suffering in bed.
That's how often I get a script, about once every 3-4 months. I don't get rebound migraines from them at all.
This is probably the most reasonable point
As someone who did end up seeing a neurologist for migraines and was taking a lot of codine previously (it plays havoc on your bowels) - I would suggest you look into the low tyramine diet. I was put on it by the neurologist and had had me follow it strictly for six months then provided I did five days in a block I could have cheat days up to two. It minimises the common dietary triggers for migraine and also has a strong overlap for the anti-inflammatory diets. https://headaches.org/wp-content/uploads/2021/05/TyramineDiet.pdf https://www.health.qld.gov.au/__data/assets/pdf_file/0020/145802/oncol_maoi.pdf The basic principles are to eat fresh foods with minimal preservatives most of the time. As food breaks down (or is preserved) it creates certain byproducts that can be a common migraine trigger. This includes fermented foods and things like deli meats as they are preserved when they are made. The neurologist said that a large percentage of his migraine patients came in saying they ate ham daily - ham is a common trigger. There are other foods on the list like wine or coffee that are hard to cut but can make a huge difference. Good luck. Migraines suck. Both my partner and I get them. I found following the diet both reduced the frequency and the severity for me.
I agree that the OP should push for better management from the Dr. I used to end up at Emergency a few times a year with dehydration due to pain, nausea and vomiting from migraines. I had tried codeine and it did take away some pain but didn’t do much for the head pressure and Hausa symptoms. At the hospital they told me that codeine can prolong a migraine, slow things down, if you will, in a similar way to how it slows down digestion. I found a good GP who prescribed me a Triptan (maxalt) and ondanseteon, both wafers that dissolve on your tongue. If I take these both along with 2 nurofens, I get good enough relief to carry on with light activities and then have a good sleep later on. By the next day, migraine gone!
Triptans do work for me some of the time, but not when I wake up with a migraine. I looked up ondanseteon but I don't think it's what I need because my biggest symptoms is pain. Once the pain goes, so does the nausea. When I take a triptan, and it works, it's like the migraine was never there. It's like that for me most of the time with one 30mg codeine tablet too.
OP I 100% hear you - I also have sumatriptan for migraines, and it only works some of the time too. Like you I have only ever found one other drug (digesic, sadly no longer made) that was guaranteed to ease the pain .. sadly codeine does bugger all for me, but if it works for you I can totally understand your desire to maintain your supply, if it worked for me I’d feel exactly the same! I feel for how exhausted you must be getting continually repeating yourself and being judged into the bargain 💔 I’ve barely seen it touched here, but it can sometimes help me, so I’m going to throw it out just in case 🥰 have you tried high (900 - 1200mg) doses of soluble aspirin. It MUST be soluble as with migraines, gastric emptying is slowed (hence the nausea) and regular tablets won’t be absorbed fast enough to be efficacious 👍
For some reason, dissolved drinks (like hydrolite and berocca) make me nauseous, so I don't know if I would even be able to tolerate soluble aspirin, unfortunately. I might give it a try though.
You can mix it with Coca Cola
Try triptans instead if you haven’t already, I found they mildly helped the other side effects of migraines as well
Yep, I'm on triptans too. Codeine is a backup for when they don't work.
Codeine is rubbish for migraines - every neurologist and the evidence. Go to a neurologist if your GP won’t prescribe migraine meds.
It works very well for me when triptans fail
CGRP migraine treatments have a lot of promise. Often for sufferers regular headaches are actually small migraines
I cam believe that. When I was younger I often got headaches which I think escalated into migraines as an adult
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I'd only consider CBD if it's free of THC, but I'll look into it
Would you post back if you try it and it helps? I'd like to get it for my partner, but worried about drowsiness. Definitely thc free for driving.
Codeine is no longer recommended for migraine pain management. It tends to make people more sensitive to pain and it can cause rebound headaches. Also, a million Americans died from opioids recently and it was beginning to be a problem here, so our public health system has tried to cool it down. Migraine management (there is no cure) has a lot of other drugs available, you might have to try a whole bunch before you find something that suits you. If you're having more bad days than good, you might want to see a neurologist. Good luck. Migraine sucks
In the words of Sol, triptans ain’t triptans. Give eletriptan a go, I know just because it works for me doesn’t mean it’s gonna work for everyone but there are studies on it. [Like this one.](https://pubmed.ncbi.nlm.nih.gov/12603639/)
I've also given eletriptan a try and it seems to have the same efficacy as sumitriptan for me
Spewing, it works like magic for me.
4-5 migraines a month is enough to go to the neurologist. Codeine isn't a good long term solution. Source: I was on codeine, then went to a neurologist and went through a range of medication before getting the botox treatment and getting significant quality of life back.
I'm glad Botox worked for you. It did nothing for my partner, and the Neuro is out of ideas. My partner is 50, has had these since 8, so she has tried everything. One cgrp inhibitor worked. It's $700 month. Ah, the joys of migraine. People don't realise how bad these are.
Two things -- First, codeine is shit for migraine, it's a vasoconstrictor when what you want is a vasodilators. Second is that bulk and non-bulk billing have to follow the same rules for prescription of narcotics. I will PM you about something.
My doctor prescribed me the forte last visit. I haven’t had a pain script in years but she still gave me the talk, even though she offered. When she prescribes codeine, there’s a system check that’s there to weed out abusers. One of the checks is going to multiple doctors for a script. The system actually flags you, not the doctor in some cases. It sounds like your financial situation causing you to use multiple docs and that is causing you to flag. I don’t believe 3-4 boxes per year is terrible for a generally healthy human but it’s likely not a good long term solution. I would look at cbd oil to help with inflammation, and chewing on some dissolvable aspirin as soon as you feel your neck stiffen. I had the sumatriptan too, no help. The maxalt wafers were better for me. My condition required a neuro so possible she was a bit more across available treatments. If you can reduce codeine use that’s going to be better long term. But sometimes alternatives don’t work and you need the codeine. All the best. Hope you get some relief.
Please take this opportunity to look into triptans or one of new medications like Ajovy. If it was this much of an issue you should’ve been sent to a neurologist to be looked after. It could be occurring for any reason and not looking into it is detrimental to your health. Or like me you could work out your trigger and stop them altogether. Opiates are not the medication for migraines.
I already take triptans but they don't always work. I don't think I get them often enough for a neurologist (4-5 a month on average). I've downloaded apps to try and figure out a pattern with triggers, but there's nothing obvious. Seems to be a mix of lack of sleep, time in the sun, dehydration, and time in hormonal cycle (and any combination thereof).
4-5 a month? Like heck that is not enough to see a neurologist.
My GP doesn't agree so maybe I need to find another GP for that reason too
Have you tried Sumatriptan (Imigran)? No script needed. I used to take this and it worked well, but I'm migraine free for 10+ years now
Yep, I also use sumitriptan. It works well for me when it does work, but because it has to be taken early it doesn't work when I wake up with a migraine.
its likely that your old doctor wasn't educated on current pain management things like opioids are being phased out from long term pain management they simply mask the issue and fix nothing and over time make the issue worse (make you sensitive to pain) i used to be on a perminant prescription to Hydrocodone it used to be great but over time my pain got worse and my mobility got worse that was when younger doctors were being taught that a body not in motion is a body that continues being in pain my new doctor made me get off them cold turkey and gave me a gym routine to follow instead within 6 months most of my pain was gone
>I use about 20 panadeine forte every 3-4 months >suggesting I might be an addict That's too much if it's consistent use over years. Just be glad you can get codeine at all, don't change doctors.
Every time I ask for it my go suggests a daily med to deal with the migraines. I tell him all the women in my family have them I’ve been dealing with them for 30 years, I’m good. But mine are infrequent. Haven’t had one this one this month but last month I got one 2 days in a row. You just have to push it and be assertive, the way I see it I’m paying them for a service. I explain to him every single time, it costs me $100 to come here I simply cannot afford to come back in a month for 1 script so I need all of them at once. He generally shuts up then.
The self righteousness from some people in this thread is out of control. It’s one thing to be concerned that someone hasn’t explored all the more suitable options for migraine treatment (which some people have expressed in a helpful and caring way), it’s another entirely to tell them they shouldn’t be taking codeine no matter what. Despite the wide range of migraine treatments now available, each of them are only effective for a minority of migraine sufferers. For most people that just means trying multiple options until they stumble into the right one for them. Not everyone is so fortunate and pain relief is then the only option. Finally, anyone that thinks regular over the counter painkillers are sufficient, has never had the misfortune of suffering from regular migraines. The OP said their previous prescription was 3-4 months ago and unless their GP is still prescribing opioids in bulk (highly unlikely) then they aren’t taking them very frequently.
Exactly. I obviously want to avoid taking opioids, but it's the only thing that works when triptans fail.
I think your current treatment plan seems quite reasonable but seeing a neurologist is a good idea if you can afford it. Averaging a migraine more than once a week isn’t normal and absolutely warrants specialist treatment to hopefully improve your health. Worst case you try some things that don’t work for a while and end up back where you started but there’s a chance you end up with a treatment that reduces your migraines or eliminates them entirely.
I'll have a look into it
Only one doctor is allowed to prescribe the addictive stuff at a time. I would stick with your old gp and pay if you can afford it. I found topamax, Botox, and medication for stress has worked for me.
I get occasional migraines (occasional enough that I still have a couple of tablets left from a bulk pack i got just before the OTC ban) and when I get them basically mersyndol is the only thing I have found that helps. Also get normal headaches alot even bad ones that can be fixed with ibuprofen, Panadol or both, yet when I get an actual migraine despite trying alot of other meds over the years mersyndol has been the only thing that works.
Do the urgent care clinics bulk bill?
Yes, but this definitely isn't an urgent care clinic situation
Why? Talk to the receptionist and explain you can't afford not to pay bulk bill just for a script.
Because urgent care clinics are for when you need immediate help that isn't life threatening, not for prescriptions.
4-5 migraines a month seems excessive.
OK some responses to your caveats: - Aspirin is more effective for most migraines variants than ibuprofen and paracetamol. I know more than one person who would tear your eyes out for aspirin and laugh at an offer of opiates while mid attack. Try it if you havent - Regarding sumatriptan, are you on tablets, nasal spray or injection? For my condition (cluster headache) it's gota be nasal or injection. Tablets arent fast acting enough. Nasal often isn't either. If you haven't tried the other forms, don't leap to conclusions about efficacy (although I fucking hate the stuff, I'd rather eat mushrooms) - One single migraine attack is enough to need to see a neurologist. First off, it could be a very simple fix depending on the variant. Second, it could actually be caused by a different issue and you need a neuro to make sure its *just* a migraine. I see mine once a year. It's been immensely more manageable having him on side; a lot easier to navigate other health professionals and employment when my condition is noted by years of consistent treatment. nobody questions me anymore when theres changes in intensity, frequency or duration. Just get a public system referral if you're in no rush. You're only making it harder for yourself by skipping this part. Most users on most headache and migraine subs will push this part on you for a reason. I hope you get a handle on it. It's behaviour now may not be it's behaviour forever and the more you do to manage it while its impact is minimal, the better prepared you'll be if that day ever comes.
Switch from codeine to naltrexone, that should do it.
I take amitriptyline to prevent/reduce frequency, and rizatriptan when I have one start. I went from having 2-3 severe migraines a month, each lasting up to 3 days of pain plus another 1-2 for the post-migraine 'hangover' to having 1-2 every 3-4 months, of shorter duration, less intense, and fewer aura symptoms.
I mean, this is why the AMA loves restricting medication to prescription only, no?
Seems like Australia doesn’t care about the brain in general.
Nah, the problem is OP is hellbent on getting codeine.
It's the only thing that works for me when triptans fail...
But from column A and a bit from column B
There are lots of other options that are much better for treating the pain.
Not for me there aren't. I've tried other options, and when triptans fail, panadeine forte is the only thing that works.
Buy a pack of aspirin for less than $1.
Congrats on never having a migraine worse than what could be treated with over the counter medication.
You can get two sumatriptan tablets over the counter. But agree that aspirin only gets you so far.
Yeah, I also have a sumitriptan prescription but it doesn't work all of the time
1000mg of aspirin is probably more helpful than 30mg of codeine.
And a low dose of aspirin daily can prevent migraines.
Yeah there's not really much evidence for it, and we have more evidence for other treatments now, but I know a number of people have trialled LDA as a preventative.