Trying to be NICE

The Chiltern Health Centre, where I have been most recently for a chiropractic consultation, and at the beginning of last year for hypnotherapy, drew my attention to a recent report from NICE, regarding medication overuse headaches. This blog, written by one of the practitioners at the clinic, talks about the report's findings and looks at it from a Chiropractic and Osteopathic perspective (the author is herself an Osteopath).

Medication Overuse headache is caused, put simply, by taking too many painkillers. This amounts to taking over the counter medicines such as aspirin, paracetamol and ibuprofen (which is an NSAID - non-steroidal anti-inflammatory drug) on more than 15 days a month, or opioids, ergots, triptans for more than 10 days a month. These latter three are anti-migraine medicines. I have in fact been prescribed with Triptans, to help fight any migraine attacks. I got a prescription of 6 tablets about 3 or 4 years ago, and am now down to my last tablet.

Taking painkillers for a headache can result in a withdrawal headache if you rely too much on the drugs to eliminate the pain. The "vicious cycle" as it so often described is accurate. My head hurts, and I want it to stop. So I take a pill. But taking the pill makes my head hurt, and because my head still hurts, I take another pill. My head still hurts. And so the cycle continues.

NICE's recommendation, according to the blog & the report, is cease taking the medication immediately, and stay off them for a month. Unfortunately, as is pointed out by the blog and many other sources, "Headache symptoms are likely to get worse in the short term before they improve and there may be associated withdrawal symptoms"

So. My head hurts. I take a pill. The pill makes my head hurt. I take another pill. Cycle.
My head hurts. I stop taking pills. My still hurts, and in fact, almost like a nicotine craving in the brain when you quit smoking, the head goes ballistic with pain because it's not getting any pills, and because you can't take any pills, the pain doesn't go away or decrease when you need or want it to. Slowly, this pain does subside, and the dependence dissipates. Eventually, hopefully, cycle broken.

I am hopelessly reliant on painkillers. It used to be ibuprofen, but more recently it is paracetamol, because (inevitably, really) ibuprofen wasn't really doing the trick. And at first, paracetamol did too. And to some extent, paracetamol still works because it often takes the edge off the worst headaches (and I now reserve painkiller usage to when I can't move without my head or face searing with pain).

The chiropractor I saw for my second opinion reminded me of these findings/recommendations, and after I saw him, I decided to give two weeks a go. I had already accidentally managed a week, so I decided to try for another week. Needless to say, this second week has not been as breezy (because my headache is self-aware and resists any attempts to remove it?) From Sunday through to Tuesday, I was in quite a lot of pain. Alcohol dulled the pain, but left me open to dehydration related agony the following day, so I kept that at a glass or two in the evening.
By Tuesday (1st Jan) I couldn't do it. I couldn't move without my head being in agony, and I couldn't get to sleep to try and make it go away. So I gave in and took a triptan tablet. This isn't strictly forbidden, from my understanding, since my dependence is on regular painkillers. And it certainly helped take most of the headache away, and I was able to actually get stuff done and be myself again. As I commented to a friend, Monday was "just one of those days that no matter what, I am my headache. There's no happiness, sadness, excitement, nothing." And that was only day two. So by day three, even though I was willing myself to be strong, I'm not made of stone, and I took a pill.

But today is the last day of two weeks without paracetamol, ibuprofen or aspirin.  Tomorrow, I'll embark on another two weeks and hopefully be able to negotiate any agony with resistance.
The end goal is freedom. If I keep that in mind, I think I'll be able to do it.

But I reserve the right to have a duvet day if I feel like my head is expanding from the inside out.

A World of Pain

I am writing this blog from a dark place that I do not visit regularly, or stay in long.
But when I leave, the door to this dark place is always open. Always ready to receive me. Always happy to welcome me into its unrelenting and tortuous arms.

Because the pain that leads to this dark place never stops. It never goes away. I can never turn my back on it, because it is always there. It is such a part of me that I think the only way it will end, is when I do.

I'm stronger than I used to be about it. I am able to write this blog. I have been able to work, and commute home from work, and when I got in I fed the cats. I have been able to take off my jewellery and get into my pyjamas.

But this pain systematically claws at this strength I cling to, looking for the weak spots.

And when it finds them, I end up collapsed on the kitchen floor sobbing my heart out, but afraid to move because every turn of my head results in more agony.

I heard on the radio this morning, that Nice have issued official advice for headache sufferers, which include Acupuncture for tension headaches, and not taking painkillers. My nan even cut out the article from The Telegraph for me.

This is something I already knew. Medication overuse is one of the vague reasons given to me for my 7 year itch headache. That, as well as psychological problems and anxiety about joining Sixth Form, riding too many rollercoasters in Florida, drinking Coca-Cola and eating chocolate. One of my GPs actually suggested that maybe when my parent's divorce had finally been settled, my headaches would get better.
Yes, the divorce they started LAST YEAR. 6 years into this pain.

So, for those suggesting that my Chronic Daily Tension Headache could be treated with Acupuncture, may I inform I have had 2 courses of Acupuncture, one lasting about 8 or 9 weeks when I was in Sixth Form (so right at the beginning of my headache), and another lasting months, and provided by the NHS, during my 2nd and 3rd years at university.
And oh wait, I'm not cured.

As for taking too many painkillers, that's a No Sh*t Sherlock situation. I have not been the most responsible with painkillers over my life time and they have usually been the first thing I reach for when my head hurts. I have pushed myself to resist, and today I did. for 4 hours. Until my headache got so unbearable I could barely walk straight and I thought I was going to pass out and/or vomit from the pain.
3 hours later, the headache is marginally better. I still feel hugely nauseous and faint.

Going cold turkey from painkillers is not mission impossible, but it is mission un-bloody-likely. Not when you've had 7 years of pain already and whilst you can cope with the day to day dull ache that NEVER.GOES.AWAY, the blinding nausea-inducing headaches are not going to go away unless you go to sleep then and there. And when you are trying to make a living and get on with your life, that's not going to happen.

The neurologist in The Telegraph article recommends that coming off the painkillers should be done in consultation with your GP about preventative medication.
Ohhh! Why haven't I tried that??

Oh wait yeah. Years number 3 and 4 of headache. Silly me.

So essentially, this new "official advice" proffered up today to us poor headache sufferers (of which there are 1 million of us with medication overuse headaches, and a further 1.5 million with tension headaches - so which group do I wallow with I if I have a Chronic Tension headache possibly caused by medication overuse and/or tension?) is nothing I haven't heard before.
Oh except that tension headaches are difficult to treat.

No wait, I knew that one too.

**

Do I walk around with haunted eyes?
Do you see the pain that resides
Behind them?

The stabbing, the scraping, the hot poker iron.
The hammer, or mallet, the roar like a lion
When it throbs, and it pounds, and whirls me around
The world of pain.
Welcome. We hope you enjoy your stay.