(2nd blog in a 3-part series)
If you are reading this, you suspect or know that you are in rebound and are considering what it might take to get through it. If you aren’t sure, read this.
I’m not going to sugar-coat it. The process is miserable. If you are in rebound, many attempted treatments may not work to get migraine under control. So, educate yourself about what to expect and how to optimize the process so you can get prepared and find your motivation. You are not alone in this. Many of us have been in terrible rebound at least once. The good news is that there is a good chance you will go back to your baseline, episodic frequency once you are “on the other side of rebound.” And, if your frequency of symptoms still has you classified as “chronic,” your doctors can help you better. We’ve come up with these steps to help you get through the process:
Step 1 – Find your motivation. What would be possible if you didn’t have chronic or daily pain? What would be possible if you did not need to take so many medications? How much better would things be?
Step 2 – Consult your physician. If you have a neurologist that you trust and who has a lot of migraine experience, he/she may be able to help you get out of rebound as well as find a solution for getting your condition under better control after you have detoxed from the rebound meds. If you do not feel like your neurologist is in partnership with you or you want a doctor with more experience with migraine, this may be a good time to consult with a certified headache specialist. Check HERE for a current list of doctors who have been certified in the subspecialty of headache medicine (a.k.a – headache specialists). Please do not do this without the guidance of a good doctor.
We often see neurologists and headache specialists evaluate their patient and determine if the rebound meds should be tapered or abruptly stopped. They will often use a “bridge therapy.” This is usually a medication to help get their patient some help to “bridge” the most unpleasant time between rebound and a time when the desire for acute meds may be less strong. They often prescribe steroids to help break the pain cycle once they understand that the rebound meds are stopped. In some cases, the recommendation may be for use of an intravenous DHE “cocktail.” Depending on the person and the available resources, the IV therapy may be done as an out-patient or as an in-patient. We assume each doctor looks at his/her patient’s situation and makes recommendations based on what they think is most effective and best for the patient. Approaches will vary. Some doctors will not provide a bridge therapy. Some docs will just advise reducing the number of days of treatment and pushing through the detox process.
It is critically important to have a plan for what you can take for relief during and after the process of detoxing from the rebound meds. There are classes of medications available by prescription that may help. Some of those meds are Zofran, Compazine and Phenergan. Additionally, Benadryl may also be something that your doctor is comfortable with you using to help. If nausea and vomiting are a typical problem for you, specifically ask for suppositories or injectables to get you through. A doctor with lots of experience helping people with migraine should be able to help you with this, but you must ask. Many doctors believe that a patients should not take medications associated with rebound for months after getting through the detox phase. Every individual is different. Some may be able to stay out of rebound after a few months yet other may need just a few weeks. We prefer being cautious and avoiding those meds for months, but you will need a plan for acute treatment with other options.
Your doctor may also start or adjust your preventive medication strategy. Keep in mind that there are several treatments besides daily meds that may help you including injections and neuromodulation devices. You may have to ask about these options if your doctor doesn’t bring them up.
There is a big and important study being conducted right now to help understand the best treatment for chronic migraine complicated by rebound. HERE is a 2-minute video from one of the main researchers. Your doctor may have some good options for you for meds besides a steroid or DHE.
Step 3 – Plan your start date. There is never a convenient time to plan feeling awful, but give some thought as to when it would make the most sense. For instance, consider planning it for a time when you would be able to take time off from work. Or, plan it for a time that friends or family would be able to lend a hand in taking care of your home, kids, pets, etc. Hope for the best but plan for the worst so you can get through the process.
Step 4 – Optimize your migraine wellness by understanding common triggers, avoiding the ones you have identified, minimizing controllable triggers (ie. dehydration, inconsistent sleep, food triggers, etc.). If you haven’t already started the evidence-based supplements like magnesium, riboflavin and coenzyme Q10, do your research and consider starting. Whether you enjoy meditating or not, now is the time to begin this practice or increase it. Studies show that our brains respond favorably to meditation. HERE is an example of one study. Ten-minutes per day can make a difference. The Calm app is free and has many options to help soothe your cranky neurons. If you find that meditation isn’t something you can do while in significant pain, try something that is “meditative” like adult coloring or going for a gentle walk.
Step 5 – Set-up your environment to support feeling as best as you can during this lousy detox phase. Read about ginger HERE and have it on-hand. Have plenty of liquids in your home to keep you well-hydrated. Have ice packs and heating pads nearby. If you like botanical oils, have those nearby as well. If you haven’t tried them, peppermint and lavender tend to be favorites for soothing migraine symptoms. Mygrastick/MigraSoothe and topical lotions/balms like IcyHot and Biofreeze also may be helpful. Epsom salt baths can be very soothing as well as magnesium foot soaks. Think through a good self-care plan that will help you stay motivated. Engage a team of supporters whether it’s friends and family or social media. Mindset is very important so you may want to read inspirational stories and watch uplifting shows. You can do this but you might need some love, support, encouragement and pleasant distraction.
Step 6 – Have a plan to keep you out of the rebound trap. Migraine is a neurological disease that occurs on a spectrum. Depending on where you are on this spectrum, you may need one or more medications and therapies. It’s also possible that you can find a good acute medication that reduces your frequency and intensity of migraine attacks without getting you back into rebound. Your doctor can help you with a plan that keeps you out of rebound and in better control of migraine flares. There is also a lot you can do with lifestyle and stress management to kick migraine to the curb and feel well again. In our next blog, we address frequently asked questions about rebound and how to avoid getting into future rebound cycles.
Important: The above information is based on reviews of medical literature, professional and personal experience. It is for educational purposes and is not a substitute for medical advice. Suggestions to “do your own research” should include your physicians as part of your research resources.