136. The Truth About Rebound Headaches and Medication Cycling For Your Migraines

In this episode, I break down a very popular migraine TikTok that talks about frequent migraines, rebound headaches, and how to rotate through different medications to manage attacks.

I want to be clear that I believe the creator means well, but this kind of advice reflects some of the biggest misconceptions in the migraine world.

I explain why I do not believe medication truly “aborts” a migraine, why cycling through more and more tools can actually deepen the problem over time, and why real healing has to go beyond symptom suppression.

f you’ve ever felt trapped in the constant math of what to take, when to take it, and how not to overdo it, this episode will likely resonate

If you’re ready to address the root drivers of your migraines, you can book a free consultation at the link below:

https://www.drlesliecisar.com/apply

Free Training: 5 Proven Steps to Being Migraine Free (Even if you think you've already tried everything.)

https://www.drlesliecisar.com/5SHMN

Connect with us:

Website: https://www.drlesliecisar.com/

Free Facebook Group: Healing Migraines Naturally, with Leslie Cisar, ND

Ready to try something radically different that actually works? Read more about my approach here: https://www.drlesliecisar.com/map

In health,
Dr. Leslie Cisar

Episode Transcript

hi everyone it's Doctor Leslie
welcome to the Healing Migraines Naturally podcast
today I want to do a little bit of a breakdown here
I'm looking at
a very popular video from a very popular TikTok
Tiktoker in the migraine space
and I want to break this down for you
and this is not in any way a criticism of this Tiktoker
I know that her heart is in the right place
she's a chronic migraine sufferer
and
she's trying to bring education
and knowledge
and information out to other women that have migraines
so again I just want to emphasize I
I don't know her
I have no doubt that her heart is in the right place
but I want to break this down
because I think this
illustrates a lot of common misconceptions
amongst migraine sufferers
so let's um
let's break this down so you know
the title is watch if you have frequent migraine OK
so yeah that's definitely gonna catch your attention
right
not enough doctors discuss having an acute
so when you have high frequency
episodic or chronic migraine
you need to be aware of medication adaptation headache
sad
okay so this is the dreaded rebound right
this is what chronic migraine sufferers
right
are spending so much time and energy trying to avoid
the dreaded rebound okay so let's dive into this
it's the reality of living with chronic migraine
medication
right out of the gate
how is this presented okay
so the I'm gonna call it paranoia
let's call it what it is
it's paranoia that you're gonna get into rebound right
it's the anxiety that you're gonna get into rebound
it's the constant cycling of medication and worrying
you know how many did I take this week
this month what do I need to rotate right
because we don't want to get into that rebound cycle
so she's presenting this as
this is the reality of living with chronic migraine
okay so
and she kind of states
it is almost like a throwaway sentence right
like of course
we all know
this is a reality of living with chronic migraine okay
now I've talked about on the podcast a lot
how what we
believe about our migraines
is going to dictate our behavior
and then our behavior is going to dictate ultimately
what happens with our migraines okay
so if we believe that
this is just an inevitable
component of having chronic migraines right
then that belief is going to drive certain actions
adaptation headache previously was called rebound
or medication overuse headache
and it's a migraine complication
that takes place
when you take a certain number of acute medications
within a certain period of time the
now she's calling this a migraine complication okay
so again that seems like um
almost like a clinical term
it seem it is it
it sounds like an inevitable consequence
of having chronic migraines
number of medications you can take within that window
depends on the class of medications that you take
but let's rewind and discuss what medication
adaptation headache is
because it's a separate diagnosis beyond migraine
according
and now she's saying that this is a separate diagnosis
in addition to the chronic migraine diagnosis right
so a diagnosis indicates a disease right
in conventional medicine
you are having unpleasant symptoms
you go into the doctor you're given a diagnosis
which is the label put on a disease
and so she's saying this is a separate disease
in addition to the chronic migraines
now where did this disease come from
well it's a disease
you got by taking the very medication that your doctor
told you to take because you have the migraines okay so
is this a disease right
it's it's you
you have this so called disease now
because you followed doctor's orders
and you took the medication
to the association of migraine disorders
someone is considered to have medication adaptation
headache when they present with more than 14 headache
days per month for 3 months or greater
this typically occurs
this headache typically occurs every day and um
or nearly every day often upon waking
the headache reoccurs as the acute medication wears off
and I say headache
okay so um
you know if if
if you know you know
right if you've been in rebound
you know the description what she's describing right
so it's uh
oh I'm getting a migraine
I take the medication I'm getting some relief okay
hopefully I'm out of the flare
and then you wake up the next morning
and it's like Groundhog Day right
here we go again right
so um
now the she's
she's stating the diagnostic criteria again
like this is you know
this is what happens with unconventional medicine okay
you go in with a problem they give you the medication
the medication causes more problems
now you've got another problem right
so she's giving the diagnostic criteria
for this new diagnosis that you get
when you follow the doctor's orders
and the frequency sounds a lot like chronic migraines
right so this is another
like notorious problem for migraine sufferers
right am I in rebound or not right
because a chronic migraine suffer
already has 15 or more head pain days per month
now
rebound on like if you're having that many migraines
that many head pain days per month
how do you know you're in rebound or not
it's very difficult to tell right
but one of the clues is that you are kind of waking up
uh oh I'm waking
I felt good when I went to bed
but now I'm waking up with more head pain or
you know even feeling like
uh oh the medication is wearing off
and now the symptoms are coming back right
that's that's a clue that you're in rebound
and some medications are much more prone
to put you into rebound than other medications
she does list some medications here
so let's go through that as well
because the common migraine symptoms
like photophobia or photophobia
likely will not occur with medication adaptation
headache
so here she's
she's going through the different drug classes
and the recommended number of times to take per month
and so let me comment a little bit on the likelihood
of going into rebound with different medications
so fioricet she has that specifically listed here
fioricet is notorious for generating rebound uh
headaches or migraines opioids
now thankfully
opioids are being prescribed less and less
even you know nine years ago
when I started working exclusively with women
with migraines I would
you know I would still have clients uh
come to me who were taking opiate pain medication
but the the number of clients now that I have
that are being prescribed opioids has
has declined I've seen that decline
and fioricet too
fioricet prescriptions in my experience with my clients
those have declined
pretty significantly over the past nine years
as well and
you know um
unfortunately right when you're in pain
you just wanna get out of pain
and you wanna feel better
so for people that respond to opioids
or fioricet with their migraines
a lot of times they're not happy when their doctor
you know won't prescribe them anymore
but the um
negative effects particularly of opiates
and then two I would say fioricet as well
the likelihood that you're going to get into a rebound
particularly the um
you know you
you you could get addicted to fioricet
that's also has a narcotic medication in it
but you know
obviously I think we're very much more aware now of the
um addiction potential
you know serious addiction potential of opiate
so these medications
I can tell people are being prescribed less and less of
trip dins uh yes
uh there's a uh
a very real rebound risk with Tryptin medications
and then Excedrin
she doesn't have Excedrin on the list here
but Excedrin another notorious uh
migraine medication that can set people up for rebounds
anytime you suppress symptoms
and I've talked about this on other podcasts
I have a free training dedicated to this topic
that will link in the description
but anytime you suppress
the symptoms that your body's trying to generate
which that's
that's what you're doing with these medications right
everyone knows that you know
we don't have an Imitrex deficiency right
so everybody knows when they take medication
that the medication is working some
you know
biochemical magic that's suppressing the symptoms
you know
if you're taking Phenergan for nausea it's not you know
you don't you're not having nausea
because you have a fenugreek deficiency right
it's it's suppressing the nausea right
the fioricet is suppressing the pain
that makes most people feel better in the short term
but anytime that we suppress the symptoms
that the body is trying to generate
the body fights that suppression
and that is a factor in what generates that rebound
because your body is trying to generate these symptoms
I know that it feels like your body hates you
and has it out for you
and that's why you have this horrible migraine right
but actually your body is generating that whole
you know cascade that whole host of migraine symptoms
not because it hates you
it's trying to do the best that it can
in the environment that it finds itself in
and if it's not in an optimal environment
if the intracellular environment is not optimal
if the mental and emotional environment is not optimal
well we don't just drop dead
thank goodness right
that's the beauty of the body
when things aren't optimal
we just don't drop dead
the body adapts to that less than optimal environment
but there's some trade offs in
in that and those trade offs are symptoms OK
so when you're suppressing that
you're interfering with the body's ability
to do the best it can in the environment that it's in
and the body's going to fight that because it
it's trying to function it's trying to do its best
and then we come in wanting to feel better
and kind of thwarting that
and then the body says well
I'm trying to survive here
I gotta make even more of this to survive
and part of that generates this rebound phenomena
because your body
then starts making more of these symptoms
the other half of the rebound phenomenon is
the toxin overload that the medication contributes to
so again
I think everybody's aware right
medications there toxic right
they have to be detoxified
your liver and your kidney has to
detoxify the medication and get it out of your body
and this is not like a you know
neuropathic woo woo term
you can open up any pharmacology textbook
I've got a bunch of them on my bookcase over there
you can open up any pharmacology textbook
and learn what are the
what are called detoxification pathways that
that medication has to go through
so that your liver can process it
and it can be eliminated from your body
before they put a drug on the market
over the counter prescription
they have to identify okay
how does the body break this down
and get it out of the body
and there are literal detoxification pathways
it's called the Cytochrome P4 50 system
it's a system of detoxification enzymes
it's sort of like you know
that that Fisher Price toy for babies
and it's like that little box
and you put a red circle in the red circle hole
and you put a green star in the green star
it's like that little sorting uh box for little babies
that's what these uh detoxification pathways are like
there's different CYP FOUR FIFTY enzyme systems
that process differently shaped molecules
so when you take an imitrex or you take a fioricet
the molecular shape of that medication
is a little bit different
right the
the imatrix is shaped a little bit differently
than the fioricet the imatrix is like the green star
and the fioricet is like the red circle
and so that little drug molecule kind of sorts itself
and you gotta put it in the right enzyme pathway
for the liver to detoxify it
so that that drug molecule can get out of your body
so when that becomes overloaded
you cannot
get the drug metabolites out of your body as quickly as
like you should okay
so you have
then drug metabolites that have built up in your system
so you take an Imitrex and again they you know
have to identify how quickly does this leave the body
but if you're all backed up and if you have migraines
those cytochrome P4
50 systems in your liver are already backed up
guaranteed
because like I've talked about on the podcast
migraines are a toxicity symptom
okay at their root
there are symptom that the body generates
when there's an overload of metabolic waste
material and toxins in the body
like I like to say
migraines are a hangover without the alcohol
it's not a coincidence that a migraine
feels a lot like what somebody
feels on a Saturday morning
after a wild Friday night OK
so
the liver is not able to clear
these drug metabolites out of the body
so you take an Imitrex
but you can't get it out of your body
it starts to build up and so it becomes
it's like
you have kind of like a continuous low dose Imitrex
instead of the burst of Imitrex
that you need in order to fully suppress the symptom
so the medication stops working as well
and then the body's fighting the suppression
that's there kind of at this low level all the time
and those two factors
that's actually what's causing rebound
so again like this is
you know
I feel for neurologists okay
they are in a pickle they are in a bind
okay because they've got like migraines are
you know very
very common neurological condition
so they got all these you know
mostly women coming into the office with migraines
and honestly
I don't think they like migraine patients that much
they seem to be very annoyed with us hahaha
I know I annoyed my doctor quite a bit right
I don't know I think neurologists
they want you know
the epileptics and they want the
you know they want kind of the
you know the sexy cases
they don't want all these women in here with head pain
right so they can be very dismissive
and then you know
I I
I feel for neurologists
they're prescribing their patients
these migraine medications
and then the medications are causing further problems
right now we actually have a whole diagnosis for this
for the problems that the medications are causing
so what's the neurologist supposed to do right
he's going in
he's giving all these women all these medications
they're taking the medications
and then they're getting into rebound
so they're going back to the DOC
you know going back to the neurologist
and the neurologist is getting frustrated
because their patient is frustrated
I did what you told me to do
now I'm in rebound the neurologist says
why did you take so much right
they're in a real pickle a real pickle
I feel for them
so you are at risk of medication adaptation headache
if you exceed the following
medication adaptation headache
doesn't that sound right it sounds so official
it sounds you know
it doesn't sound like rebound right
I just get such a kick out of conventional medicine
right it's like
okay let's turn a problem into a fancy diagnostic term
just in a side
and this is why triptans are limited by insurance
and this is also why headache specialists
and neurologists who understand migraine
are hesitant to prescribe medications
like an opiate or fioricet
because they can really complicate your migraine
disease
so uh yeah
this is another common issue right
so woman with migraines goes into the neurologist right
she's having
maybe she's having two to three migraines a month
she decides you know what
the Advil isn't cutting it
I don't wanna take Excedrin
cause I kind of feel jittery with all that caffeine
so I'm gonna go to the neurologist and I'm gonna get
you know
I'm gonna get a prescription medication for this
so you know
she's 2 3 migraines a month
she gets the uh
imitrex prescription takes it home
you know she'd rather not take medication
of course but you know
if I only have to take something twice a month
and then I feel better and I can move on with my life
I guess it's not the worst thing in the world right
so she starts to take the imitrex and um
Lo and behold six months later
she's not having 2 3 migraines a month
now she's having you know
seven to 10 migraines a month hmm
how'd that happen right
well now her prescription for 9 imitrex a month
now we're cutting it really close right
so she goes back into the doctor
I need more imatrix right
like last month
I actually had 10 migraines and I ran out
you know now I'm thinking I better stockpile this
well she can't get that prescription right
the neurologist says well
your insurance won't cover that
I can only give you nine and
right it's like
oh my goodness
these insurance companies right
what's wrong with the system well
the insurance company is limiting you to nine
not because they're greedy bastards
but because they don't want you to feel even worse
right
a lot of times the neurologist won't tell people this
they'll kind of push it off on the insurance company
but I agree I agree with her
if the neurologist is you know
prescribing responsibly he's going to cut off
cut you off around 9 too
because if you continue to take more than that
you're at a higher risk
you're at a high likelihood of going into rebound
but here this is what happens right
they start off with two two to three a month
I mean this is how I start
I just wake up one day and have
you know a migraine every other day
and I'm vomiting if I'm if I'm in the car
what this starts off as is
you know a couple migraines a year
and then we take the Advil or we take a little excedrin
and then you know
things start getting worse and worse and worse
and then eventually
you're running into hoarding your medication um
mad at the insurance company
and frustrated with your neurologist
and if you have episodic
or high frequency episodic migraine
this can really put you on the fast track to chronic
migraine which let's be honest is not cute or fun
uh yeah no kidding
also it can take months to recover from medication
adaptation headache
and it even can require inpatient hospitalization
so this is
okay so
you know again
this is why nobody wants to go into rebound right
so what's the standard approach
if somebody does go into rebound
uh well
the standard advice is cold Turkey withdrawal okay
which is brutal
you are going to have a massive rebound headache right
because you know
here's the thing
when we take these medications
and we're suppressing the symptoms
it's like
we're putting like a 20 pound weight on the migraine
think of it like um
you know that
like schoolyard game
where you put your hands out and you press
you press your hands against your friend's hands
and the two of you are balancing against each other
and if the two of you stay in balance
you're both gonna be okay
you're both gonna stay upright
but if one of the little girls like bolts
the other girl's gonna topple over right
because the other little girl is pressing
against the other little girl with force
that's the interplay between your body
and the medication okay
your body is pushing out with 20 pounds of force
and the medication is pushing back with 20
pounds of force
if you suddenly discontinue the medication
when your body has become adapted to this state again
you're you're not feeling good okay
you're pushing
the migraine is pushing with 20 pounds of force
so you've you've got a migraine
it's not like you feel good
but it's an equilibrium with the medication right
cause the medication is pushing back at 20 pounds
it's not making the pain go away
you're having daily head pain
you're in rebound
you're waking up every morning with this pain
but your body is in equilibrium
if you just discontinue the medication
you're gonna topple over right
because your body is generating those symptoms
it's pushing out with force
and then suddenly it's
there's nothing to counterbalance it
you're in for a whopper okay
this even happens to women that are not in rebound
but their body knows sort of acclimated to the fact
okay as soon as I start to generate a migraine
I know she's gonna take something
I know she's gonna take an excedrin
or I know she's gonna take an imitrex
so the body will anticipate that dosing
I've had this happen to clients
maybe they left their home
and they were going to run some simple errands
but they
so they didn't bring like their migraine kit with them
okay and then they're coming home from the target
and then there's a bad accident on the road
and they're stuck in traffic for a half hour
uh oh
I'm getting a migraine uh oh I can feel it uh oh oh no
I don't have my migraine kit with me in the car
what did I do
what was I thinking to leave the house without my kit
and they're stuck in traffic
and they will have a whopper
just like an insanity level migraine
because the body was anticipating look
I gotta generate this migraine right now in order to
you know function the best that I can
in the environment that my body is in
but I know she's gonna give me that imetrex'cause
that's what she does every time
so I'm going to like
if she's gonna push on me with 20 pounds
I gotta push back with 20 pounds
and the body sets itself up to do that
but then you don't come in with the imatrix
you don't put you don't put your hands up and push back
and so the body just topples over okay
so you might have experienced that
the extreme end of this is
you've been taking Excedrin twice a day for 10 years
and you know you're in rebound
you know you're in Excedrin rebound and trust me
if you take Excedrin every day for 10 years
you're going to get into Excedrin rebound
no bones about it
and then one day you're gonna wake up and you say
you know what I gotta get off this excedrin
I'm gonna just gonna stop taking it
it's called a cold Turkey withdrawal
many neurologists they'll say look
what are you doing taking this acetaminophen every day
the bottle told you not
to take it every day the woman sitting there like
but I'm in pain I gotta function
I gotta take care of my kids I gotta go to work right
but they're being chastised now by their neurologist
and the neurologist says
you gotta do a cold Turkey withdraw
and I mean you're gonna be in bed for days
with that type of approach now
I can tell you it's not necessary
I work with this all the time okay
I used to have clients that were in furious at rebound
fairly routinely I don't see that as much anymore
thank goodness because they're
not prescribing that medication as much anymore
but Excedrin Rebound oh yeah
you know you can you can get that over the counter
and so
I have clients where they are in Excedrin Rebound
and we do not have to do that cold Turkey withdraw
I have a client
we just went through this with her last month
she was in Excedrin Rebound
she had been taking Excedrin daily for years
and we got her weaned off of that Excedrin
and out of that Excedrin rebound
she she wanted to take a vacation with her family
and she wanted to feel better
because when you're stuck in that rebound
you know
every day you're gonna have that head pain right
so
we were able to do that over the course of a few weeks
prior to her going on this nice trip with her family
and when I talked to her after the trip
she said you know what I've
I haven't felt that good on a vacation since
I don't know when
I'm so glad that I got off that excedrin
now she's still having flaring migraines
but that daily grinding rebound
she feels so much better so
it's possible to do this
without going through the cold Turkey withdrawal
that's recommended that's a standard recommendation
or an alternative recommendation
would be to give a steroid pack
steroids suppress everything right
so sometimes doctors will recommend like a 5
or a 7 or a 10 day steroid pack taper protocol
so that the medication
that's in rebound is cold turkeyed
but the steroid is suppressing everything in the bodies
and then you are kind of
weaning off the steroid over the course of a few days
or you know
between five to 10 days
and sometimes that'll be used
but I'm telling you
you don't have to go through all of that because look
most people don't feel good taking prednisone
taking those steroid packs
most people don't feel good doing that
so yeah so let's see what else she has to say here
this is why it's important to do everything
you can to avoid it
so let's get into acute medication cycling
that's what I call it or having an acute action plan
okay so here's
here's the proposed solution
and I know a lot of you are doing this right
this is rotating medication
oh my goodness this is so exhausting right
so um
here I
I I think I know what she's gonna lay out here
let's listen to her and we'll
kind of break it down okay
it's really important that you discuss
with your provider
having multiple acute medication options
and treatment options for your migraine attacks
research shows that treating migraine
as soon as possible for example
during the prodrome or during the aura or at the very
very beginning of the acute phase
increases your chance of
successfully aborting the attack
or minimizing its symptoms
so this is a very um very common misconception
medication does not abort a migraine attack
medication never gets you out of the migraine flare
and I know that this is shocking for people right
and and
and you're gonna hear me say this and you're gonna say
what are you talking about
when I take my imitrex I feel better right
it's it's suppressing the symptom
the symptoms of the migraine
it's not aborting the attack
once you go into a migraine flare
the only thing that gets you out of the migraine flare
is your own what I call resilience and vitality
pushing you back up out of the migraine flare
medication
is never going to take you out of a migraine flare
the best we can hope for when we take a medication
is that it's going to be strong enough
to suppress the symptoms
and last long enough
so that the suppression is as long as the flare lasts
so I want you to think about it right
people take you know whether it's Excedrin
whether it's a Tryptin
whether it's a new CGRP antagonist right
whether it's something with an narcotic in it
like fioricet
people take these medications and do they feel 100%
not normally right
they still have some lingering symptoms
they still have some
some of the brain fog with their migraine or
you know their stomach is still a little queasy right
the medication is
not bringing us back to a state of health
it's just dampening everything
so that we can continue to function
and normally for most people
when they first start taking medication
the medication works pretty good right
when you first start getting migraines
a couple times a year and you take some Advil
usually it works right
but you don't correct the underlying conditions
that are generating the migraines
in the first place and then
you start having more and more severe migraines
more and more frequently and you're like
this Advil isn't cutting it anymore right
but even in those beginning stages right
what's the typical thing that
that we do when we first started getting migraines
right oh
my head's hurting
it's kind of the end of the day at work
let me go home
let me take some Advil and let me lay down
overwhelmingly when women first start getting migraines
they'll take something over the counter
and they'll rest and then when they wake up
they'll feel like themselves again
so the resting period that was enough at that
in the at that point in time
in the early stages that little bit of rest
was enough for their own resilience and vitality
to kind of pop them back up out of that migraine state
now
as your resiliency and vitality continues to decline
you're not gonna be able to do that anymore right
and so you know I
I remember this when I first started
getting migraines again I wasn't just out of the gate
getting them every other day
I mean
I started having headaches and stuff when I was a kid
so to me it was normal
your head starts hurting you take something right
and then you rest a little bit or whatever
and then you feel you feel better
I mean that started for me in childhood
so this this framing right
and you know
again it
it when we take the medication
it feels like the medication is aborting the migraine
because we're not feeling the symptoms anymore
or the remaining symptoms that we're feeling
aren't that severe
and maybe we don't pay that much attention to them
or what not so
we think the medication
is getting us out of the migraine
and this is the this is the first uh
first false belief
that gets laid down in the mind of migraine sufferers
the medication is not getting you out of the migraine
state it's not the
once we go into the migraine flare
the migraine flare has to run its course
and when it runs its course
then we will come out of the migraine flare
and we will feel like ourselves again
the medication is not going to do that
it just it just lowers
our perception
of the symptoms that the body's generating
in that flare but so many of us right
so I I've shared on the podcast
my mom had I mean
my mom was in Excedrin rebound for decades
and we had no idea she had daily head pain
my entire childhood every day
she would go over to the kitchen sink
and she had like a little
a little
you know
organizer box with her excedrin and her aspirin and
you know
all her little over the counter headache medication
and every day I would hear her clink the bottles
I could hear the little pills clinking in the bottle
as she would take her medication
so to me this was just normal
I thought everybody like
I thought having head pain was like routine
like I thought most people had head pain and
and took something right
so what what happens is
right the first time I had a headache
Mama my head hurts
oh come here
little Leslie let me give you a little children's
you know children's aspirin or
you know
children's Tylenol or whatever it would have been that
that she would give me
why wouldn't she give me those things
so it sets up right
I take something and the pain goes away
I take something and that makes me feel better right
that's not the case with migraines
with any medication right
it's not curing any disease
it's suppressing the symptoms of disease
but it feels to us like
I took the aspirin and then I felt better
and the aspirin made me better
and that's not the case
so you can kind of hear that again
this is you know
this is not a criticism of this very caring woman
trying to get this information out
but you can hear that you can hear that conception
underneath the language here
and why is this important
it's important because of central sensitization
so this is the other really maddening
maddening thing that drives women crazy
when they go into their neurologist okay
so this is the advice to as soon as you feel something
and this is what I call the uh oh moment right
I the very first little sensation right
I call this the uh oh moment we go uh oh
I'm gonna I think I'm gonna get a migraine right
and it's it's a little different for everybody right
for some women it's like uh oh
I've got that little funny feeling in my stomach uh oh
I think I'm gonna get a migraine or uh oh
I'm you know I'm yawning a lot uh oh
I think I'm gonna get a migraine uh oh
the light is starting to look a little different right
it's getting a little over sensitive right
that uh oh moment right
that could be what what is commonly called the prodrome
right or like you actually have a have an aura
or right the very first stage is like
uh oh I got a little I got a little twinge here right
I got a little twinge on the right side over my eye
uh oh I think I'm getting a migraine
the advice is to take medication immediately right
and the neurologist
as he's handing you the prescription
he's telling you this take this right away okay
now when you do that you're gonna go into
you're you're you're setting yourself up for rebound
not right away right again
this usually
for most people is building slowly over time
but if you
if you take something right at that uh oh moment
again this reinforces
that the medication is taking the migraine away
because look
you can have an uh oh
moment and not actually go into a full blown migraine
right and so we realize this
we don't want to take medication
nobody wants to take medication
and then if we're afraid of getting into rebound
we really don't want to take medication so women wait
right because you know
just because I have an uh oh moment
doesn't necessarily mean that I'm going to get
a migraine so let me just wait and see
let me wait and see maybe I can do a couple other
little things over here that aren't medication based
and this will get better and again
what are we experiencing
we're waiting to see if our own resilience
and vitality is gonna pop us back out of the flare
that's what we're doing right
so but that's but then if you do that
then you're chastised right
you're no no no you're supposed to take this
as soon as you have any uh oh moment
you're supposed to get this medication on board
but don't get into rebound
do you see how these two pieces of advice
are contradictory right
take it as soon as possible
don't wait and see
maybe your own resilience and vitality
will get you out of the flare
cause that's the only thing that it ever does anyway
but don't go into rebound
don't take so much medication
that you're gonna go into rebound
but take your medication at the first 0 0 moment right
you're you're being set up to fail OK
you're being set up to go into rebound
and you're being set up to become paranoid
and hyper vigilant
and have anxiety over your medication dosing
let's continue
in really simple terms
central sensitization is when the pain
areas of the brain become so over stimulated
that these areas misinterpret regular stimuli as pain
so simple thing
okay so this is she goes into this for a bit
I'm not gonna play the whole thing
I'm gonna try to summarize here
so this is sort of a a newer theory around migraine
and it ties into this theory that
uh you're sort of uh
creating pain pathways
that wouldn't ordinarily be there
because you're in pain itself
and that's exacerbating the problem
I do not believe that this is the case
because if it were
the things that I recommend to my clients
wouldn't work
your
if you wanna say your brain is oversensitive to pain
why is it oversensitive to pain
the the answer can't be well
your brain is oversensitive to pain
because it's in pain right
that's a circular argument okay
on other podcast I break down
why we have the migraine phenomenon in the first place
but let me just kind of summarize here
when you have a body that is overloaded with metabolic
waste material
and other toxins
that body becomes hypersensitive okay
it becomes hypersensitive to all kinds of things noise
light
uh the weather
other uh
other pain signals OK
a body that's overloaded with toxins
is a hypersensitive
body
but when we talk when
when we talk about it like this
it just sounds so medical
it sounds so you know scientific
I I will just say that this theory of migraines I
I do not believe that this theory
theory is accurate at all
because I have clients that
I have had migraines for decades
you know 30
40 years and within 3
4 months they're not having migraines anymore
and we're not doing any of the techniques that
so called remap your brain and
you know unwire these pain signals and
and so on we're not I
I don't do things like that with my clients
so I don't think that this is
that this is a a correct theory for migraines
like fabric
or breeze or smells can trigger a pain response
and this is why trigger avoidance can be more difficult
when you have chronic migraine because
yeah what she's describing are toxicity symptoms
so those types of sensitivities
those are sensitivities that are generated
when you have a toxin overload or
or metabolic waste material overload in your body
this is pretty well documented
in the neuropathic literature
going back 100 years but in conventional medicine
they don't consider that to be a factor
even though if you under you know
if you open up a physiology textbook
or a biochemistry textbook
you're going to learn about all of the metabolic
waste material that the body generates
detoxification pathways in the liver
they pharmacology textbook talks about drug toxins
right but even though conventional medical doctors
and your neurologist
went through conventional medical school
and had to sit in the same basic science classes
that I had to sit in
I have the same textbooks that medical doctors have
when it comes to physiology
and biochemistry and pharmacology right
there isn't some sort of separate
naturopathic biochemistry
biochemistry is biochemistry
those medical textbooks I had to buy and I had to study
and I had to sit for
all of those tests in naturopathic medical school so
even though they learn all of this
they're not applying it to people's symptoms okay
it's it's
it's a real it's really something
when you have chronic migraine
you have more frequent central sensitization
and the tricky thing with central sensitization
is that it kind of builds on itself
so pain begets pain management as well because of
or having an acute
treatment plan can enable you to treat
at the beginning so that you decrease
it's not it's not really difficult to reverse okay
this again um
this is a belief right
that migraines are a chronic condition
that somehow you caught right
like
where did all of these chronic conditions come from
where where did your migraines come from
did it just fall out of the sky
onto your back and attach to you
and now you have migraines
where where did these come from right
this is a question
that no neurologist seems to have an answer for
the chance of central sensitization
so why is all of this important
central sensitization
is thought to be involved in the pathogenesis
of allodynia and the chronification of migraine
more migraine attacks mean more central sensitization
and once you have increased central sensitization
it's really difficult to reverse med cycling
or having an acute
do you see what we have here
here's the kit here's my migraine kit right
here's my makeup bag that has all my meds in it
oh
this just breaks my heart
it absolutely breaks my heart
and again I know her heart is in the right place
I know she's a chronic migraine sufferer
my heart goes out to her it truly does
but oh my goodness this is no way to live
this is no way to live right
what if you forget to bring this when you go to target
and you get a migraine
on your drive home from the target
now what do you do you're trapped
you're absolutely trapped
the panic that people will feel right
I've left my house without stuff in my purse
and I've turned around and had to go back right
this is no way to live
this is no way to live look at all this stuff
so what she's gonna describe is
cycling through the various medication classes
or other you know
non medication um
palliative of therapies that you can use
you know like an ice hat or a cephaly or
you know these types of things
so yes if you rotate through different drug classes
your suppressing symptoms
but you're using a different mechanism to suppress
the symptoms so if every time you have a migraine
you're taking a Tryptin
your body is acclimating to the Tryptin
it's expecting the tryptin
and our body like I say
it's generating the migraine for a
for a useful reason we don't like the symptoms okay
but it beats the alternative all right
trust me
it beats the alternative our body is trying to function
it's trying to function the best it can
in the conditions that it's in
so humans are highly adaptable
we can live in a lot of different environments
we may not thrive in a lot of different environments
but we can survive in a lot of different environments
so that's a real gift
but that is what generates what we call symptoms okay
so um when you're suppressing these symptoms
if you're using the same drug every time
and your body starts to anticipate yep
I know she's gonna give me this medication
your body starts to figure out
how do I generate the symptom
in the face of this chemical
that's going to try to disrupt me
your body adapts to that
and it figures out how to do what it wants to do
if you kind of surprise it right
if one time you do a tripton
and the next time you do a nertec
and the next time you do a fioricet
and the next time you do an excedrin
you're kind of like your body doesn't quite know okay
what she gonna do next
can't generate the symptom as well
in the face of that surprise
so this cycling through medication
this will usually work for people so how this plays out
right we've got the initial stages
we're using over the counter
now they're getting worse and worse
I've got you know two to four migraines a month
let me move to a prescription instead of taking
you know Advil all the time
so I get an imitrex that works uh oh
six months later now I'm getting you know
about seven a month right
well let me go back in because I'm hitting the wall
so now I've got a nurtec right
so now I'm gonna take a nurtec one day
a trip to the next and when you add in that nurtec what
right
first you start with the Advil
and it stops being as effective
you add in the imitrex oh yeah okay
whoo whoo this works okay
I got a solution until it doesn't
so then you add in the nurtec
oh oh oh this nurtec is working great oh whoo
thank God I got a solution right
until your body acclimates to the nurtec right so
how does this play out
this is how it plays out okay this is how it plays out
you're not the only one that this has happened to
this is this is the course of things
this is the course of things
this is the inevitable course
when you when you go down this road
and I know you didn't want to go down this road
in the first place I know none of you want to take
no one wants to take medication
the only reason
we're taking medication is we're desperate
I get it I'm not shaming you for taking medication
but if you didn't want to go to Chicago
why did you get on the train right
cause once you get on that train
it's gonna it's gonna take you into the station
and this is the station
and as well because of central sensitization
and having just a bottle of Excedrin migraine
or getting a bottle of 30 triplins at
from Cost Plus drugs
so you can treat every single attack that month
is going to put you on the path to
medication adaptation headache
so what you're gonna do is
you're gonna talk to your provider
about having multiple acute
treatment options so that you can treat
every single attack that you have
without the risk of medication adaptation headache
okay
yes right
so let me get as much medication as I can right
so you know if I have nausea with my migraines
not everybody has nausea but you know
a lot of people do so I'm gonna get that phenergan
right I'm gonna get that anti nausea medication
I'm gonna get a variety of abortive medications
you know she's got her I think it's a leave up there
which is an ensaid right
I've got all this stuff so now I can rotate right
one day I'll take the trip in with the fenugreek
the next day I'll take the olive uh
with some ginger right
you know we're gonna throw in some natural stuff too
I got my ice hat my cephaly right
I got all this stuff that I'm gonna keep rotating
it'll work for a while it'll work for a while
but eventually none of it's going to work
and this is where women have continuous 24
7 daily head pain with migraines flaring on top of it
and nothing works nothing works
do I have clients like this
that come to me in this state
absolutely absolutely
so again I don't know this woman
I know her heart's in the right place
and if this is working for her now
bless her heart but it's going to stop working
this is not a Panacea this is not a strategy
this is not a way out because you're going to
the more medication you take
the more your body is gonna say
oh boy
she's really giving me a challenge here
right before it was just one thing I had to figure out
now I got two three
four five
whoo I'm really gonna figure this out
because I have to generate this symptom
I have to adapt in this way because the
this is the environment the physical
the mental emotional environment that I'm in right now
and to function in that environment
I've got to generate these migraine symptoms
so boy
you're gonna give your body a challenge
and it's gonna rise to the challenge
trust me
it's going to figure out how to generate the migraines
no matter how much you rotate this medication
so med cycling works like this
your toolkit is going to be robust you're
the more robust it is the more drug metabolites
going to treat every attack appropriately
so you're going to discuss
multiple acute medication and delivery systems
as well as anti nausea medications
and neuromodulation devices
because the toolkit isn't just about ice packs
lenses and electrolytes
it's about hitting migraine from every single corner
so this is an example of what a
medication tool kit can look like
and you want to be able to mix and match these meds
for each attack so here's an example of how you
look at this chart
again
I'm not saying this from a place of judgment
I'm not saying this from any place
other than absolute heartbreak
absolute heartbreak because I know
I know in the core of my being
that if I had not followed the inner voice
the inner intuition that I had when I was 25
that if I took this medication
that my doctor was prescribing me
that I was gonna that I was gonna feel worse
my intuition was telling me that
and if I had not followed that intuition I'm 54 now
there's not a doubt in my mind
that I would be bedridden
and I know a lot of you are listening to this right now
in bed
and there's not a doubt in my mind
that I'd be right there with you
not a doubt in my mind
these are our lives
we're fighting for our lives here
and this is what we're being told to do
and again
this is a good hearted woman
she's not a medical professional
she's somebody that has done so much research
I'm sure
she has gone into every appointment with a notebook
and questions and notes
and she's given her care team a run for their money
right because she's not gonna
just be satisfied with the pat answers
she's gonna dig deep with those providers
and what is it gonna get her
what is it gonna get her
look at this flow chart
this is the anxiety that women with migraines deal with
all the time every day
not only do I have my care kit right
not only do I have my medication kit with me
everywhere I go
but now I gotta think about is this a
is this a is this a mid level
is this a mild level is this gonna turn into a
you know a real skull buster
should I take a chance it seems like it's gonna be mild
so should I just start off
you know with that top line
or gosh you know
tonight we were gonna go to the movies
tonight is my daughter's ballet recital
I can't risk turning you know
I can't risk being in bed at three PM
I got a lot to do before it right
so should I go should I go for the big guns
but I don't know I don't know what to do
it's not that bad right now
but what about you know
this weekend oh my goodness
I I can't go into a three day flare right now
we're leaving for Hawaii on Saturday right
I mean oh
this is an absolute nightmare
being presented as a solution
this just breaks my heart
absolutely breaks my heart
because it's not necessary it's not necessary
mix things up with your toolkit
and you can do it based on the color scale
as opposed to the traditional pain scale
so with a green or mild attack
you would do your neuromodulation device
and an ice pack lidocaine patches
essential oils
other tools like um lenses or green light therapy
progressive muscle relaxation
a yellow attack could add a medication
an acute medication and an anti nausea medication
with your tools and lifestyle measures
and then as the attack progresses
you would add more and more medication
so that a severe attack would include
like an intramuscular shot
or an intranasal spray with a neuromodulation device
Benadryl anti nausea meds
ice pack lidocaine patches
a lot of people are cagy with diphenhydramine
or Benadryl but the reason it's used for migraine
is that it passes the blood brain barrier
if a woman starts off
with most of her attacks on that top line
what's gonna happen over time is
most of her attacks
are gonna start to move to that middle line
and as time goes on
most of her attacks are gonna move to that last line
and by the time you get to that point
you're taking a lot of medication
I mean let's take a look I mean
Benadryl anti nausea meds
those knock you out I mean
the migraine abortives themselves
knock most people out uh
maybe you know the CGRP antagonist
you know like a nertec
you brelvy maybe
maybe people don't get as knocked out on those
but uh
trip tens people feel like they've been hit by a bus
right
Benadryl
good luck staying awake with that one anti nausea meds
again
those put people to sleep
injections
huh lidocaine patches good luck with that
by the time you're on that last row lidocaine patch
I mean
for most people that's gonna be a drop in the bucket
if it helps you great
I'm happy for you
but by the time you need to use that much medication
by the time you have to take that much medication
for your migraine attack you're on preventatives
what how do you feel on those preventatives
can you walk up a flight of stairs
can you find your keys in the kitchen
can you stay awake at two PM at work
are are
are you falling asleep on the couch at 7:30 at night
and your kids are saying Mama
can you can you do something I can't sweetheart
we deserve better than this
but if you right I
I wanna circle back because what this wonderful woman
this good hearted woman
has been told is that she has an irreversible
chronic condition
that somehow fell out of the sky
and attached to her back and now she's got migraines
how'd that happen where'd that come from
no one knows no one knows right
just somehow she caught it
and if you believe that to be true
then you're going to act accordingly
and then your actions are going to generate
the results that follow
and that's what this that's what this generates
and
it just breaks my heart it just breaks my heart
so if you're in this situation
I want you to know that I might be able to help you
and I'm not saying that flippantly
what I would recommend is that you reach out to me
and book a free consultation call
we'll go over where you're at and I'll
if I can't help you I will tell you that
but I have had so many clients over the years
that are on that last line
they're taking multiple preventatives
they're in rebound they've been told
you know you need to go impatient
you're gonna have to go to the impatient
headache clinic because we gotta get you off these meds
right it's like you're going into like a drug rehab
right to detox
that's what happens to migraine sufferers
they're treated like drug addicts
that have to go to an impatient treatment center
that's how they're treated
because they have been put on so many medications
that have made the problem worse
they've followed the prescribing guidelines
and taken the medication
when they're supposed to take them
and that's given them a new diagnosis
a new health condition
just from following doctor's orders
and then they got to go
inpatient for a full fledged detox
this is outrageous
we gotta stop doing this
the first question is
what does your body need to feel good again
let's get that question answered
and let's get you feeling better
let's get you out of rebound
let's get you
so you don't have to take all of these things
you can get off your preventative medication under
you know I don't change any of your medications
that's between you and your prescribing doctor
but once you start to restore your health
you start to give your body what it needs
and it starts feeling better
we start to turn around that internal environment
so that your body doesn't have to generate migraines
to adapt to a less than optimal environment
you start feeling better
you can come off these medications
and you can start to feel like yourself again
and that's what I wish for every woman listening
because when I see this I see what
what could have been what could have been me
and I don't want that for you
if you're if you're there
let's get you out of there
and if you're not there yet
if you're still on that top line
let's get this turned around before you go any further
because
going further down this checklist is
I'm I'm not trying to be dramatic here
but this this robs women of their life
it robs women of their life
I have clients where part of their
healing process is working through the grief
of missing their children's childhoods
it can happen
this is no joke
so
joining me today it's a bit of a heavy topic
but it's too important not to talk about
and I'll talk to you soon