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Suggest Treatment For Severe Headaches
Question: what can I do for this headache? Is HYDROMORPHONE ADDICTIVE?? PLEASE ANSWER BOTH QUESTIONS AS DETAILED AS POSSIBLE
Brief Answer:
Hydromorphone is addictive.
Detailed Answer:
I read your question as well as some of your past ones and I am sorry that you still aren't feeling well.
You do not give many details on your headache and it has been many months since we have communicated, in February I think, so I might not remember all the details. I remember you were about to be given a new drug by your neurologist but didn't follow-up to say what drug was that.
First step in the treatment of any headache are either acetaminophen or over the counter antiinflammatory drugs like Ibuprofen, Naproxen. Also combinations of antiinflammatory drugs with antiemetics are also used successfully, one example is combination of indomethacin/prochlorperazine/caffeine brand name Difmetre, but there are many different versions in different countries.
If those result ineffective then treatment with ergotamine or triptans (zolmitriptan, sumatriptan) can be effective in interrupting the headache.
As for drugs like hydromorphone, they are opioids, and as such it does carry the potential for addiction, all opioids do. So its use is generally restriced only for exceptional cases and not regular everyday use.
I remain at your disposal for further questions, but in case you do please provide some more detail on what medication have you been taken, any changes in your shunt functioning or headache characteristics in these later months.
Hydromorphone is addictive.
Detailed Answer:
I read your question as well as some of your past ones and I am sorry that you still aren't feeling well.
You do not give many details on your headache and it has been many months since we have communicated, in February I think, so I might not remember all the details. I remember you were about to be given a new drug by your neurologist but didn't follow-up to say what drug was that.
First step in the treatment of any headache are either acetaminophen or over the counter antiinflammatory drugs like Ibuprofen, Naproxen. Also combinations of antiinflammatory drugs with antiemetics are also used successfully, one example is combination of indomethacin/prochlorperazine/caffeine brand name Difmetre, but there are many different versions in different countries.
If those result ineffective then treatment with ergotamine or triptans (zolmitriptan, sumatriptan) can be effective in interrupting the headache.
As for drugs like hydromorphone, they are opioids, and as such it does carry the potential for addiction, all opioids do. So its use is generally restriced only for exceptional cases and not regular everyday use.
I remain at your disposal for further questions, but in case you do please provide some more detail on what medication have you been taken, any changes in your shunt functioning or headache characteristics in these later months.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I am currently taking keppra 1500 2 times daily lamictal 200 twice daily I am also taking oxcarbazepine twice daily 600 mg I am also taking Zonegran 150 at night only they currently only have me on this opioid only because the fact of the matter is they know I do not have headaches are not everyday Anymore. They did end up doing a shunt revision because it was malfunctioning when I last spoke to you so the neurosurgeon told the emergency room to prescribe dilaudid only every 4 hours with a XXXXXXX of 4 milligrams a day no more after that and try otc medicine first but if the headache does not respond take dilaudid at that point no more then twice a week. The shunt is only. For hydrocephalus and he will not touch the shunt unless ventricle enlargement from the last CT SCAN.... I hope this is the information that you needed too help me more
Also the headache is an 8 of 10 when I do get them. I also did not know if I only take it twice a week that it could very well be addicted at that point. the neurosurgeon said that he did not really want me to take it if I really did not have a very SEVERE HEADACHE
Also the headache is an 8 of 10 when I do get them. I also did not know if I only take it twice a week that it could very well be addicted at that point. the neurosurgeon said that he did not really want me to take it if I really did not have a very SEVERE HEADACHE
Brief Answer:
Read below
Detailed Answer:
Thank you for that additional info.
I would agree with the neurosurgeon advice. So the first step drugs which I mentioned should be tried first (the antiinflammatory drugs). Dilaudid can be taken only if they do not work and the pain is severe, 8/10 is severe and its use is justified. There are not precise dosages and frequencies for which addiction develops but limiting to no more than twice a week should be safe.
While I understand that revising the shunt might not be recommended I wonder if you have had tests for increased intracranial pressure apart from CT, tests like watching the eye fundi for swelling of the optic nerve, a sign of increased pressure, or a spinal tap to measure pressure. If there is increased intracranial pressure due to hydrocephalus, diuretics like acetazolamide or furosemide might be of help.
Looking at the rest of your medication I see that you have 4 antiepileptic drugs which is a lot. You hadn't mentioned before you have epilepsy as well. Now to be honest I think that is a lot, evidence shows there is little chance that therapy with four drugs will be any more effective than triple therapy really, some cases are just resistant to therapy and adding more and more drugs is not the answer. The reason I am saying that is because all those drugs can have headache as a side effect. So you should discuss with your doctor whether all those drugs are necessary and whether reduction couldn't be considered.
I hope to have been of help.
Read below
Detailed Answer:
Thank you for that additional info.
I would agree with the neurosurgeon advice. So the first step drugs which I mentioned should be tried first (the antiinflammatory drugs). Dilaudid can be taken only if they do not work and the pain is severe, 8/10 is severe and its use is justified. There are not precise dosages and frequencies for which addiction develops but limiting to no more than twice a week should be safe.
While I understand that revising the shunt might not be recommended I wonder if you have had tests for increased intracranial pressure apart from CT, tests like watching the eye fundi for swelling of the optic nerve, a sign of increased pressure, or a spinal tap to measure pressure. If there is increased intracranial pressure due to hydrocephalus, diuretics like acetazolamide or furosemide might be of help.
Looking at the rest of your medication I see that you have 4 antiepileptic drugs which is a lot. You hadn't mentioned before you have epilepsy as well. Now to be honest I think that is a lot, evidence shows there is little chance that therapy with four drugs will be any more effective than triple therapy really, some cases are just resistant to therapy and adding more and more drugs is not the answer. The reason I am saying that is because all those drugs can have headache as a side effect. So you should discuss with your doctor whether all those drugs are necessary and whether reduction couldn't be considered.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
To be honest with you, I have mentioned A nerve stimulator he said no he would not recommend that simply because the medication therapy is currently working. I did however, mention to him that I am on way too many drugs. He said is it helping? I responded by saying not really, he said Well we have Tried Combining Seizure meds
Which is currently not working. So I will have to check with my colleagues. If they recommended It, I would be more than happy to recommend it and have your neurosurgeon insert it by putting you in the hospital the same day of me seeing you
Which is currently not working. So I will have to check with my colleagues. If they recommended It, I would be more than happy to recommend it and have your neurosurgeon insert it by putting you in the hospital the same day of me seeing you
Brief Answer:
Read below
Detailed Answer:
If the multiple drug therapy is not working then vagal nerve stimulation can be considered. It is currently approved for partial onset epilepsy but other types of epilepsy can benefit as well. Medication is still continued remember that, but for your case where you seem to take so many it may be reduced.
Of course the doctors must be convinced that drug therapy is not working, so, if you do not do that already, I suggest you keep a diary of your seizures in order to monitor their frequency under the current regimen.
Read below
Detailed Answer:
If the multiple drug therapy is not working then vagal nerve stimulation can be considered. It is currently approved for partial onset epilepsy but other types of epilepsy can benefit as well. Medication is still continued remember that, but for your case where you seem to take so many it may be reduced.
Of course the doctors must be convinced that drug therapy is not working, so, if you do not do that already, I suggest you keep a diary of your seizures in order to monitor their frequency under the current regimen.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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