Using Opiates Like Morphine to Treat Cluster Headaches
My history with morphine started some 5 years ago when I was forced to reduce my use of imitrex as an abortive for my cluster headaches. It was becoming less and less effective, and top of that, I was having frequent attacks of chest pains due to angina as a result of a heart attack I suffered in 2001, when they implanted my first coronary artery stent.
My first line of defense up until then had always been O2 and up to seven imitrex injections a day, followed by a trip to the ER and morphine injections when that defense failed to stop the really bad attacks. The oxygen therapy available to me when I was first diagnosed was 7 to 9 liters/minute and although it worked for minor attacks while I was awake, that flow rate was useless when the attacks came at night while I was sleeping.
Around a year and a half after I was diagnosed with cluster headaches, I was able to get the oxygen prescription changed to 15 liters/minute. That proved to be slightly more effective during the day, but again, it was not ineffective in aborting the high Kip-scale night attacks. On top of that, my cardiologist prescribed nitroglycerine for my angina attacks. While the nitroglycerine was effective in reducing the chest pains, it was also an obvious trigger for more frequent cluster headache attacks and it made their onset even more rapid than they already were.
I didn’t know what to do so I finally asked my GP if I could try morphine injections at home because I just had to have something to take the edge off the pain of my cluster headache attacks. I can remember my GP saying, “We have to be careful or we both could be in trouble.” I felt the morphine injections “worked” as expected, but in reality, they only took the edge off the pain of my cluster headaches to make them more bearable and did nothing to abort the actual cluster headache attacks. This treatment was neither good nor lasting, but at least I could function. At that point, the morphine made me honestly feel I had control of my life again. For the first time in years, I finally had a happy life again with my family, but the stage was set for a perfect storm and my dance with the devil had begun.
In looking back with 20/20 hindsight and a clear head, I had become dependant on morphine in a matter of months after starting the injections. Only Bente and my GP knew I was using morphine, but neither of them realized the extent I was using it to get through each day. I had become a functional addict with a nearly unlimited supply of morphine. In the beginning I was using one or two 1.5 ml morphine injections a day at 10mg/ml. By the time I entered detox five years later, I was dosing with four to six 1.5 ml morphine injections a day at a concentration of 40mg/ml.
Shortly after I started the morphine injections, I suffered two more heart attacks in rapid succession over a five-month period. At that point I was seeing my GP, my cardiologist, and my neurologist of over 20 years, but only my GP was aware of my involvement with morphine.
The sequence of events associated with each heart attack didn’t help. What is the first that the EMTs give you when they respond to your call saying you’re having heart attack? Morphine, even before they start checking you. Then they take you to the ER at the hospital and what do they give you when you arrive in the ER? Yes, more morphine. And if they have to treat another higher priority case while you’re lying there, because you were not lucky enough to be first in line, they give you more morphine.
Then, when you wake up in the recovery room, what is the very first they give you? Yes, more morphine.
And “lucky me”! As a chronic cluster head, they gave me more morphine, several times a day. Totally, up to 8 morphine injections a day. While all this was happening, I still refused to admit even to myself, that I was addicted to morphine.
By the time I had suffered my third heart attack and had the third coronary stent implanted, I had become a master of disguise in hiding the fact that I was using morphine regularly each day from my friends and family. I had also learned that if I ran out of morphine and the withdrawal symptoms started before I could get a refill, all I had to do was call the hospital and let them know I was having chest pains and the EMTs would deliver the morphine faster that the pizza man could deliver pizza. At this point, not a day went by without morphine injections and each day revolved around them. I had become a functional morphine user and was extremely adept at hiding that fact from everyone including myself.
I received excellent treatment at the two hospitals in USA when I was admitted for my fourth heart attack in July of this year, while staying with Pete and Joyce in Virginia following the conference in Dallas. Plaque had built up in the third stent I had been given to the point where arterial plaque was blocking 70% of the blood flow through my right coronary artery. The before and after video the cardiologist sent me from the cath lab was sobering. Although that heart attack was very real and very serious, I was still given morphine for my cluster headache attacks.
Throughout this five-year period, my cluster headache attacks continued, usually at a rate of 3 to 5 a day and some times higher. During the 2007 Clustercompagniet Conference in Trondheim, Chuck made a presentation on the demand valve therapy he was using as a part of the pilot study Pete was running to determine it’s effectiveness. Chuck’s description of this therapy was so convincing, I prevailed on our local oxygen supplier to loan me a demand valve system. The demand valve and therapy Pete developed made a tremendous improvement in my ability to abort cluster headache attacks during the day, but some night attacks were still a problem. Despite my claims to all about using oxygen as my first line of defense for my cluster headache attacks, it was morphine I reached for first when these attacks hit then the oxygen if I used it at all.
By the time Pete arrived in Oslo last September, I needed a morphine injection just to get to the airport to pick him up. I even had to take a shot to be able to go to the store just to buy a pack of cigarettes. That’s when it all started to unravel and the wheels began falling off my wagon. I had run out of morphine the day Pete arrived, but was determined to make the trip to Haugesund without it. I recall telling Pete the night before we left that I was afraid I had become addicted to morphine, but still clung to the story line that I only used it “as needed” for my cluster headaches. I know that sounded like a good rationale to me, but it was clear from his comments, Pete wasn’t buying it.
Later that evening around 11 PM, the withdrawal pain had gotten severe and it became clear the trip to Haugesund would be impossible without morphine, so I called the hospital and told them I thought I was having another heart attack. As usual, the EMTs arrived with the morphine injection and the withdrawal pains started to subside. I received a second shot in the ambulance on the way to the hospital, and a third at the hospital while waiting for the cardiologist. As the EKG revealed no sign of a heart attack, they assumed it was only angina and released me early the next morning. The trip to Haugesund was uneventful, but after two nights staying with Ole Orre and his family in Sauda, I had again started into withdrawal.
By the time we arrived at the symposium site in Haugesund the next day, I realized what was happening and finally admitted to myself that I was no longer in control, the morphine was. To make matters worse, on top of the withdrawal, I was sure I was having a nervous breakdown. I begged a dear friend who suffers from migraines for anything that would help, and as it was clear I looked like death warmed over with a bad case of the shakes, she gave me six sobril and a couple valium tablets. That helped calm my withdrawal symptoms enough so that I could at least perform my duties at the symposium as expected, but the cat was out of the bag, and there were now several people who knew just how badly I had become addicted to morphine.
I took the opportunity to speak privately with Dr. Monstad about my problem with morphine while in Haugesund, but the combination of sobril and valium had masked my withdrawal symptoms so well, it must have been clear to him, there was no real sense of urgency.
Had I been smart, I would have called the pharmacy and told them to cancel the prescription, but NO – morphine was running what was left of my life. I did relatively well, while my dear friend Pete was with us after returning from Haugesund, but as soon as he left for the airport and his flight home, the very first thing I did was to go to the pharmacy to get even more morphine and started to shoot up again.
The next month was a rollercoaster of emotions marked with short euphoric highs from the morphine and bouts of depression every time I realized what had become of my life all spiced with moments of fear over the thought of going through detox. I knew I had to do something. After speaking with several of my closest friends who were aware of my addition to morphine and who all said it was good that I wanted to go into detox, I scheduled an appointment with my GP in the hopes he would be able to have me admitted for detox.
To my surprise, my GP passed me off to a pain specialist who I saw a few days later. He sent me off with a prescription for oxycontin 80mg X 2+ cataflam 50mg X 3 to detox at home, but I had to wait for my disability check to arrive in order to buy the medications. It seems that our method of social medicine here in Norway that is so good at collecting the tax to keep it running, and it will give you all the morphine you want, but once you become addicted to it, you’ve got to buy the detox medications out of pocket.
When I explained what was happening to Pete, Pål, and Oliver, they all told me in no uncertain terms, that this was NOT the way to detox, it cannot be done at home, and that I needed professional help by people skilled in working with people addicted to opiates through the entire detox process and follow up therapy. They also called the pain specialist who had sent me home to detox “Dr. Feelgood” and quack, along with a few other names I can’t repeat. What I didn’t know at the time was that these three were meeting on Skype at least twice a day along with Chuck and Michael to work out a plan of action to have me admitted to a proper detox facility.
They were right. A few days after starting the detox process at home I was a physical and emotional train wreck in progress… Somehow Pål managed to get hold of Dr. Monstad who agreed to see me the following day. When I arrived at Dr. Monstad’s office I must have been a sad sight. He took one look at me, shook his head in disbelief and said, “Jesus Christ, Svenn you really need help.” The first thing he did, was write me a prescription for sobril and then he told me to stop taking the oxycontin and cataflam. He also said he would have me admitted me to a detox facility as soon as a bed became available. Three days later I was admitted for detox
The 2-week stay at the detox facility was something I would not wish on my worst enemy and I have learned my lessons. As Pete kept most of you up to date on my status with daily SITREPS, I’ll spare you the details of my stay at the detox facility. What I can say at this point is my recovery from morphine addiction is still in progress and likely to be so for some time to come. Although I feel so much better physically, the memory of morphine still lingers.
There are several lessons to be learned from my story, but the most important is simple, opiates like morphine are NOT a medication for cluster headaches. Obviously, in extreme cases, opiates like morphine, can be administered as a temporary intervention, but only under controlled conditions by competent medical professionals. The frequency of cluster headache attacks and continued use of opiates as a method of intervention is a recipe for disaster with a very predictable end point. Once your brain becomes dependant on opiates, words like control, strength, and will power are meaningless. Your brain will make you do anything to get more. I have promised myself NEVER again.
Opiates do NOT stop a cluster headache attack. They only mask or take the edge off the pain.
Oxygen therapy administered with a demand valve or with a non-rebreather mask at flow rates high enough to support hyperventilation is a very effective abortive if used early, properly, and there are no other medical conditions that interfere with it. Oxygen therapy is also very safe and it can be used in conjunction with triptans to actually abort the cluster headache attack and stop the pain.
By telling my story I really hope you understand that opiates like morphine are not the medication for us, and not something you should play with.
Svenn
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