Have I displayed drug seeking behavior??

[elthia]

I really scared myself today.

I've been having debilitating migraines, that last 5-10 days. Horrible, nasty migraines with dizziness, tinnitus, stabbing pains, photophobia, phonophobia, diarrhea, and intractable n/v. Yes, I have been taking my topamax. Yes, I have started seeing a neurologist, and he started me on elavil and doubled my topamax dosage. I am actually having almost daily migraines, and I take Axert, if the axert x2 doesn't work then the sucker last a week, give or take 3 days. Phenergan po or supp doesn't work, zofran po occasionally works, I've lost 8 pounds in the past month from n/v, I have NO paid time off left or sick leave left, I'm probably going to have to file FMLA if I want to keep my job.

Insurance only pays for 6 axert a month. that translates to 3-6 migraines a month. I am having almost daily migraines right now. So I got very panicky and had a complete meltdown when I ran out when my pharmacy was closed yesterday( my pharmacy has limited weekend hours). Axert is $21.00 a pill in the US. My script was written for 15 pills a month, insurance would only pay for 6, so the pharmacy only filled for 6, and when I called this morning and requested the other pills that I would pay out of pocket for, the tech said I would have to wait because it was 3 weeks too early to fill the scipt. At the time of the conversation I was having an aura, and I told her that. I called as soon as they opened. I almost had a panic attack, I couldn't get her to understand that if the script was for 15 and only filled for 6 then technically I was still 9 pills short for the month. Well I finally got the pharmacist, who allowed me to pick up 6 more pills, but too late. It took 45 minutes to get them, took one, then later took another. Went to work and had to leave early because I was dizzy and puking my guts out. My head is just killing me.

I was so terrified of having another full blown migraine, I didn't think I could lose my cool that way. I was almost yelling at the tech. I need to get off the computer, it's hurting my eyes, thanks for letting me vent

[Warpster]

I saw typical drug seeking behavior in post op patients whenever I followed Nurse Tylenol. People in real pain can and do display classic drug seeking behavior, especially when some martinet has refused to address their pain. The behavior wasn't because they were addicts. The behavior was because their pain had not been treated appropriately.

Pain is ridiculously undertreated in this country. Insurance companies are adding to the problem by trying to ration drugs in a one size fits all format.

You are having a legitimate problem and you deserve appropriate treatment. Go ahead and pitch a fit. Scream and throw things if you need to. Any of us who have ever experienced a migraine will understand. Find out if you can afford an emergency supply on your own while you drag that insurance company into arbitration.

Just don't give up. This isn't your problem, it's their problem. You're just the one who is doing the suffering.

[grandee3]

Forgive me if this was already mentioned, I did not have time to read all post.

What about a mail order of your Rx. Usually it cost less and you can get a 3 month supply. Not all ins co. have this option but it's worth looking into.

Hope you can find some relief.

[elthia]

I'm going to start ordering axert from canada.

[HJS27]

Ditto on getting a THOROUGH neuro workup, and cardiac workup to rule out PFO. If your migraines might be hormonally triggered (even if only some of them are), you may want to check into hormone manipulation. Consider getting a script for injectable Zofran. Sure beats po meds when you are having N/V. Also, consider trying Toradol injections...your doc can prescribe them just like oral meds. If given very early in aura stage, Toradol can sometimes actually abort the migraine altogether. If it does not abort, it definately helps with the pain, and may be used in conjunction with Triptans. Don't forget, different people respond differently to different meds. If one triptan doesn't work for you, try another.

Now, for the true gem, Botox injections as a prophylactic. Yep, the research is not promising. When using Botox treatment for migraine the dose and placement need to be tailored to each patient through trial and error over time. And, unfortunately, this doesn't work well during a clinical trial. It doesn't work for everyone. But, if used properly, you can have amazing results. AND, insurance WILL often pay for it. Yes, I said it. I did therapeutic Botox prior auth for a neurologist for two years. The process can be tricky, and the insurance companies don't really like to pay for it. But, unless they have a policy that strictly disallows payment for Botox for headaches, they can be made to pay. Depends on the particular policy. It really helps to push the auth through if the patient has neck problems/muscle spasms (cervical dystonia is the phrase/coding you want on your auth request). But, before you say, "I don't have neck problems", pay attention to how your neck feels for about two weeks. A large percentage of migraineurs have chronic neck muscle spasms they either don't realize exist or discount as sequellae of the chronic headaches. Are you constantly rubbing your neck, or trying to stretch it? Does your neck stiffness and pain increase in the days just prior to H/A onset? A daily headache diary kept for a month will show you alot about your pattern. The easiest way to get Botox paid for by your insurance is to request authorization for the neck, and have your doc obtain a vial specifically for you by sending a script for the Botox to the specialty pharmacy your insurance requires you use. That way you have the entire 100 unit vial to use on the neck, and the face as well. The specialty pharmacy will obtain the auth from ins...make sure they check under your major medical benefit AND your pharmacy benefit. I have obtained a vial of Botox for as little as $16, the patient's pharmacy benefit copay. Botox retails for about $600/vial.

[elthia]

Thanks, I'll look into the toradol. It's just so frustrating. I had another migraine today, it went away with axert, but I threw up and had to go lay down for 2 hours until the second axert kicked in. Now I'm just drained.

[nfahren05]

I would ask your doc to request an exception on your behalf from the insurance company. Sometimes insurance will grant an exception to the coverage guidelines based on the recommendation of a doctor. HTH

This does work with most insurance companies, if the reason is clinically sound. The OP needs to consider, however, the "rebound" effect that many triptans have when deciding to purchase additional medication out of pocket or processing an appeal with the carrier. More important than "how can I get more Axert" is the question "why do I need this much?" Getting both the patient and the provider to stop and consider this question is part of why quantity limits are set on certain medications (besides, of course, the financial burden related to certain high dollar drugs.)

[woody62, RN]

I'm going to start ordering axert from canada.

I am not sure how much you will save. The Canadian dollar is currently equal to the U.S. dollar. And six pills sell for just under $85. Sorry but perhaps you should have gone this route much earlier then now.

Woody:balloons:

[AgentOrange]

this form asks the md/np to explain why the pt is in need of this particular med.

she filled it out, got it approved, and my insurance paid everything except my nominal copayment.>>

I agree, the OP should have her physician try a prior auth form. Unfortunately, insurance's many times deny them, but they do occasionally approve them (esp. if the pt has a history to justify it--ie if they are having to pay emergency room visits twice a week, they will surely see that it's cheaper to pay for more triptan's).

[middlekane]

Ibuprofen has been used successfully in patients for RESIDUAL pain, no the migraine itself.

Not true. There are actually some of us who have migraines who are lucky in that ibuprofen can treat it. I get a migraine anywhere from once a month to 20 times a month, but I am lucky in that 90% of the time, ibuprofen can take care of it. If it doesn't, then I use a triptan which sometimes works. My doctor says they are migraines, they are one sided, stabbing, I get nauseous, sometimes smell funny odors, can't stand light or sound, but I am one of the lucky few. It's always worth a try.

[sharona97, BSN, RN]

The whole ibuprofen issue was mainly directed at residual pain(not acute migraine pain).The idea is to treat the inflammation of the vascular system after an acute migraine. If Ibuprofen works for you great, I just wanted to reiterate what my point was in terms of an antiinflammatory response post acute migraine pain.

The rebound effect is true what HM2Viking posted is true as well.

I am hoping whatever the cause for your HA's will be found soon and give you some relief. Migraine's suck!

[sharona97, BSN, RN]

Thanks, I'll look into the toradol. It's just so frustrating. I had another migraine today, it went away with axert, but I threw up and had to go lay down for 2 hours until the second axert kicked in. Now I'm just drained.

Elthia,

During my migrainous years, I often would get Tordahl 60mg IM at work and be able then to finish the shift. I hope this works for you too

[elthia]

I am not sure how much you will save. The Canadian dollar is currently equal to the U.S. dollar. And six pills sell for just under $85. Sorry but perhaps you should have gone this route much earlier then now.

Woody:balloons:

Well last week at my pharmacy I paid $132 for 6 pills. Yeah it sucked.

If after 2 axert, I still have a migraine, I don't take any more triptans with that migraine. My downfall is the migraine causes intractable n/v which leads to dehydration which feeds the migraine which leads to more n/v and so the downward spiral into status migraine begins. Even with phenergan and zofran I still have n/v. You would think I had hyperemesis gravidarum, except I'm not pregnant. (I can't count how many pregnancy tests I've had this past month) One time I had dry heaves every 30-45 minutes for 6 hours, finally went to the ED cause I couldn't stand it any more.

http://www.fpnotebook.com/NEU136.htm

I really don't take triptans more than 15-20 days a month. The almost daily migraines have started in this past 4-6 weeks. But I DO get more than 6 migraines a month.