Saturday October 25th 2014

Can I get addicted to migraine medications (Xanax and Valium)?

Will I get addicted to Valium?

Hi. I was prescribed Xanax and it was very helpful for me. It was like I was given a new lease on life. I suffered numerous disabling injuries in a car accident years ago and I suffer from never ending pain. I also suffer from severe migraines.

When I started taking the Xanax, my migraines all but disappeared and the medication also relieved my pain. I think because my body was not so tensed up, with my teeth clenched, every single second of my life was better. Previously, even when I slept, I sometime woke up, my head inches off the pillow, my body stiff as a board. Also, because I was not in so much pain I wasn’t so tired all of the time and I was more active and outside more, not so afraid of someone bumping into me.

The problem is I started noticing that I was thinking about taking another dose of Xanax before I was due. I tried to stop thinking this way because the medication was really helping me, but to no avail. So I decided to stop taking this medication.

Now I am back to the migraines, and the pain is worse! I’ve actually broken a tooth from clenching and I don’t have any energy to do the fun stuff with my children. My doctor suggested valium but I do not want to chance it if it will cause me to build up a tolerance and “crave” it like I did the Xanax.  Plus, I learned that the half life of Valium is pretty long and might not be the most efficient if I need drug testing or screening.

Would the Valium be okay for treating symptoms of a migraine? Are there any other medications that would provide the same relief without the same risk? Any advice that you would provide me would be greatly appreciated.  Signed, D.

Addiction doctor (MD) answer – Yes, Valium is addictive

Dear D,

Addiction isn’t just physical dependency. Anyone who takes medication like Xanax or oxycodone for more than a few weeks may feel physical withdrawal symptoms if they stop the medication suddenly. But for the diagnosis of true addiction, psychological symptoms must also be present. You gave an excellent example of a psychological symptom, when you described thinking eagerly about your next dose of medication.

It doesn’t sound like you actually developed addiction, since you recognized potential problems with the medication, and were able to stop it. You likely saved yourself a great deal of suffering.

Both Xanax and Valium are brand names of medications in the benzodiazepine family of medications. These drugs are used to treat anxiety and insomnia, but also have a muscle-relaxing effect. And both drugs have the potential to cause addiction.

Decisions about medications are always a risk versus benefit analysis. In other words, does the potential benefit outweigh the potential risks? Because of your experience with Xanax, I feel Valium would be a high-risk medication for you to take, unless all other treatment options failed.

Since there are other means to treat your condition, Valium may not be necessary anyway. Many prescription muscle relaxants can be prescribed in place of Valium or Xanax, with little, if any, risk of addiction. Anti-inflammatory drugs, like ibuprofen or naproxen, may be helpful.

Additionally, there are non-pill ways of treating muscle tension, such as massage, heat, and biofeedback. I would encourage you to talk with your doctor about these alternatives. These methods admittedly take more time than taking a pill, but can be effective, and much safer.

More on uses of Valium

Photo credit: Deborah Leigh (Migraine Chick)

Leave a Reply

7 Responses to “Can I get addicted to migraine medications (Xanax and Valium)?
Jason GIles MD
12:36 pm February 17th, 2011

Excellent synopsis of the physical and mental facets of addiction, Dr. Burson. Clearly stated.

As for D, I wonder if your headaches are cervical (neck) in origin. Your fear of being bumped, for example, makes me think the pain is cervicogenic. More, the relief from the benzodiazepine may be due to altered perception of pain instead of specific muscle relaxation. All of the “non-addicting” relaxers work on the brain and spinal cord.

Tolerance is bound to ensue. Best bet is probably a non mood altering strategy for pain relief.

D
11:00 pm February 18th, 2011

To J. Glles, M.D.: My migraines most likely (according to my neurologist and the studies done to properly diagnose this condition) is due to TBI sustained in the car accident. I do have mild compression of the brain stem and my atlas fractured my skull and rides high and is fused in this way. As for my fear of being bumped into, I broke my neck (posterior and anterior fractures of the C1 and C2) in that accident. I’m told it is EXTREMELY rare for a person to survive these fractures. 8 months later, I underwent occipital to C3 fusion with hardware to stabalize these fractures and an attempt to correct the rotator deformity was performed. (I suffer from what I can only describe as charlie horses around where the screws (nails) in my skull/neck are palpable and I am unable to predict when this will happen-it can happen if I raise my arms to wash my hair or put on my coat, if I bend to pick something off of the floor or reach for something, …when I tense up, etc.) and as I am unable to turn my head or look up and I live in a densely populated city where people are constantly stepping on the backs of my feet, bumping me with strollers or just bumping me when passing me on the street as I tend to walk rather slowly. My body is always tense. I must travel by walking, bus or subway where people are constantly bumping into me and it really hurts me, physically…tensing up in itself also causes me physical pain. Also, I constantly clench my teeth. I am unable to open my mouth wide enough to eat a sandwich. I cannot use a fork as my teeth push the food right off of it. I use a small spoon so that I am better able to manipulate food into my mouth. I usually keep my tongue between my teeth to prevent clenching and I wear a mouth guard while sleeping. A very caring doctor, the only one who took the time to even consider why this may be offered the following explanation; during the accident, my face was injured (upon examining my mouth with his fingers, he said that he could feel what may be splintered bone. He said that blood probably pooled behind my cheekbone(s) and eventually turned into fibrous tissue. So, either I have splintered bone or fibrous tissue preventing me from opening my mouth. Some of this inability to open my mouth may be due to guarding because under anesthesia, he was able to open my mouth almost 1/3 more than I could do on my own. My body is in a constant state of tension, for lack of a better word.So although I can see where the relief I experience from the benzodiazepine is due to my body being more relaxed and not so quick to tense up, the relief I experience is real (less charlie horses in my neck, less painful lumps (spasms?) in my abdomen. less clenching of my jaw, less frequent migraines (which in my case are triggered by mental stress, physical tension and when I am overly tired) – the headache part of my migraines usually happen at night, waking me from sleep. Forgive me for rambling but I am not sure what you mean by “altered perception of pain instead of specific muscle relaxation.” I also suffer compression fractures of my thoracic spine which were not diagnosed in time for kyphoplasty, developing scoleosis, a deformed throat, half of which is paralyzed….among other disabling injuries. I have tried every single treatment offered, suggested and/or advised (except for fusion of the thoracic fractures) including years of physical therapy for my body and excersizes to “stretch my mouth”. Please provide me with a list of all of the “non-addicting”relaxers that you mentioned above. I am willing to try anything that would benefit me and my family. Although I believe chemical dependence, drug abuse and addiction are not the same thing, I do know that anything that causes chemical dependency has the potential for abuse and addiction and I would prefer not to take that risk if possible. I am seriously considering the use of benzodiazepines again because it improved the quality of my life in such a way that I felt like I was no longer just surviving hour by hour but again living (to a certain extent) and although I know the risks and am vigilant, I am so saddened and worried, to say the least, that after so many years of trying so many medications, the one that finally offered me more that just “some” relief could, in the long term, ruin my life when I just want to make it better. I need to know, if I do decide to reincorporate this medication back into my regimen, what I can do to prevent addiction. I have spoken to my trusted doctor who believes that I am responsible enough to take this medication since it clearly helps me, I have spoken with every doctor with whom I’ve had the opportunity and I have researched as much as possible for myself and I am still unsure. I am, with all sincerity, not seeking permission, just any and all advice and/or referrals to information regarding this subject.

P.S. I was not just taking benzodiazepines for migraines alone although as previously stated they all but disappeared when I started using them and started up again when I discontinued using them.

Thank you in advance for your time in reading this and, hopefully, for your anticipated response. D

Jason Giles MD
1:08 pm February 23rd, 2011

Hello D,

Goodness you have been through a lot. It is a testament to your will and courage that you keep on keeping on. Bravo.

Obviously you have at least a half-dozen causes for severe headaches. I usually like to stay away from the term ‘migraine’ because it has been so overused as to be non-specific. In point of fact, traumatic brain injury or TBI is not a source of pain per se. Ironically brain tissue has no sensation itself. Now mind you the tough covering around the brain called the Dura has nerve endings that sense pain but the brain does not.

By far the more likely culprit is your neck. Extra-cranial sources of headache are the rule and intra-cranial pain generators are the exception. With your cervical (neck) fractures and the extensive displacement of the muscles in the neck to access the bones for screw and plate repair it is no wonder to me that you have headaches. Not sure this is all that helpful to you even if I am right and the headaches start at the top of your neck. A headache is a headache is a headache.

Regarding the BZDs for pain I think their mechanisms of action in you are 1) suppression of secondary anxiety around impending pain (chewing, being bumped) 2) suppression of “angry” cut nerves in your neck that make your head hurt (Valium decreases peripheral nerve transmission) and 3) a sense of input and control of at least part of your pain (people feel better when they are not helpless).

I agree with Dr. Burson that anti-inflammatory medications may be helpful but you have to keep an eye on your kidneys and liver if you’re going to use them on a chronic basis. She is totally bang-on in her suggestion of biofeedback and meditation. I have seen them work wonders.

As to your desire to resume BZDs there are two sides to the coin. What we did in the pain clinic where I did my fellowship was observe patient’s behavior with new or additional opiates, BZDs and other mind-altering drugs. If people were able to do more on the drug than off then we kept them on it. This is not just about how you feel but about how much more of your life you can live ON as opposed to OFF the medication.

Your jaw diagnoses sounds off to me. It is an answerable question with CT scan though you may have a lot of artifact on the scan results with the hardware in your neck. Check out the muscles of the neck called the omohyoid and the digastric. Both of them may be contributing to the neck pain.

Hang in there. Often times these things will just die down after a time.

Dr. G
Since

D
12:52 am February 26th, 2011

I will look into your suggestions. It has been 8 years now and I’ve never even heard of the omohyoid or dgastric muscles in the neck and will look into this as you can imagine muscle spasms around the hardware are horrible. Unfortunately, CT scans have not been of any use regarding diagnosing my jaw issues.

Thank you for your response Dr. G.

D

Donna
9:17 am July 13th, 2011

My son has been taking Xanax for either “migraines”, which his headaches were originally called by his neurologist, who did do an MRI on him but never told him what it said, or “cluster headaches”, which is N.P. said they actually sounded more like to her and put him on oxygen therapy, which he said didn’t help. He went to another neurologist’s P.A., who tried to start him on the same regimen his previous neurologist had him on, which had quit working. Then he went to another doctor who tried to send him to a pain clinic, where he would have loved to have gone but they wanted a lot of personal information about how he was supporting himself, which was hard to answer. Anyway, the Xanax appear to no longer be working. He’s tried getting into a headache clinic but hasn’t been able to. Would appreciate any advice. Thank you. DP

julia
12:29 am March 20th, 2012

You’ve built up a tolerance to Benzo’s. This can happen. Doc’s like to deny/pretend Benzo withdrawal doesn’t exist, but it most certainly does. I recently got off Klonopin, another Benzo. It can be unpleasant, but it’s doable.

Also, I’d suggest exercising (if you can) and eating well (no sugar/soda, eat as plain as possible, such as fruits and veggies) will help. Don’t drink, alcohol affects the brain similarly to Benzo’s. Avoid smoking as well(if you do).

Read the Ashton Manual. It will explain all your symptoms to you, and this will all make sense. Professor Ashton, the author of this manual, has years of experience dealing with Benzo’s, Z-Drugs (Ambien, Sonata, and Lunesta which are sleeping pills that act similarly to Benzo’s). Prof Ashton suggests Valium (which has a far longer half-life than Xanax, which has a short half-life) for tapering Benzo’s. It makes the taper easier and more bearable. It also prevents a likely “Protracted Withdrawal” syndrome. Read the manual, and if you need more help, don’t hesitate to ask.

julia
12:31 am March 20th, 2012

Also, Dr. Giles, if you’re trying to suggest that Benzo’s are not mentally/physically addictive, you are incorrect. They most certainly are.

Leave a Reply

About Dr. Jana Burson, MD

Jana Burson M.D. is board-certified in Internal medicine, and certified by the American Board of Addiction Medicine. After practicing primary care for many years, she became interested in the treatment of addiction. For the last six years, her practice has focused exclusively on Addiction Medicine. She has written a book about prescription pain pill addiction: "Pain Pill Addiction: Prescription for Hope." Also see Dr. Burson's blog here.