Dr prescribed my 14 yo tramadol for headaches - this normal?

[BayesianBlues]

We live abroad so wondering if this would happen in the UK.
14 yo daughter has been suffering from headaches for a month or so. Not totally debilitating like migraines but not nice and quite frequent. She usually would take paracetamol which takes the edge off enough that she can function. Sometimes ibuprofen. Probably every other day on average she's been getting through maybe 4 paracetamols and a couple of ibuprofen if needed.

So the doctor said that this amount of paracetamol is not good for the liver and the ibuprofen isn't good for the stomach and that DD should take tramadol for her headaches. She's prescribed us 10 50mg tabs to take home.

I was a bit shocked that she jumped straight to tramadol. And I wouldn't have thought 4 paracetamol and a couple of ibuprofen every other day is that terrible?

I'm not a dr but it's a VERY different medical culture here (very very quick to prescribe meds and had to push back against the over use of antibiotics) so I'm wondering if this would be considered normal in the UK if anyone has any experience?

@Scrunchies

We have an acute pain service at my hospital, which is run by consultant anaesthetists and pain specialist nurses. Quick Google suggests that this is not rare, for example:

www.bfwh.nhs.uk/our-services/acute-pain-service/
www.bfwh.nhs.uk/our-services/acute-pain-service/the-team/

The true test of if someone is a doctor would be to have a look at their handwriting .

@Hobnobsandbroomstick

I've only seen tramadol used for post operative pain or severe chronic pain in my experience as a nurse. I've never heard of it being prescribed purely for headaches, and prescribing an opioid for a 14 year old seems wrong.

If the headaches are that frequent then they need investigating rather than masked with strong pain relief. Has she had her eyes tested? Does she drink enough water? How much caffeine does she drink? Is she stressed about something? Is she getting enough sleep?

Also Google "medication overuse headaches".

Tramadol was prescribed to my son when he had 4 wisdom teeth out and they were huge teeth. He was thrown loads of painkillers and warned to take them continuously so as not to let the pain take hold, every 3 hours for 48 hours.

Try a can of coke for the migraine, sip it as quick as she is able.

For some reason it can arrest the migraines progress...this as advised by a hospital consultant, it works.

In wouldn't be giving my 14 year old tramadol for headaches that she is managing with paracetamol/ibuprofen.

@Scrunchies I'm another anaesthetist.

You totally can specialise in acute pain. I have three colleagues who cover the in hours service at work. The rest of us cover it on call only!

My first thought is that you get medication withdrawal headaches. I"d try to get her push through with no analgesia (sorry) and see what happens. Migraine trust have some useful advice.

Other option if they think the headaches are migraneous would be to start some kind of preventative medication.

I, personally suffer from Migraine. They aren't currently troublesome but when they have been in the past a neurology colleague pointed me to the guidance that 900mg of dispersible Aspirin (it's a HUGE dose) taken early can often stop one in it's track.

Worked a treat for me (apart from the day I got the beginnings of one at work, could only get 75mg Aspirin from the onsite pharmacy - I paid!) and had to take 12 tablets. Felt like a major junkie!

OP, we’re in the Middle East and there’s a similar culture of over-prescribing. We have two massive boxes of unopened medications in our house.

That, coupled with the fact that not all drs here are well qualified (not all countries have consistently high-quality medical education) and financial incentives means that we’ve had to do a lot of ‘shopping around’ to find drs we like. I always prefer to look for drs who have worked in the NHS - not necessarily British drs - because they’re a lot less likely to overprescribe, in my experience. We’ve quite often gone for second opinions too.

My 5yo DS is terrified of drs now following some really shitty experiences when he was little and don’t even get me started on how I was treated during his birth. A British dr told me it’s like the Wild West out here.

As far as I know, children can be particularly vulnerable to the physical addition bit of opiate use. I would not let her take any of these. This is ridiculous. Also using opiates in general for headache isn’t recommended as it can cause painkiller overuse headache.
Just no.

I’m a chronic pain and migraine sufferer. At one point I was getting a migraine almost every day. After a lot of consultations with my GP, a neurologist and a headache specialist we realised that it was Tramadol that was causing my headaches. I was taking a slow release tablet twice a day so they weaned me off it. I can’t take any opiates now, even the tiniest bit of codiene guarantees me being in bed for a couple of days with a severe migraine.

I was, also, taking paracetamol 4 times a day, every day. I reduced that down too, because on the days I didn’t have a migraine I still had a headache. They thought it was probably due to medication over use.

I take a magnesium supplement, now, which has really helped my headaches but I don’t know if children can have that. Acupuncture works well too.

I had Tramadol prescribed once post-surgery. I managed 2 days and then had to stop. It totally messed with my mind, I hated it. I can not even begin to imagine what it will do to a young mind. Personally, I would not let a child take Tramadol. Do you have any Holistic Doctors where you live? Finding the cause of the headaches is the priority.
Did the doctor take a full health history for possible causes? Stupid question maybe but your daughter drink enough fluids. I get terrible headaches if I get dehydrated.

I get tramadol for kidney pain but only when it's really severe & co codamol isn't working. Going straight to it for a 14 year seems strange

[quote Scrunchies]@Cyclingforcake are you a Dr in the UK? I really don’t know anyone who would describe themselves as being ‘in anaesthetics and acute pain’. One would normally say they were an anaesthetist, and you can’t specialise in ‘acute pain’ in the uk….

Your posts just don’t read like you really are a Dr unless you’re a nurse practitioner?

But to be frank it really is no skin off my nose/ I dont really care so crack on [/quote]
Anaesthetists specialising in acute pain really isn’t new or uncommon. (DOI: anaesthetist… who does not specialise in acute pain).

@Lilifer

Is Tramadol the one with codeine in it?

Not being funny but why didn't you question the doctor about this at the time??

I know right ???

I’ve been a GP for 25 years and I’ve never prescribed tramadol to a child.

I was on tramadol constantly for 18 months. It took me another 4 to ween myself off of it and I will never take it again. Its an awful drug. I wouldn't give it to my teen unless there were extreme circumstances, there are a few lower strength painkillers between paracetamol and tramadol.

If you can get esomeprazole (BNFC approves paediatric usage) OTC where you are it might be worth doing - and prescribing a PPI is what the doctor should have done if concerned about stomach damage (& possibly a stronger NSAID with it if really REALLY really felt stronger analgesia needed, plus a clear plan for how/when to step things up & down; a headache diary; lifestyle recommendations…)

If paracetamol is used within the appropriate dose parameters (& you do need to keep track of the doses particularly carefully if you’re using it on a long-term basis) it is a very safe & effective drug. If the doctor is concerned about hepatotoxicity, tramadol is a rather odd choice - as with paracetamol, overdose causes liver damage to the point it can be liver failure that kills rather than a more direct/instant result of overdose.

I hope your DD’s able to get some answers soon.

When you say 4 paracetamol a day, do you mean 4x 500mg as per UK dosing? I'm just wondering if e.g. they're sold as 1000mg tablets where you are or something that might mean she was maxing out?

Because 4x 500mg plus some ibuprofen wouldn't be a risk of liver damage at all I don't think: paracetamol is fairly regularly prescribed at the maximum dose for months on end as the base for treating we.g. chronic arthritic pain.

Is your daughter stressed? I had a headache which lasted 6 months during a particularly stressful period of my life. Wasn't great but did go away eventually.

Tramadol seems extreme but if paracetamol is only taking the edge off then obviously paracetamol and ibuprofen isn't adequate. If headaches are bad enough to warrant a trip to the doctor you can be shocked that decent painkillers have been prescribed.

Weird that codeine wasn't trialled first though and I also wouldn't have queried the doctors advice in the moment I think...

There are lots of preventive meds for daily headaches to try, like propranolol candesarten some epilepsy meds.
Not going for strong pain lilkers
Also triptans to try
She needs specialist headache doctor usually a neurologist

I had Tramadol for a torn hamstring, so it seems a little OTT for headaches.
Sorry if you have already said has she seen an optician?

From the Web
What are the medicines that prevent migraines?
Anticonvulsants (antiseizure medicines), including valproate (such as Depakene)
Antidepressants, including amitriptyline.
Beta-blockers, including propranolol (such as Inderal)
Calcium channel blockers, including verapamil (such as Calan)
Botulinum toxin, such as Botox.

My goodness! No! Tramadol is addictive and very strong. A boy I knew as a teenager used to take it for fun because it knocked him out so much. Definitely not appropriate for casual use for something like headaches.

DD isn't having migraines. The headaches aren't as bad as that. This is the thing - the concern is the frequency over a prolonged period rather than the severity. They're bothersome and worrying as we don't know the cause but not totally debilitating. Which is all the more reason why tramadol seems ott. Its not like dd is crying in pain with these headaches.
Shes generally been feeling quite low and tired, not herself at all, so I wanted the dr to take bloods to rule out anemia or an infection (which she did do).
Next step optician (although she had a check up 6 months ago) and massage i think. Plus dr wants her to see an endocrinologist.

Dd is nowhere near the daily limits. The para tabs are 500mg. Ibuprofren is 800 so double the UK but she takes it if the para isn't working as well, one or sometimes two tabs. So on her worst day she's not even hitting the maximum.

The tramadol will stay in the drawer...

Have you looked into headaches caused by taking painkillers all the time?
www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/medication-overuse-headache/

I've only ever had tramadol in my possession twice, and both times it was provided by a vet for a cat or dog who'd had surgery.

my child has headache issues and we were referred to a neurologist to investigate further - this may be appropriate for you. Tramadol is fairly hard core and I have only had it post a major surgery and suffered hallucinations from it ( which I found out later from the nurse can happen). I would get a second opinion if you can.