I started getting a non-stop headache right in the middle of my senior year of high school. I saw a neurologist pretty quickly and we started trying different medications. He also gave me a prescription for a dozen or so Vicodin, telling me to take it only if I absolutely had to. Over the next six months I only took one and the though of using it more frequently was far from my mind (even though my headache was getting worse).
Then I started college and the headache and the accompanying migraines became unbearable. I started to depend on the Vicodin because it was the only thing that made me feel well enough to get to class and be able to leave my dorm room. My neurologist wasn't happy with the situation but he decided that, if it was the only thing keeping me going, then I could continue with it for a while, until we found something better. So I ended up taking a lot of Vicodin. Later we tried methadone and tramadol and I kept on taking a lot of pain meds for about two and a half years.
Then I started going to a headache clinic and they didn't allow narcotic painkillers to be used. So, despite being pretty unhappy about it, I slowly withdrew and didn't take any narcotic/opioid/barbiturate painkillers for almost three years. At that point we had exhausted every treatment option that the headache center (and several other specialists) offered and I started taking painkillers again to help with my vastly declined quality of life.
After trying a bunch of medications, we settled on Oxycontin. For about two years I took 40mg of Oxycontin three times a day and usually an additional two 15mg instant release oxycodones. That regimen made the pain significantly easier to deal with but I eventually realized that it wasn't helping me move forward in my life and be more functional. So I talked with my neurologist and asked if we could try a detox. She agreed and I did the hospital detox and I stayed off Oxycontin for around a month (and, by the way, I'd recommend a slow at home detox over a hospital detox but that's just my preference). It was a grueling month and I decided, along with my doctor, that I'd do better still taking pain meds, but taking a significantly decreased dosage. So, now, compared to the 140mg/day total that I was taking in the past, I'm taking 60-70mg/day. And I think it's a good balance.
So, that's essentially my history with painkillers. Let me share some thoughts I have about your situation.
First, and mainly, you said, "I'm afraid that detox won't solve a 55 year history of migraine." I would counter that fear by asking if you really feel like being on Fioricet for the last 22 years has solved your migraines or whether it's really helped more than it harmed overall.
Second, I understand your fear about telling your doctor that you've been using more than you've been prescribed. After all, trust is an important aspect in a doctor/patient relationship, especially when painkillers are involved. But you're going to have to be honest here, especially because you hope to do what sounds like the right thing for you and try to switch to a less potent medication. Continuing to keep secrets now will make it that much easier to keep secrets in the future and potentially endanger the progress you're trying to make. And if that means that your doctor feels like you have to be monitored more closely in the future then that's probably what's best for you anyway. Also, it's very important that you doctor and the staff at the hospital how much Fioricet you've been taking to safely and successfully get you through the detox.
To paraphrase what a pain specialist that I've known for years once told me: Painkillers can only be used successfully and safely if you acknowledge that they're going to help only a certain amount. If you start to try to get the medication to help you more than that amount then you start running into trouble and the treatment fails.
It is quite possible to downgrade the painkillers that you take. But you need to recognize that you may be in more pain (or probably will be in more pain) and accept that sacrifice. If you don't feel like you're doing the righ tthing for you then it's going to be a lot harder.
I wish you the best of luck,
DX: NDPH (2003-present), CRPS (1998-?) Abdominal Migraine (2010-present)
RX: Lamictal, Indomethacin, Propranolol, Provigil, Viibyrd, Oxycontin, Clonazepam, Zyprexa, Melatonin, Magnesium, Boswellia Serrata extract (Boswellic acid)
CPAP for mild sleep apnea
I'm a patient at the Thomas Jefferson University Hospital Headache Center in Philadelphia, PA.