Opioids are highly controversial in the world of headache medicine. Beyond the obvious issues of dependence and addiction, there are risks specific to headache disorders. In this short video, two headache specialists address some of the issues, including:
- Taking opioids more than eight times a month puts a person at risk for rebound headache (also called medication overuse headache or MOH).
- Opioids can reduce the efficacy of other migraine medications, including abortives and preventives.
- Migraine is an inflammatory condition. Opioids may increase inflammation, counteracting any migraine relief they might provide.
- Opioids aren’t particularly effective for head pain to begin with. The receptors of the brain associated with head pain have few opioid receptors, so there’s not much for the opioids to work on.
This is a huge, controversial topic, but the more I learn about it, the more convinced I become that opioids should be of limited use in treating headache disorders. Opioids have a place, but that place is small and specific. They shouldn’t be a front line treatment, which they too frequently are.
3 thoughts on “Opioids (Narcotics) for Migraine & Headache Disorders: Two Specialists Weigh In”
I plan to take this article to my neurologist. Last month after a four day migraine with no relief, I ended up in he emergency room where I was given an IV cocktail that included dilaudid. Within 15 minutes after the medicine was injection in my IV I could already feel my migraine returning. I was also given a prescription to be filled for dilaudid and told I could take it for pain along with Imitrex. This article confirms what I experienced with this migraine treatment in that it did very little to treat the migraine.
Emergency rooms are unfortunately not well-equipped to treat migraine. Here are some great tips to make for easier ER visits: http://migraine.com/blog/tips-and-tricks-for-a-successful-emergency-department-visit/. And a patient-oriented review of the medications used in ERs: http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?productid=1716&pageaction=displayproduct.
In my opiniom, opioids are big cannons, causing major blasts. Most migraine sufferers are far better off with a sniper aiming at, and hitting, the personal and specific cause of migraine in a specific patient. That way, there’s no collateral damage and better, lasting results, but you *need* the sniper to be an expert in using homeopathic precision tools.