Opioids Should Not Be Used in Migraine

Keywords: opioid, migraine, narcotic, acute treatment, chronic migraine, nociception

Stewart J. Tepper MD

Opioids should not be used for the treatment of migraine. This brief review explores why not. Alternative acute and preventive agents should always be explored.

Opioids do not work well clinically in migraine. No randomized controlled study shows pain-free results with opioids in the treatment of migraine. Saper and colleagues’ 5-year study showed minimal effectiveness, with many contract violations, interfering with the therapeutic alliance.

The physiologic consequences of opioid use are adverse, occur quickly, and can be permanent. Decreased gray matter, release of calcitonin gene-related peptide, dynorphin, and pro-inflammatory peptides, and activation of excitatory glutamate receptors are all associated with opioid exposure. Opioids are pro-nociceptive, prevent reversal of migraine central sensitization, and interfere with triptan effectiveness.

Opioids precipitate bad clinical outcomes, especially transformation to daily headache. They cause disease progression, comorbidity, and excessive health care consumption. Use of opioids in migraine is pennywise and pound foolish. Article first published online: 27 APR 2012 DOI: 10.1111/j.1526-4610.2012.02140.x

Here at AZ TMJ, we also believe that the use of narcotics/opioids for migraine treatment comes with more risks and side effects, than benefits. We focus on conservative treatment options like trigger points to find the root cause of your headache. Dr. Stan Farrell is a member of the American Headache Society and has extensive training in the treatment of all types of headaches. If you have been prescribed or are currently taking narcotics for the treatment of your migraine headaches, you owe it to yourself to come and see Dr. Farrell; there may be a more conservative alternative available. Call and schedule an appointment at 480-945-3629. www.headpaininstitute.com