Opioids for Migraines - Why Not?

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An issue with any medication we take when we get a Migraine attack is the possibility of medication overuse headache (MOH), aka rebound. Essentially, MOH occurs when we take these medications too frequently and they actually complicate the situation by creating medication overuse headache.

One of the biggest frustrations to those of us with frequent Migraines or headaches is that pretty much anything we take when we get a headache or Migraine can cause MOH...

  • ergotamine medications such as DHE-45 and Migranal Nasal Spray.
  • triptans - Imitrex, Maxalt, Zomig, Amerge, Relpax, Axert, and Frova -- as well as Treximet, which is a combination of Imitrex and Naproxen Sodium.
  • simple analgesics such as acetaminophen
  • opioids such as codeine, morphine, Demerol, Dilaudid, etc.
  • barbiturates such as the butalbital in Fiorinal and Fioricet
  • a combination of any of the above.

Some sources say the usage of some of these medications must be limited to 15 days a month; the use of some must be limited to 10 days a month. The rule of thumb still followed by many is to not take these medications more than two or three days a week. You can read more in Medication Overuse Headache: When the Remedy Backfires.

Probably the biggest frustration is for those who have Migraines or headaches more than those two or three days a week. We still need to function, even if we've already used those medications as many times as we're supposed to in any given week. We have lives, jobs, families who need our attention. We're trying to maintain a decent quality of life, but how are we supposed to do that if we're in pain.

The answer to this dilemma isn't simple or easy. It lies in Migraine and headache management:

  • Identifying our triggers so we can avoid them if at all possible, thus reducing how many Migraines we have.
  • Working with our doctors to find effective preventive regimens that reduce not only the frequency of our Migraines or headaches, but the severity as well.

That answer can be a very bitter pill to swallow (pun fully intended). The bottom line, however, is that this is what's best for our health. In the short-term, it seems almost punishing. In the long-term, however, when we can push ourselves to look at it objectively, it makes sense. If, while we're trying to find that seemingly elusive preventive regimen that works for us, we overuse medications, use opioids that can increase our risk of transformed Migraine, and get our bodies messed up from those medications we take for Migraine attacks, it will take far longer to find an effective preventive regimen, AND we can do some damage to our brains and other organs in the process. Let's remember that when we're looking at the medications we take when we get a Migraine (prescription or over-the-counter), we're looking at some medications that can cause liver or kidney damage too.

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