Why You Should Avoid Opioids for Migraine Treatment

Why Using Opioids may Create More Problems than Just Your Migraine

Why Opiods are not a Good Idea for Your Headaches
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Opioids alleviate pain by both reducing pain signaling among nerves and by reducing the release of pain-related neurotransmitters, or chemicals, in the brain. The problem with opioids is that they often create more problems than simply treating your migraines.

Let's examine 5 reasons why you should avoid using opioids to treat your migraines, if possible.

Side Effects

The side effects of opioids can sometimes be more distressing than the health condition the opioid is being used for, which is quite a paradox.

Possible side effects include:

  • Sedation
  • Respiratory depression or a lowered rate of breathing
  • Euphoria
  • Cough suppression
  • Sleep disturbance
  • Nausea and vomiting
  • Low heart rate and blood pressure
  • Constipation
  • Itching

Other potential side effects include sexual dysfunction, mind fogginess, mood disturbances like anxiety or depression, problems with motivation, abdominal cramps, and dry mouth.

Medication Overuse Headache

Opioid use can lead to the development of a disorder called medication overuse headache. This disorder is caused by overuse of acute pain-relieving medications for 10 to 15 days per month for at least 3 months. A medication overuse headache, also known as a rebound headache or drug-induced headache, usually resolves after the over-utilization of medication stops.

Transformation to Chronic Migraine

Opioids can trigger the transformation from acute to chronic migraine -- a migraine that occurs for at least 15 days a month for at least 3 months.

This means that your migraines will occur more often and make them more difficult to manage.

Tolerance and Dependence

If a person takes opioids chronically for their headaches, they are at risk for developing tolerance, which can develop just after 2 weeks of continued opioid use. Tolerance means that a person needs to take more of a medication to achieve the same effect or pain relief in this case.

Eventually, tolerance may lead to dependence, meaning a person needs opioids to function and develops withdrawal symptoms if not taking them.

Opioid withdrawal usually begins about 6 to 12 hours after stopping opioids and last about 2 to 3 days -- but this is overall variable and depends on the person, dosage, and type of opioid. Opioid withdrawal can be serious so please inform your doctor if you are experiencing symptoms. Symptoms of opioid withdrawal may include:

  • runny nose
  • tearing of the eyes
  • generalized pain
  • vomiting
  • diarrhea
  • anxiety

Opioid Use Disorder

If you use opioids for your headache disorder regularly, you are at risk of developing opioid use disorder. According to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, there are several features of the opioid use disorder -- of which at least two must be met within a 12 month period. These features must impair a person's ability to function in their everyday life.

A couple examples of these features include a person who craves opioids, is unsuccessful in trying to cut back on their use of opioids, spending a lot of time recovering from the effects of opioids, and giving up on important activities or not meeting obligations due to opioid use.

This is a debilitating disorder and can be difficult to treat and overcome.

Who is a Candidate for Opioid Headache Therapy?

This all being said, there are some people who may need opioids, especially those who suffer from refractory migraines, or migraines that are resistant to medications, like triptans or nonsteroidal anti-inflammatories (NSAIDs). Other candidates may be people who have medical contraindications to traditional headache medications.These patients should be well known to their doctor and have no history of psychiatric illness, drug-seeking behavior, or addictive disease.

Intense monitoring is usually required by the physician including a written contract and regular appointments. A doctor may also advise urine drug screens and/or counseling to prevent addiction.

Sources

Headache Classification Committee of the International Headache Society. (2013). "The International Classification of Headache Disorders: 3rd Edition (beta version)". Cephalalgia, 33(9):629-808.

Levin, M. (2014). Opiods in headache. Headache, Jan;54(1):12-21.

DISCLAIMER: The information in this site is for educational purposes only. It should not be used as a substitute for personal care by a licensed physician. Please see your doctor for diagnosis and treatment of any concerning symptoms or medical condition.

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