From the Guidelines
Morphine is not recommended for treating headaches or migraines due to its potential for dependence, tolerance, and addiction, as well as its ability to worsen headaches through medication overuse headache syndrome. For most headaches and migraines, first-line treatments include over-the-counter pain relievers like ibuprofen (400-600mg every 6 hours), acetaminophen (500-1000mg every 6 hours), or aspirin (650-1000mg), as well as specific migraine medications such as triptans (like sumatriptan 50-100mg) 1.
Some key points to consider when treating headaches or migraines include:
- The use of nonsteroidal anti-inflammatory drugs (NSAIDs) as a first-line treatment choice for all migraine attacks, including severe attacks that have responded to NSAIDs in the past 1.
- The effectiveness of triptans, such as naratriptan, rizatriptan, sumatriptan, and zolmitriptan, in the treatment of acute migraine 1.
- The potential for medication overuse headache syndrome with the frequent use of opioids, triptans, and other medications 1.
- The importance of developing an effective acute migraine management strategy and encouraging patients to identify and avoid triggers 1.
Overall, the goal of treatment should be to provide effective pain relief while minimizing the risk of adverse effects and medication overuse headache syndrome. It is essential to consult with a healthcare provider to determine the underlying cause of headaches or migraines and develop an appropriate treatment plan.
From the Research
Morphine for Headache or Migraine
- Morphine is not recommended for acute migraine treatment due to serious adverse events 2, 3, 4.
- The American Headache Society and other organizations recommend using triptans, nonsteroidal anti-inflammatory drugs (NSAIDs), and antiemetic drugs as first-line treatments for acute migraine 2, 3, 4.
- Injectable morphine and hydromorphone are best avoided as first-line therapy for acute migraine due to lack of evidence demonstrating efficacy and concern about sub-acute or long-term sequelae 4.
- Acute migraine treatment includes acetaminophen, NSAIDs, and combination products that include caffeine, as well as migraine-specific treatments like triptans and gepants 5.
- Combining triptans with NSAIDs has demonstrated better efficacy for acute migraine treatment, with the fixed combination of sumatriptan and naproxen sodium offering improved benefits over monotherapy 6.
Alternative Treatment Options
- Triptans, such as sumatriptan, are effective for acute migraine treatment but may have adverse effects like transient flushing, tightness, or tingling in the upper body 3, 5.
- NSAIDs, like ibuprofen and naproxen, are also effective for acute migraine treatment and can be used in combination with triptans 2, 3, 6.
- Gepants, like rimegepant and ubrogepant, are a new class of medications for acute migraine treatment that can eliminate headache symptoms but may have adverse effects like nausea and dry mouth 5.
- Lasmiditan, a 5-HT1F agonist, is also available for acute migraine treatment and appears safe in patients with cardiovascular risk factors 5.