From the Guidelines
Naltrexone for migraine treatment is typically prescribed at a low dose of 4.5 mg daily, known as low-dose naltrexone (LDN). This is significantly lower than the standard 50 mg dose used for addiction treatment. Patients usually take LDN at bedtime, and the treatment may require several weeks to months to achieve maximum benefit. Some physicians may start at an even lower dose of 1.5-3 mg and gradually increase to 4.5 mg to minimize side effects. LDN works differently from traditional migraine medications by modulating the immune system and reducing neuroinflammation rather than directly blocking pain pathways. It may be particularly useful for patients with chronic migraines who haven't responded well to first-line treatments or who cannot tolerate their side effects. Common side effects are generally mild and include vivid dreams, sleep disturbances, and headaches, which typically resolve within the first week or two of treatment. Patients should be aware that LDN is often prescribed off-label for migraine, meaning this use isn't specifically FDA-approved, though many headache specialists have found it beneficial in clinical practice 1.
Key Considerations
- The dose of naltrexone for migraine treatment should be initiated at a low dose and gradually increased until desired outcomes are achieved 1.
- The use of a headache diary may help to determine treatment efficacy, identify analgesic overuse, and follow up on migraine progression 1.
- Certain behavioral interventions, such as cognitive behavioral therapy, relaxation training, or mindfulness-based treatment alone or combined with other components, may decrease the frequency of migraine headaches 1.
- Prescribe less costly recommended medications 1.
Treatment Approach
- Initiate pharmacologic treatment for the prevention of migraine at a low dose and gradually increase the dose until desired outcomes are achieved 1.
- Switch pharmacologic treatment for the prevention of episodic migraine headache if an adequate response is not achieved during a reasonable trial period (generally 2 to 3 months), or earlier if an adverse event occurs 1.
- Consider reevaluating the balance of benefits, harms, and costs of preventive treatment with the patient 1.
From the Research
Naltrexone Dose for Migraine Treatment
- The recommended dose of naltrexone for migraine treatment is not widely established, but some studies provide insight into its usage.
- A case study 2 investigated the efficacy of low-dose naltrexone (LDN) in reducing the frequency and severity of chronic migraine headaches, with a therapeutic intervention of low-dose naltrexone titrated to 4.5 mg nightly.
- Another study 3 used naltrexone in patients with gastrointestinal disorders, with doses ranging from 2.5 mg daily to 4.5 mg daily, depending on the condition being treated.
- However, it is essential to note that naltrexone is not a primary treatment for migraines, and other medications like NSAIDs, triptans, and antiemetic drugs are commonly used for acute migraine treatment 4.
- Other studies 5, 6 focused on the use of naratriptan and almotriptan for migraine treatment, but did not provide information on naltrexone dosing.
- Based on the available evidence, the dose of 4.5 mg nightly 2 may be considered for migraine treatment, but further research is needed to establish a standardized dosage.