From the Guidelines
Opioids are generally not recommended as first-line treatment for migraines due to their potential for dependence, tolerance, and medication overuse headache. When other treatments fail, butorphanol nasal spray (Stadol) is considered one of the more effective opioid options for acute migraine relief, typically dosed at 1 mg (1 spray in one nostril), which can be repeated in 60-90 minutes if needed, with a maximum of 4 doses per day 1. Other opioids sometimes used include hydrocodone (5-10 mg orally every 4-6 hours as needed) or oxycodone (5-10 mg orally every 4-6 hours as needed), but these carry higher risks of dependence. Opioids should be limited to no more than 9 days per month to prevent medication overuse headache. These medications work by binding to opioid receptors in the brain, reducing pain perception and providing relief. However, patients should be aware that regular use can lead to decreased effectiveness over time, physical dependence, and potentially worsen migraine patterns. Non-opioid treatments like triptans, NSAIDs, anti-nausea medications, and preventive therapies should be tried first under the guidance of a healthcare provider specializing in headache medicine. Some key points to consider when using opioids for migraines include:
- Butorphanol nasal spray is a more effective opioid option for acute migraine relief compared to other opioids 1
- Opioids should be limited to no more than 9 days per month to prevent medication overuse headache
- Non-opioid treatments should be tried first under the guidance of a healthcare provider specializing in headache medicine
- Patients should be aware of the potential risks of opioid use, including dependence, tolerance, and medication overuse headache.
From the Research
Opioids for Migraine Treatment
- There is no evidence to suggest that opioids are effective for treating migraines 2, 3, 4, 5, 6.
- In fact, several studies suggest that opioids should be avoided in migraine patients due to concerns about misuse, abuse, and dependence 3, 4, 5, 6.
- The use of opioids for migraine treatment is associated with more severe headache-related disability, symptomology, and comorbidities, as well as greater health-care resource utilization 3.
- Alternative treatments, such as triptans, NSAIDs, and anti-emetics, are recommended as first-line therapies for acute migraine attacks 2, 5, 6.
- Metoclopramide has been suggested as a non-opioid alternative for aborting acute migraines, with a 10 mg dose considered "highly likely to be effective" by the American Headache Society 5.
Recommended Treatments
- Triptans, such as sumatriptan, are considered effective for acute migraine attacks 6.
- NSAIDs, such as ibuprofen and naproxen, are also recommended as first-line therapies for mild to moderate migraine attacks 2, 6.
- Anti-emetics, such as prochlorperazine, can be used to alleviate nausea and vomiting associated with migraine attacks 6.
- Acetaminophen is suitable for mild to moderate migraine attacks and remains the first choice for children and pregnant women 6.