Pain Relievers (Opioid)
Opioid pain relievers are narcotics, and because they can cause physical dependence and have many side effects, they are used with great caution in migraine treatment. They are only prescribed to rescue those patients who experience moderate to severe migraines, and usually only after other migraine medications have been used without success. It's important to note that there are currently no opioid drugs that are FDA-approved specifically for migraine relief. Most have general pain-relief indications, but many have been used in clinical trials and as an “off label” migraine therapy by physicians.
Opioids that may be prescribed for migraine treatment include butorphanol (Stadol), oxycodone (Oxycontin), morphine (Avinza, Kadian, MS Contin, MSIR, Oramorph, Rescudose, Roxanol), meperidine (Demerol), fentanyl (Actiq), levorphanol (Levo-Dromoran), propoxyphene (Darvon), and methadone (Diskets, Dolophine, Methadose). These drugs are available in either oral, suppository, injectable (i.e., intravenously or subcutaneously), or transdermal (i.e., skin patch) formulations. Butorphanol tartrate is available in a generic nasal spray form for faster pain relief. Codeine, the mildest opioid analgesic, is usually used in combination with acetaminophen or other nonopioid analgesics (Tylenol #3).
What is “off-label” drug use?
When a doctor prescribes a drug for a use that has not been approved by the U.S. Food and Drug Administration in the drug's official labeling, it is called “off-label” use, which may be appropriate when it is backed by published medical literature or recommended by medical organizations or other government health agencies.
To prevent drug dependence and rebound headache, opioid analgesics should be used no more frequently than two days a week. Overuse of opioids causes a patient to become physically dependent on the drug, and increasingly tolerant of doses, which have to be raised to achieve similar efficacy. When opioid use is stopped abruptly in someone who has become dependant on the drug, not only do headaches recur with increased severity but also symptoms of withdrawal can occur, including sweating, abdominal pain and nausea, vomiting, sweating, and diarrhea.
Because of their potential for physical dependence, opioids are usually reserved as rescue, or abortive, migraine therapies. This means that they are a second-line treatment that is used only when nonopioid therapies are ineffective and migraine pain is severe. If your migraines don't respond to preventative therapies because they are infrequent and unpredictable, and they are moderately severe to severe in pain intensity, your physician may prescribe these drugs as a backup to nonopioid analgesics.
Side effects associated with opioids include nausea, vomiting, forgetfulness, confusion, fatigue, constipation, and itching. They are sedatives, so should never be used before driving or operating machinery. Opioids should not be taken with alcohol, and they must be used with caution in people with reduced liver or kidney function. Because opioids depress respiration (decrease breathing rate), they are not a good treatment choice for anyone suffering from lung problems such as chronic bronchial asthma, emphysema, or chronic obstructive pulmonary disease (COPD).
