Migraine research and opioids
“We’ve been very concerned about the use of opioids broadly as a society,” Lipton says. “To a surprising degree, opioids are used for migraine.”
Recent studies have shown that of people with migraine who take acute prescription medications, more than a third keep opioids on hand to relieve their attacks. “It turns out men are more likely than women to get opioids, people who are obese are more likely to get opioids than people who are thin, and people who go to the emergency room for migraine are more likely to get opioids than people who don’t use the emergency room.”
However, opioids are a problematic treatment. “There’s good evidence from longitudinal studies that the more frequently you take opioids to relieve your migraine, the more likely you are to progress,” Lipton says. “There’s also evidence that treating with opioids makes other acute migraine medicines less effective. The high rates of opioid use among people with migraine is a problem that we need to work on solving.”
Lipton says that opioids make the nervous system more active and sensitized so that stimuli becomes painful where it ordinarily wouldn’t be. “And when that happens, the drugs that we normally use to treat migraine become less effective.” Not only are opioids less effective than migraine-relieving medications, he says, “their frequent use makes headaches come more often. And the third problem is that they may make other generally more effective acute medications less [so.]”
When opioids are appropriate
Narcotics should be the last solution for migraine, says Lipton. “In people who can’t tolerate or don’t respond to what are first-line options, opioids are occasionally useful.”
But instead, he says providers should coach migraine patients on managing symptoms so they don’t need to go to the emergency room, where opioids are more frequently prescribed.
“In many ways, I regard needing to go to an emergency room for migraine as a failure to plan or a medical failure. When that happens, I think long and hard about how to prevent future emergency visits. And really, the reasons are when you have a migraine, you’re sensitive to light, you’re sensitive to sound, you’re sensitive to odors,” he says.
