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Migraine is a very common type of headache, which can cause a lot of distress. Migraine attacks can last for hours – or even days. They can cause intense pain, nausea and vomiting. They can make you sensitive to light or noise and they can affect your life and work.
Medicines specifically for migraines, and non-prescription painkillers, are the most effective migraine treatments. However, many patients with migraine continue to be offered strong painkillers, called opioids, to treat migraines. Examples of opioid painkillers available in New Zealand include codeine, tramadol, morphine, oxycodone, fentanyl and pethidine.
There are three main problems with using opioids for migraine:
Using opioids for migraine can cause more headaches and chronic migraines than you had to begin with. This is called “medication overuse headache”. It is possible with all pain medications, but is more likely with opioids.
There are other medicines that can reduce the number of migraines you have, and how severe they are, better than opioids. This includes medicines called triptans, which work directly on the blood vessels in your head to relieve the pain from migraine.
Opioids are strong medications, which may cause you harm, including dependence and addiction. Opioids can cause serious withdrawal symptoms if you stop taking them suddenly. People who use high doses for a long time may need to be in the hospital in order to stop using them.
Opioids, even at low doses, can make you feel sleepy or dizzy. Other side effects include constipation and nausea. Using them for a long time can lower your sex drive and cause depression and sleep problems.
The type of medication you need depends on many things, including how frequent and severe your migraines are. Your doctor will advise you on the best treatment, based on your symptoms and experience.
A usual approach is:
All of these options work best if you use them when the migraine is just beginning.
Anti-sickness medicines may also be used to relieve nausea associated with migraine. Examples include metoclopramide, domperidone and prochlorperazine.
If you have migraines often, or if they are very severe, ask your doctor about other medicines to prevent headaches.
If you have certain medical conditions, such as some heart diseases or you are pregnant, you may not be able to take the migraine-specific medicine. Talk to your doctor if this applies to you.
In some people, the migraine-specific medicines don’t work. Opioid painkillers may be a short-term “rescue” option for these people. In this situation, you should not take opioids more than 9 days per month. At the same time, you and your doctor should continue to focus on other strategies to help you prevent and manage your migraines. Long-term follow-up is needed to make sure you do not develop complications from taking opioids.
Some migraines can be managed without medication. Talk to your doctor about how to:
For more information about migraines visit HealthNavigator.org.nz.
It’s OK to ask questions
If you have questions about your symptoms or the medicines managing your symptoms, speak with your health professional.
Developed by Choosing Wisely New Zealand, 2018. Adapted from Choosing Wisely Canada (2015), Treating migraine headaches: some drugs should rarely be used, and Health Navigator (2017), Migraine (severe headache). Choosing Wisely does not assume any responsibility or liability arising from any error or omission or from the use of any information in these resources.
This article is part of our content on Choosing Wisely, a campaign encouraging a change in thinking by health professionals and consumers to avoid unnecessary medical intervention.
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