Migraines & Opioids: “The Good Stuff”

By Wanda

You just want the pain to stop; it’s unbearable, as if your head is determined to kill you. Why can’t you just take a really powerful pain killer like Norco or another opioid? They are supposed to be so strong–great for killing pain. Is it too much to ask?!

If they work on broken bones, surely an opioid would kick your migraine to the curb. We know pain isn’t the only compound of a migraine, but it is the consistent one, and the one we want gone fastest.

The problem lies with how opioids work: they only mask the pain for a short period of time. According to The American Migraine Foundation, opioids are not at all recommended for migraine pain relief for a number of reasons.

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The situation I’ve found to be the worst in combination with a migraine is: narcotics cause nausea. I don’t know about you, but nausea is my weakness. Give me pain any day, just not the sea sick, can’t handle moving or smells feeling. Another draw back to opioids and migraines is something called a rebound headache.

Rebound headaches are also known as medication overuse headaches and are a horrible cause and effect round robin for migraine sufferers. People like us who have a preexisting headache disorder are prone to rebound headaches. If you take narcotics more than a couple times a week, a rebound headache is probably in your future. Here in lies the main problem for opioids and migraines.

If you have a migraine and treat it with a narcotic, chances are extremely high, according to the Mayo Clinic, that you will have a rebound headache. In this case, most people end up taking another opioid, which causes another rebound headache and it becomes almost impossible to figure out where the migraine starts and the rebound headache ends.

As a spoonie, someone who deals with chronic pain or illness, doctors may prescribe a narcotic like Norco for something other than migraines. This is where knowing your body well is key–knowing your body is essential to living with both chronic pain AND chronic migraines. IF you need the opioid for an injury, post procedure, or to end a “flair” of your pain symptoms, you have to be ready to balance out the narcotic use and the possibility of rebound headaches.

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Being a spoonie and living the “chronic life” is a hard path to travel, and chronic migraines complicate matters tremendously. You have to remember, not all pain killers are the same and they don’t work the same–Norco only masks the pain. You can’t take a triptan like Imitrex and expect it to work for a twisted ankle, nerve pain, or arthritis. In turn, you can’t take an opioid and expect it to work on migraine pain. Different pains involve different systems of your body and each require a different type of medication.

The National Institutes of Health (NIH) states the case against opioids for migraine pain in the simplest terms: “Opioids should not be used for the treatment of migraine.” Over a five year study, they found narcotics to be minimally effective and to have a number of adverse side effects and state they “are adverse, occur quickly, and can be permanent.” These include a decrease in the grey matter of the brain, reversal of migraine central sensitization, and interference with triptan effectiveness.

There are cases in which a doctor and patient might decide an opioid is the only way to end an intractable migraine. Migraine.Com says:

“While some physicians believe that all opioids are bad for Migraine, most doctors and advocates believe that they’re sometimes necessary, though they’re used sparingly. For those doctors who do utilize opiate pain control, pain contracts are often implemented.”

Just remember those side affects as well as the rebound headaches.

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In the end, opioid usage is all up to you and your migraine management team, but migraineurs especially need to keep opioids for other pain and depend on migraine-specialized medications for migraines. Chronic pain is a balancing act. Chronic migraine is rather like living a game of Russian Roulette. Reach out to your doctors, pain management team, and migraine specialist to find a plan that works for you.


Sources:
https://americanmigrainefoundation.org/understanding-migraine/opioid-narcotics-and-headache/
http://www.mayoclinic.org/diseases-conditions/rebound-headaches/basics/definition/con-20024096
https://www.ncbi.nlm.nih.gov/pubmed/22540203
https://migraine.com/blog/the-confusion-about-codeineopioids-and-migraine/
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