Opioid Narcotics and Headache

If you break your arm or have your appendix taken out, opioids (narcotics) can be great. They cover up pain, and when pain is expected to be short-lived (like an arm healing), they are very useful.

What about when the pain is part of a recurring problem like migraine headaches? Just like you wouldn’t use the narcotic as a replacement for treating the broken arm, you would not want to use a narcotic as a replacement for treating a migraine. As we all know, migraine is more than just a pain in the head—there is also nausea, light sensitivity, and often a host of other symptoms present in migraine. So, ideally, we want to treat the whole migraine syndrome, rather than just the pain. Treat the migraine and the pain goes away along with everything else.

But what about using narcotics for the pain part only? Is that effective? It turns out that opioids are not even a good choice for the pain portion of a migraine. For some people, it may cover up the pain for a short period, but there are many drawbacks to using them in migraine. For example: opioids can cause nausea—not a good thing when you have a headache. But more importantly, when an opioid wears off, you are MORE sensitive to pain. Your pain threshold is actually lowered by the narcotics through a process called narcotic-induced hypersensitivity. Studies have shown that this effect can occur after only a single, high-dose of opioids. Add to that the fact that your body will make more receptors for narcotics each time you take them (resulting in dependency). This creates a recipe for disaster—you hurt more and you need more narcotic to get relief. This is the proverbial slippery slope.

Fortunately, we have a variety of non-narcotic rescue strategies for the pain and other symptoms of migraine, many of which are discussed here on the ACHE website (add link: http://www.achenet.org/resources/patient_handouts/). So steer clear of the opioid narcotics and don’t let well-intentioned (but ill-informed) healthcare professionals lead you into the narcotic quagmire!

Robert P. Cowan, MD, Founding Medical Director, Stanford Headache Program, Stanford University School of Medicine, Palo Alto, CA.