Many people living with migraine are impacted by our country’s opioid crisis.
Opioids can be an effective as-needed treatment option for people experiencing severe migraine attacks, says Dr. David Watson, a neurologist and director of the Headache Center at the West Virginia University School of Medicine. However, these medications can also be addictive and render other migraine treatments less effective.
“For too long, physicians were too free with prescribing opioids. Too many people with migraine were placed on opioids as a primary treatment for their pain,” says Dr. Watson. “And now we have a problem with addiction and dependence, and it’s more challenging to treat headache because of that.”
In addition, with the spotlight on the national opioid crisis, some patients with migraine who could benefit from these treatments cannot access them due to stricter regulations. “We have people who are probably good candidates for being on opioids who can’t get them because the climate has become so toxic against them that doctors are now afraid to prescribe them,” Dr. Watson says. Below, Dr. Watson expands on opioids as treatment for migraine attacks, and whether they are an effective option for some patients.
Are Opioids a Beneficial Treatment Option for Migraine?
Whether or not you are a good candidate for opioids depends on many factors, including your history of addiction.
In some cases, opioids can make patients less responsive to other treatments. “Even if they don’t have the psychological components of addiction or physical dependence, they now have a more difficult headache disorder to treat because of their exposure,” he says.
In addition, Dr. Watson sees patients who have benefited from opioids in terms of pain reduction, but at the cost of their day-to-day function. “I try to have a conversation with patients to determine how much opioids are actually helping them. I tell people all of the time, ‘I can make your pain go away, but you may not get off the couch, and that doesn’t do you any good.’ It’s important when we think about treating migraine disorders that not only are we treating a number on a pain scale, but we’re treating people’s function level. We’re getting them back into society, back to work, back into social activities.”
Access to Opioids
When taken every couple of months for a particularly severe migraine attack, opioids may be an effective treatment option for some patients; however, these patients might also struggle with obtaining a prescription from a health care provider.
“I think it is a good thing in the long run that we prescribe fewer opioids for patients in general,” Dr. Watson says. “But we have to make sure that we don’t penalize the people who are the appropriate candidates for them by making it completely inaccessible.”
Because of the risks associated with opioids, Dr. Watson advises patients considering this medication to speak with their health care provider about trying other possible treatment options first. “Use trial and error, because we have enough options out there that for most people, we can find good options that improve not only their pain levels, but also their quality of life,” he says.
Patients who are unsure of other current and available treatment options should consult a headache specialist in their area. New treatment options are on the horizon, and a headache specialist can help develop a custom treatment plan for you based on your frequency and intensity of migraine attacks.
Trust Between Patient and Doctor
Dr. Watson says he prescribes opioids very infrequently, but may recommend them if a patient has a medical condition that prevents him or her from taking a migraine-specific medication. In cases of severe migraine attacks, he will rarely prescribe opioids as a “rescue” medication.
“When I’m trying to make a decision about whether it’s the right thing to do, the first thing is that I have to know the patient,” Dr. Watson says. “I’m not going to put somebody on [opioids] the first time I see them, the second time, or even the third.” Trust between the patient and doctor is crucial when prescribing opioids. “If prescribing medications that have significant downsides, I need to trust them and know that they understand the risk and the concerns.”
For more information on seeking medical help for your migraine, current and available migraine medications, how to determine the best treatment plan for you and more, visit our doctor-verified resource library.
Reviewed for accuracy by the American Migraine Foundation’s subject matter experts, headache specialists and medical advisers with deep knowledge and training in headache medicine. Click here to read about our editorial board members.