Opioids are highly controversial in the world of headache medicine. Beyond the obvious issues of dependence and addiction, there are risks specific to headache disorders. In this short video, two headache specialists address some of the issues, including:
- Taking opioids more than eight times a month puts a person at risk for rebound headache (also called medication overuse headache or MOH).
- Opioids can reduce the efficacy of other migraine medications, including abortives and preventives.
- Migraine is an inflammatory condition. Opioids may increase inflammation, counteracting any migraine relief they might provide.
- Opioids aren’t particularly effective for head pain to begin with. The receptors of the brain associated with head pain have few opioid receptors, so there’s not much for the opioids to work on.
This is a huge, controversial topic, but the more I learn about it, the more convinced I become that opioids should be of limited use in treating headache disorders. Opioids have a place, but that place is small and specific. They shouldn’t be a front line treatment, which they too frequently are.