Which medications in the drug class Opioid Analgesics are used in the treatment of Migraine Headache?

Updated: Oct 21, 2019
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

Opioid Analgesics

Patients who not respond to routine abortive treatment may require additional analgesics. Practice guidelines recommend nonopioid medications as first-line therapy. Opioid analgesics should be used sparingly, but they remain an option. [4] Opioids should not be used long-term, because they are habit-forming. Also, they can contribute to rebound headaches. A review of opioid equivalents and conversions may be found in the following reference article:  http://emedicine.medscape.com/article/2138678-overview

Oxycodone (OxyContin, Roxicodone, Oxecta, Oxaydo, Xtampza ER)

Oxycodone is an opioid analgesic with multiple actions similar to those of morphine. However, it may produce less constipation, smooth muscle spasm, and depression of cough reflex than similar analgesic doses of morphine. It can be used as adjunctive therapy when patients do not respond to abortive treatment for migraines. It is habit-forming and should not be used long-term.

Morphine (Arymo ER, Astramorph, Depodur, MS Contin, Duramorph, Avinza, Infumorph, Kadian, MorphaBond)

Morphine is the drug of choice for narcotic analgesia because of its reliable and predictable effects, safety profile, and ease of reversibility with naloxone. Morphine sulfate administered intravenously may be dosed in a number of ways and is commonly titrated until the desired effect is obtained. However, the use of morphine for aborting migraine should be very limited; it can be tried as adjunctive therapy when patients do not respond to first-line abortive treatment for migraines. It is habit-forming and should not be used long-term. Arymo ER is a morphine sulfate abuse-deterrent formulation.

Meperidine (Demerol)

Meperidine is an analgesic with multiple actions similar to those of morphine. However, it may produce less constipation, smooth muscle spasm, and depression of cough reflex than similar analgesic doses of morphine.

Hydromorphone (Dilaudid, Dilaudid-HP, Exalgo)

Hydromorphone is a potent semisynthetic opiate agonist similar in structure to morphine. It is approximately 7-8 times as potent as morphine on a milligram-to-milligram basis, with a shorter or similar duration of action. It can be used as adjunctive therapy when patients do not respond to abortive treatment for migraines. It is habit-forming and should not be used long-term.


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