Table 2 Examples of Opioid Medications
Chemical name
Brand name
Hydrocodone Vicodin®
Oxycodone OxyContin®
Morphine Kadian®
Codeine Codeine®
*May be sold under more than one brand name.
Ask your doctor for more information.
Currently, the guidelines say drugs that mix opioids with pain
relievers may be used for migraine in some situations. More
recent research agrees with that recommendation. However,
some experts believe the risks of addiction and overdose,
outweigh the benefits of these drugs and avoid prescribing
them for safety reasons. Opioids can be useful when other
medications fail to work. However, they can lead to serious
problems if they are not used appropriately.
If your doctor prescribes an opioid for migraine, it is
important to remember that you should never take opioids
on a regular basis. Use them only as a “rescue” drug–after you
have taken another migraine medication which you are sure
has not relieved your attack.
Although new evidence may result in changes in some of
the recommendations in the “evidence-based” guidelines,
many will remain. For instance, the recommendation to use
prescription drugs for moderate or severe attacks is not likely
to change–newer studies confirm that they can be effective and
are generally safe for use in migraine.
For over-the-counter drugs (OTC), there may be some
changes. Published studies on the use of acetaminophen,
aspirin, ibuprofen, and the combination drug containing
aspirin, acetaminophen, and caffeine reported after publication
of the guidelines show their efficacy in migraine treatment.
Because some of these studies did not include data from
patients with the most severe attacks and some did not report
improvement in nausea or in helping patients return to work,
the recommendation to use them for mild or moderate attacks
will probably not change.
But are all these drugs similar? Not if you look closely at the
research. Based on a review of the research data, if ibuprofen
is more effective than aspirin or acetaminophen in treating
acute migraine, and the combination agent of acetaminophen,
aspirin, and caffeine (relieves pain better and faster than
20
HeadWise™
|
Volume 3, Issue 3 • 2013
Not sure what to think about caffeine? Don’t
worry; you’re not alone. When it comes to
migraine, caffeine is a sword that can cut
both ways.
Moderate caffeine intake produces no
increased risk to health, according to the
US Food and Drug Administration. For many
years, doctors have been using caffeinated
medications to treat patients with migraine.
For migraine patients, pain relievers with
caffeine work much better than those same
pain relievers without caffeine.
Too much caffeine can cause withdrawal
symptoms, such as headache, sleepiness,
and impaired concentration. To experience
these symptoms, most people need to
drink about 2 or more cups of coffee (or
a similar amount of caffeinated soda or
“energy” drinks) every day for at least 2
weeks. Since the combination agent with
acetaminophen, aspirin, and caffeine
should never be used more than once
per day or 2 times per week for migraine,
you cannot get enough caffeine to cause
withdrawal symptoms unless you misuse
it. But you can reduce the effectiveness of
the medication by consuming excessive
amounts in your diet. As far as the
combination agent causing “rebound
headache”—where medications end up
triggering headache rather than relieving
it—all medications used to treat migraine
put you at risk.
Since everyone is different, it is important
that you work with your physician and pay
attention to how caffeine affects you.