Opioids migraine

Opioids and derivatives (e.g., meperidine, butorphanol, oxycodone, hydromorphone) provide effective relief of intractable migraine but should be reserved for patients with moderate to severe infrequent headaches in whom conventional therapies are contraindicated or as rescue medication after failure to respond to conventional therapies. Opioid therapy should be closely supervised. 

Pethidine and morphine, used as opioid analgesics, may cause dependence following repeated administration. Zolmitriptan, a 5HT, agonist used in the treatment of acute migraine attacks, is not associated with dependence. 

Serotonin syndrome (sibutramine) The rare, but serious, constellation of symptoms also has been reported with the concomitant use of selective serotonin reuptake inhibitors and agents for migraine therapy (eg, sumatriptan, dihydroergotamine), certain opioids (eg, dextromethorphan, meperidine, pentazocine, fentanyl), lithium, or tryptophan. Because sibutramine inhibits serotonin reuptake, it should not be administered with other serotonergic agents. 

Flupirtine is both a nonspecific antagonist NMDA and an agonist of opioid receptors. This analgesic is prescribed for migraine. Neuroprotector effects in neurodegenerative diseases (Alzheimer and prion diseases) are being investigatived. ... 

Unlabeled Uses Diagnosis of pheochromocytoma, opioid withdrawal, prevention of migraine headaches, treatment of diarrhea in diabetes mellitus, menopausal flushing... 

Pain research is a traditional and well established field within the pharmaceutical industry. Beginning with the isolation of morphine in a small pharmacy by Adam Serturner (1806), the next major breakthrough in pain treatment was achieved by the synthesis of acetylsalicylic acid by Felix Hoffmann in the Bayer Laboratories in Wuppertal (1897). Further outstanding contributions by the pharmaceutical industry were the first fully synthetic opioids pethidine (1939) and methadone (1946). Continued efforts up to now have resulted in many potent and clinically accepted analgesics with reasonable side effects and covering nearly all facets of pain treatment. However, pain treatment is far from being satisfactory in respect to more complex pain states, e.g. neuropathy, visceral pain or migraine. 

Many theories have been proposed to explain migraine pathogenesis. Alterations in neurotransmitter systems (e.g., glutamate, nitric oxide, opioids), anatomical structures (e.g., the raphe system, vasculature), and the autonomic nervous system may be either primary or secondary factors in the evolution of a migraine attack. 

Opioids, NSAIDs, acetaminophen, and COX-2 inhibitors (all discussed in previous chapters) are the most commonly used pain relievers, but they do not relieve all types of pain. Neuropathic pain (also called neuropathy) and migraine headaches are for the most part unaffected by these pain relievers, so different medications are used to treat these conditions. 

Patients with migraine who use daily codeine or other opioids can be more susceptible to chronic daily headaches this is evident in opiate overuse. In a pilot questionnaire study of 32 patients who used codeine or other opioids for control of their bowel motility after colectomy, chronic daily headaches occurred in those who were misusing opioids, but only if they had pre-existing migraine (3). The study had significant limitations, including the small sample size, diagnosis by means of a mailed questionnaire, a short duration of overuse of opioids, and the fact that it was uncontrolled. 

Bringing about symptomatic relief from the pain associated with migraines and other migraine symptoms is achieved by prescribing antiemetics (antinausea, see Chapter 18), ergot alkaloids and related compounds, NS AIDS (see Chapter 12), and other analgesic (nonopioids) opioids, and triptans (see chart). 

An opioid analgesic should be given only if ergot alkaloids or selective serotonin receptor agonist medications (migraine-specific medications) are not effective in treating the pain. 

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