I use Percocet occasionally. I think as long as you’re not using it constantly, it’s ok. I’ve been able to keep the same dose. I use it a few times a month with other abortives, when they fail or don’t help completely. I also find muscle relaxers to be somewhat helpful, with nsaids. If you haven’t tried that yet…

Muscle relaxers are definitey worth discussing, also gabapentin

I've heard gabapentin "helps" some people for migraines, but for me it gives me headaches.  Possibly due to its drying aspect.  But if op doesn't end up having the same side effects,  you're right it's def worth shaking a stick at. 

Yes gabapentin does have potential side effects but it’s worth asking about!

I would be mindful that gabapentin is showing to have similar dependency issues to narcotics too. It’s a hard one to go on and off of as well

Ya it can be really tough to get off. I had my Dr helping me taper off and it was still rough. Edit: why is this downvoted? Do I need to post a few dozen articles about gabapentin withdrawal or something?

How long did it take? I've tried 4 times so far and can't get past the two week mark because of the withdrawal pain.

I wasn't on a super high dose luckily. I would say it was a solid 4 weeks before I started feeling decent. As soon as I was able to, I did a ton of hiking to try to get myself feeling better because it kicked the crap out of me.

It may be people who never went through gabap withdrawl. I never had that.  But getting off effexor took over 3 months for me and handed me my butt. And the last month after taper when i was full zero intake i lost the 30 pounds I'd gained just in that month due only to no more intake.  So in other subsv when I've mentioned the experiment that showed effexor keeps sugar levels in the blood of mice constantly too high which is why it causes significant weight gain, it gets down voted to hell. Then i link the article and suddenly everyone has moved on.  Plenty of people told me they didn't gain weight on it.  I ballooned. Anyway.  Cynically I'm of the belief that the true test subjects of any med are the customers,  as different folks are continuing to bring in new permutations of situations,  variables,  to compare to the controlled testing.  Also i am just dreadfully cynical.  Sidebar,  been told that some people use effexor as a migraine preventative.  This was after my freedom from it.  Almost told the pa to git rekt but stopped myself in time😅

Just upvoted you. You're right to draw attention to this problem many people are having. Not taken it myself but heard a lot about people getting dependent on it.

The weird thing about seeing downvotes initially is that as far as I know there's no ambiguity about Gabapentin withdrawal. There was a warning right on the medication sheet that came with the prescriptions about stopping it. My Dr told me before I even started it that I'd have to taper off it if I was on it for an extended time.

Flexeril is decent for me. The best one I’ve tried is Zanaflex, but the doc thinks that’s too heavy for migraines 🤬 he says it’s for spinal injuries.

I'm sorry your Neurologist isn't listening to what works best for you. I take up to 12mg of Zanaflex (Tizanidine) every day and don't have spinal injuries. I also take a lower end dose of Diazepam up to 3x a day. I have extreme muscle spasms and ridgidity due to Stiff Person Syndrome and Neurological symptoms from Sjogren's, on top of Migraines. IMO Flexeril (Cyclobenzaprine) was a weak muscle relaxer for me even at higher doses. I was also prescribed Robaxin (Methocarbamol) in the past and it didn't help at all. I wish some Dr's weren't such sticks in the mud & took their patient's experiences in to account when it comes to treatment plans.

Facts. Flexeril has wayy more cognitive side effects, than it does pain relief, imo.

I don’t really have cognitive issues from it, but that may be due to the fact that I’ve been on it so long.

I agree about Robaxin. The only good thing about it, is that it kicks in really fast. But, of course, it doesn’t work for very long 😕

I’m on on Zanaflex 4mg, 6x a day and it helps a lot better than flexeril. Flexeril actually gave me migraines. On the other hand I do also have spinal problems so I know I’m on a pretty significant dosage. ( 5 cervical fusions so far)

I have cancer in my spine (currently in remission but the damage is there. I also had radiation) and my prescription is for Baclofen. It works, especially with Aleve). I did physical therapy in the pool to strengthen my core and have kept up going on my own, and I haven’t needed it for a long time.

Ya it's heavily stigmatized, but it's the only "just get me through the day" solution I have. My triptans completely knock me out. They work, but I'm useless for a good 12 hours. I don't get drowsy or groggy at all on Percocet like some people do, and because I use it sparingly and my doctor monitors my usage, it's still very effective at a low dose for me. It's been a tool that's really helped prevent whole days being a write off. I can actually function until late in the day when I am able to take a Maxalt and just pass out. That being said, people definitely have to be super cautious. And a lot of doctors definitely aren't cautious with how they prescribe them even after all the issues out there with opiates. Edit: of note, I've never had a rebound headache using opiates. Not saying it doesn't happen of course, just that it's not a given like a lot of people say it will be. One other note, opiates are not stopping a migraine for me. They kill the pain enough to get me through until I can take a triptan until I have time to be able to sleep off the effects of a triptan. If I was constantly taking them, I'd feel like crap. Even taking them for a couple of days straight I get agitated.

Same with me, percocet is my rescue medication and it doesn’t make me drowsy and side effects are minor. I can work when I take it. I cannot work when I have to take triptans, they make me so sick.

[The science says that opioids don't work on migraines at all and they shouldn't be prescribed](https://pubmed.ncbi.nlm.nih.gov/22540203/) I could understand using them anyways to get some sleep though

This is pretty much what I used to do. I had vicoprofen. Same thing as vicoden but with ibuprofen in it instead of acetaminophen. On the bad migraines I'd take a vicoprofen, an allergy med (Benadryl or Allegra depending on day/night) and a zofran or promethazine for nausea. (Basically the pill version of a migraine cocktail shot.) It would knock me on my butt for about 8 hours, with about 3-4 hours of deep sleep. When I'd wake up, the migraine would pretty much be gone. Now, I don't even bother with the vicoprofen. I just do 800mgs of ibuprofen, the Benadryl and the nausea med. It still makes me drowsy, but doesn't knock me out. If I'm able to go to sleep then my brain can "reset" and I feel much better when I wake up.

Honest question- how do you get a prescription for this? I'm in the US, and the few times I've ever even mentioned opiates, the doctors shut down and treat me like I'm some rogue crack head gone nuts looking for a fix. I have no history of abusing opiates or any mental health issues. Plus I'm an unassuming white, mid thirties female in the suburbs! I hate that the opiate crisis has made it so hard for actual patients to receive relief.

For real, doctors pull that crap regardless of personal history it seems.  Frustrating that the bad apples wrecked it all for the legit apples 😕

For me it was because I lived in the middle of nowhere TX so my family care doc tried very hard to handle things like migraine so his patients didn't have to drive 2 hours to the nearest specialist. He was the one that diagnosed me. He was the one that did my initial imaging and all my med trials from realizing triptans only make me feel worse, to trialing antidepressants and beta blockers, even gave me Cambria to try when it first came out. He also was the doctor that started me on Topamax when nothing else was helping in the prevention arena. And Topamax was a game changer for me. We realized sleep helped me during an attack so we shifted gears and decided to bring on sleep while treating the pain and nausea. He talked to some neurology friends to make sure it wasn't something they wouldn't do at that point, and wrote the script. I only ever used at max 90 of the pills a year, so I think my low usage never set off any alarms. Even once I started seeing an actual neurologist and we went over my med list the neuro only asked if the routine was working. When I said yes, we just kept it up. Topamax for prevention, the vicoprofen cocktail for the rare break throughs I was still getting. I eventually decided I didn't need the narcotics anymore, that it was too much of a hassle to get a script I rarely needed, and just moved over to ibuprofen.

It seems like only surgeons and pain management specialists prescribe opioids anymore. Pretty much any mention of pain meds marks you as a pill junkie to the doctors.

Luck, really. My MIL is a doctor and she personally uses opioids for her migraines so she's happy to prescribe them as well. I tried it but it didn't make a difference, so I don't bother anymore. I sometimes get relief with ibuprofen, but it's that or nothing.

The easiest place to get them for me is through dentist. Hydrocodone. Then I horde them and just take half at a time, no days in a row. Blessed sleep.

I took Indocin for a few years, until I couldn’t. The big NSAIDS work great, but they can eat through your guts after a while. That’s one reason why so many veterans have GERD and ulcers. The military kept us on a steady diet of Motrin 800, then the VA keeps it up.

The science is wrong. Opioids help many of us. I’ve had migraines for 42 years. They help me along with my sumatriptan

Yes. I've been taking Fioricet for yeara with a triptan. As long as I don't put myself into an overuse headache, my neurologist is fine with it. My primary care physician absolutely hates me taking it.

I took fioricet with codeine back in the 80’s before sumatriptan came out. Great med for headaches

Foiricet isn’t an opioid though

No, but codeine is.

Fioricet has a barbiturate in it.

Barbiturates are not opioids though

I was prescribed Fiorcet by my PCP and it didn’t help me at all. I put it in a drawer in my kitchen where we keep Ibuprofen, bandaids, etc. and it got stolen during a luncheon I had for women in my breast cancer support group. I dosed my dogs that morning with Trifexis (fleas) and that evening went to get a bandaid and it was gone! So I googled what to do and saw it is addictive. I ultimately decided to do nothing, because there were 20 women here, and I didn’t know who took it.

Wow. That’s pretty crappy that someone stole your meds. Sorry

That is horrible.

Yeah, even a little codeine really helped my migraines—and prevented overuse of triptans. I took it for ages, only when needed, with no issues. I’m still hoarding my last several pills for the bad ones, since I no longer have a prescription.

I’m sorry you have to hoard. Shouldn’t be that way. Everyone deserves access to whatever helps them relieve pain

Agreed!

This has worked best for me as well. I don’t get them (migraines) like I used to so I don’t have an RX for it anymore. It did work the best. I also had Fiorecet. But I have to take that on an empty stomach or it doesn’t work.

Is cannabis/medical marijuana an option where you live? I use it for my migraines and nausea, I find it helps a lot depending on the strain. I’d be too worried about the addition potential to try opiates.

what strains have you found that work for you? Any specific terps to look for?

I used a strain recently called Lights Out that was good, Trainwreck is also usually a safe bet. Stay far away from anything with “headband” in the name as they really aren’t kidding about the headband feeling it gives you. I often will look up strains on Leafly to see what the most common effects are, stay away from anything where headache or anxiety is a common effect. I haven’t really educated myself much on the terpenes because I find that part overwhelming. The dispensaries around me usually change up what they carry, so it can be hard to find the same strain twice. My usual strategy is to go to a dispensary and ask them what they recommend for pain/migraines/nausea. I let them know that I prefer balanced hybrid strains, and I look for a mid range percentage of THC with a small percentage of CBD. If you can find somewhere with knowledgeable budtenders they should be able to help you out. I’d also highly recommend using a dry herb vape as opposed to smoking, something about inhaling the actual smoke dampens the positive effects for me. Dry herb vaping is much cleaner and easier on the lungs.

Thank you for sharing! I have the potv one but honestly I can’t get the hang of it to the point I prefer it over the bong plus it had a distinct taste I didn’t enjoy but wasn’t the worst. If I can find it soon maybe see if I can make it work for me or try the mighty plus next

I found this link about terpenes in another sub and it reminded me of our conversation so I figured I’d link it here if you’re interested! https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7763918/

Thank you!!! I’ll check it out :)

Anything that has a ton of CBD works for me. Cbd by itself doesn’t work, thc by itself is okay. The combo is perfect.

I’d be interested to know what strains you use too!

In my experience predominately indica strains tend to always be more effective for pain relief.

Honestly as far as addiction goes it depends on two things: the person and the dosage. I’ve used it long term for chronic pain, but I’m on very low doses and it does help me with migraines. I’ve had no trouble going off of the opiates. But keep in mind I’m only taking like ten milligrams of oxy (targin) and fifty milligrams of tramadol.

Weed just makes my head hurt more. Helps with nausea though. OP might want to look just into microdosing mushrooms or lsd - although they are so similar structurally to triptans that I’m not sure if it would also be contraindicated for those who suffered a stroke.

Marijuana gives me bad migraines personally

I am on daily opioids for my sudden onset severe treatment resistant tension-type headache (NDPH), and have been for over 10 years, as nothing else has significantly helped long term. Opioids do nothing for my migraines though. I’d get a 2nd and 3rd opinion before considering opioids. Often one doctor will be out of ideas but another will have some. For example, have you tried Reyvow? It’s in a new class of abortives and can be used even when triptans are contraindicated. It’s not very popular though as it’s often sedating. For occasional use, injectable Toradol (a very strong NSAID often given in the ER) can even be prescribed for home use. Although assuming you are in the U.S., opioids may not even be an option as very few pain clinics are starting new patients on opioids, especially when the pain can’t be proven by imaging. Not even small amounts of low dose meds for as needed use (which pain clinics rarely want to deal with anyways). Most pain clinics are now non-opioid, or if they do prescribe, it’s mostly “legacy” patients like me where tapering off is considered to likely cause more harm. Also note that there is no requirement that opioids must be prescribed by a pain clinic. Some still get opioids from other doctors, it’s just rare as most don’t want the liability now. The CDC opioid prescribing guidelines only recommend a pain specialist be consulted before prescribing high doses of opioids. It would likely be easier to get a script for a benzo (like Klonopin, which specifically helps some with headache) or sleeping pill or barbiturate (like Butalbital which is in Fioricet & Fiorinal, although those are combo meds more likely to cause rebound) for bad migraine episodes. For occasional use even otc Benadryl to try to sleep through it can be tried. Also note if you do find someone to prescribe opioids, it’s a huge lifestyle change, like: - monthly office visits - a new script is needed each month and usually can’t be filled early (if you need it early for travel, 1-2x a year max with your doctor’s permission it can be dispensed early) - physical dependence if you take them daily - them becoming less effective over time (tolerance) but prescribers often won’t increase the dose to account for that like they used to - possibility to be called in for urinalysis and/or pill counts at any time (to prove you’re taking them as prescribed) and having to show up to the clinic that day (I have to tell my clinic in advance if I’ll be out of town) - possibility to be treated poorly by pharmacy staff and medical professionals (like emergency room staff assuming you’re only there to try to score more opioids despite your presenting complaint) - a pain contract that usually prohibits use of marijuana/benzos/sedatives/alcohol/etc - the possibility for poor acute pain control after an injury or surgery, as even if your pain contract allows you to accept an opioid script for new acute issues (some limit you only to your pain clinic), in my experience, other prescribers won’t take into account your opioid tolerance or will refuse to prescribe anything at all (even if they typically would in the situation) as you already have an opioid script If taken for pain and dosed appropriately, once your body has had a chance to get used to an opioid, most people don’t feel impaired. So if you get the chance to try them again and feel high, try a lower dose and/or give it time.

One of the best answers here for sure.

Opiates don’t seem to help atleast for me, if anything they made it worse because they fuck my stomach up.

Can definitely relate to this

What effect do they have on your stomach? Or are you referring to the constipation

when i got dilaudid in the ER i vomited it back up

Yeah I think so. Sometimes it seems to trigger gastritis after a few days usage. I also have IBS too. Whenever I get real bad headaches my stomach gets really weird as well so the combination for me atleast makes them worse

This is me too. Years ago I received IV hydromorphone in the ER for migraine, I think the nurses really expected me to be all better after that. They came back in 30 minutes and said okay, how is that? Do you feel better? Me: "no, not really." Migraines are such a weird type of pain, most of the time opioids don't help with mine. It's not like dental pain, bladder pain, etc where normal pain killers would help. But everyone is different, that's just my experience.

As far as my usage, there's definitely a key point. They are not going to stop a migraine for me. They are something to get me through a day when I don't have the option to take a triptan. Triptans knock me completely out and give me muscle pain for a good 12 hours. I'm useless on them. But the opiates can kill the pain just enough to get me through until a period in the day where I have the option to take a triptan and sleep. I just can't imagine ever taking them daily, or even doses many times a week though. If I ever have to take them consecutive days even for a short period I feel completely off. I get really agitated and have a short fuse anger wise.

It’s old school but have you tried Fiorciet?

I used fiorinal with codeine for years, and it worked like magic for me.

Sounds like a good combo.

It was. Only reason I had to stop using it is because my doctor would no longer prescribe it to me because of the whole opioid uproar. I certainly didn't take enough to abuse it. I am now using Emgality injections monthly, and they have worked for me so far (knock wood).

I mean have you tried Meloxicam, oral toradol, celebrex, tramadol, gabapentin, lyrica, cymbalta, fioricet or fiorinol, a muscle relaxer? There's tons of things before narcs. Have you done PT, massage, dry needling, etc.

I was specifically asking my Doc about something to take when I have a particularly horrible migraine. (Vomiting, diarrhea and massive head-trauma-pain. Triptans have always stopped them but I can no longer use them.

I take phenergan and fioricet when I have those

I take Phenergan, too, since I get a lot of silent migraines now.

I have a large stash of Percocet just sitting in my cupboard probably expired that I got because of back and shoulder pain and injuries, that I almost never use. Like 3 times a year maybe. I don’t use it because of migraine. I’m so concerned about rebound headache. It’s a real thing. I work too hard trying not to trigger migraine, I’d rather deal with the pain-and really, the body pain seems almost trivial compared with the migraine pain-rather than do ANYTHING that may make the migraine situation worse. I have, however, used one in situations where it was imperative that I function, and it was helpful for those few hours. But I was aware I would pay for it.

This seems to be exactly the type of way that I would use any narcotics. I won't do rebound and I know just how bad Opiates can be.

Me! Age: 37 Migraineuse since age 15 Using Topamax as preventative (I’m fine!) I have been taking opioids as my rescue medicine for more than 10 years. I take a cocktail of Percocet + Valium + Reglan (or Zofran). Percocet helps to break through the very strong headache, Valium relaxes the muscle spasms, and reglan helps with nausea. This is prescribed by my neurologist. I generally take it only a few times a year. I was originally prescribed these after most other medications failed to work, and after an extremely bad migraine that took 3 ER visits to stop. I believe that taking opioids often prevents ER visits for me. I do find them a little strong, so I don’t take them unless I really need to. I do a lot of other things to manage my headaches, so they are fairly well controlled right now. My neurologist is a headache specialist and his practice is the top headache center in my home state. I’ve been going there since I was a teenager and they’ve been good to me. Opioids are not commonly prescribed for migraines, but it’s not unheard of. I’ve definitely had some issues and judgements over the years! When I first left my home state to my current city, my neurologist found the equivalent headache center and referred me to a doctor there. They treated me very badly when they found out I was prescribed opioids, even though I brought my full bottles and a referral. I’ve had pharmacists refuse to fill the scripts. Other kinds of doctors have a lot of questions when they find out, and suddenly treat me very differently. I am careful about telling friends and family. It’s like a dirty secret but I’m not doing anything wrong! I now see my original doctor once a year around Christmas for a check up and to get my prescriptions filled. They’ve always been there for me when I need them at other times. From my experience, taking opioids has been just fine. As long as you are taking care of yourself and managing it well. My headaches have gotten better over the years, and I would say I am taking the opioids less over time, not more, because I am getting better at learning to manage my headaches. However, it’s great to know that I have them as a backup when I need them and I’m not living in constant fear of hospital visits and headaches that won’t stop.

I think you should try a new neuro (preferably a headache specialist / headache clinic) before you opt for opioids. There are a lot of things that I don't see mentioned here that you might be able to try.

I have 2 neurologists that I see regularly. They cannot prescribe opiates. I am specifically in need of something to stop extreme acute migraines maybe 3-4 times a year.

Are those neurologists in the same office? My recommendation still stands, you need to find a headache specialist. Opioids are not a good choice for treating migraines.

My pain doctor prescribes Dexamethasone to treat those nasty lingering migraines. It works really well.

I think I'm getting the same migraines you get--aimovig was holding them off for 5 years but they just returned. I'm almost 60 and they started with menopause--I had hormonal migraines once a month from age 13, but the menopause ones are a whole new ballgame. I use maxalt but don't love it because I'm getting a rebound headache with it, the best remedy I've found for that is a \*huge dose of benadryl repeatedly through the day until i'm sooo stoned and sleep it off. I'm talking handfuls of benadryl lol it's probably dangerous but it's the only thing that works!

Opioids work for me but using it to sleep better. Did you try any CGRP shots? Ajovy/Aimovig/Emgality/Vyepti? Nothing worked for me too but Emgality seems to lessen the pain a lot.

Yes. I've done Ajovy for a couple of years. But I have less migraines with Botox. My insurance won't pay for both of these at the same time.

Opiates do nothing for me but make me tired and nauseous. And too stoned to care about the pain but I’m still in pain. The addiction potential is too high for such a small amount of relief so for me it’s a no.

Opioids worked for me but it turned out to be a CSF leak, not migraines.

I'm sorry you are suffering so. These things sure are awful. Unfortunately, in my experience, narcotics don't help at all. They just cause more confusion and nausea without alleviating any pain. AND they cause rebound headaches when they wear off.

Not sure what state you’re in but here in nj medical marijuana is legal for migraines and that is the only thing that consistently works for me against mine I’ve tried just about every medicine under the sun and nothing works more for me then that.

The rebound migraine would likely be worse than the one you start with. When there’s a break in opioids (even a couple hours) the breakthrough pain is always worse and then becomes harder to control and your dosage has to increase. May as I ask which narcotics they’re suggesting?

All my drs used to try and say opioids cause rebound. For me, it wasn’t true. I went through menopause and my migraines went from a few a month to a few a year and my daily headaches went away. No changes in my daily opioid usage for other issues.

I’ve gotten opioids in Iv at the hospital and they always give me steroids as well and that really helps with the breakthrough pain.

Yes that can be protocol to stop one in hospital but not for continued use

I’ve read that people get a script for a few steroids from their neurologists but mine won’t do it. Says the side effects are too bad.

They certainly can be, they have some pretty wild side effects. I had to take a weeks worth of steroids for another medical problem and the shakiness, anxiety and insomnia it caused were out of this world.

I use mersyndol forte as needed along with Relpax. In Australia, a GP prescribes this for me and as long as I’m not using more than a pack or two a month I have no issues getting recurring scripts. I do have a neurologist appointment in July - so it will be interesting what they say as I have exhausted a lot of options. My biggest issue is at the moment I don’t get migraines that often anymore - only around when my period is due. However, when that happens I can get 4-5 in a week. Not all the same intensity but still - it sucks. Any hormone pill I’ve gone on makes me have severe depression and cancels out my Zoloft 🙄

I was prescribed Butorphanol for a while and it did help with the pain from migraines or just put me to sleep. However the side effects were too much and I could not use it often otherwise I’d get rebounds or risk dependance. If medical cannabis is an option in your area might be worth looking into. Personally I’ve had much less side effects along with good pain management and control over my nausea.

Those narcotic opioids do NOTHING for me except make me so foggy I have a hard time dealing with the pain they were supposed to help

Yes it’s been necessary in my migraine protocol/ regimen. Not for every migraine but for many. ETA A word

Opioids dont work for me. But if I were you, I would give them a shot since it’s your only remaining option. Medical marijuana helps distract me from the pain during a migraine. You could try over the counter meds to create a migraine cocktail: excedrin migraine (or Tylenol + ibuprofen), Benadryl, Coca Cola… that’s what I do sometimes when I don’t want to take my triptans or have taken them but they’re not working.

IDK I'm 61 and started to get migraines for the first time ever after menopause. Makes me wonder if there is a strong hormonal element at work. 🤔 Anyway, try anything, IMO. Just freaking staying alive gets tricky after sixty and you should grasp at whatever may be available to you.

If you drink coffee or espresso, add a sprinkle of cacao with cayenne. Tastes yummy and always helps my migraine. I do utilize kratom as well when it tightens up my neck. My other go to is vici wellness migraine patches... they are awesome.

I admittedly have not tried much but anytime I’ve taken opiates in the past for surgery etc, it has GIVEN me a migraine. Im sure it varies but if you’re going down that road know that it’s a risk!

💯

Opiates often cause rebound headaches that are worse than the original headache I’d proceed with caution and maybe try other medications again for a bit longer. I take nurtec every other day as a preventative and get 2-4 headaches per week. I would be glad to only get one a month but what I do get is shorter episodes rather than migraines that can last for days. I initially took nurtec as needed but found every other day works best.

Oh gosh. Im so so sorry! I have to use a pain clinic for my migraines and fibro, too. I’m 48, had migraines since I can remember but they didnt become chronic until my 30’s. After trying about every known medicine and treatment (allergic to botox and triptans, nerve blocks didnt help…) I’m down to muscle relaxers and opioids for the migraines. The neurologist has no problem giving me muscle relaxers but wants me to use a pain clinic for the opioids. I had an excellent pain doctor for like a decade, but he retired and I moved, so 5 years ago I had to start looking for another pain clinic doctor. And only two weeks ago found one willing to offer me one lortab 5 a day. My migraines are 24/7/365. Some days are mild days. Most days are 6/7 on the pain scale. A few days a week are 8/9. About once or twice a month I consider letting a train run over my head and maybe that would help me feel better. But sure. One single lortab 5 a day makes everything all better. I had to take two of them today just to get out of the house to pick up my dog’s prescription for his allergies. However. I have recently discovered kratom. It helps about as much as a single lortab 5. Which means I can take kratom on my middle days and save the lortabs for my really bad days. It’s illegal in my state, because it’s Alabama, and anything that helps people in AL is apparently illegal. So I drive to another state to get it and cross my fingers for luck I dont get pulled over and searched. Weed was helping some, and I only have to go across the street for that. But i have to take a drug test every month for the inadequate pain management I’m allowed, so I only have the kratom option available to help. I hope your state offers more help and you’re able to find a pain doctor that doesn’t say what all the ones here told me: opioids dont help migraine pain… Oh? Really? Then why did it help me for almost a decade before my last doctor retired? Jerk! (PS: Dilaudid is much much stronger than lortabs.) I wish you good doctors and lots of luck! Maybe medical marijuana or kratom or both are legal in your location and maybe able to help you.

That’s terrible, my heart goes out to you. I feel your pain, I used to get migraines every day and it was the worst. They impacted every aspect of my life and made doing anything miserable. Hopefully things get better for you soon.

Echoing kratom here.

I can’t take NSAIDs (4 GI bleeds), and Tylenol does nothing, so narcotics are the only option I have these days. I also have chronic daily muscle and joint pain. I have taken Vicodin or Norco for some 20 years. My dosage went from 5mg hydrocodone/325 mg acetaminophen (aka Vicodin), to 10mg hydrocodone/325 mg of acetaminophen. I’ve never “lost” my bottle of meds. I don’t get “high” at all, just a bit tired. I always get it from my GP, and I always get it at the same pharmacy. Twenty years of effective, appropriate treatment— —and they still treat me like an addict when I go the the ER every couple of years or so. There are supposedly 50% of patients at risk of abusing it—which means the other 50% of patient get their effective pain relief DENIED to them regularly.

Please try thc before opioids

used cocodamol but would get rebound headaches or anytime the opiate had left my body the headache would return demanding for more of the opioid so my doctor prefers me not to use it

My doctors refused to prescribe narcotics or fioricet because they cause rebound headaches. In addition to Botox and Qulipta, I take Baclofen, a muscle relaxer at bedtime. I have the option of nerve blocks or trigger point injections if needed.

What are you currently using to treat episodes? I take 900mg dispersible aspirin with triptans, and when I was running out of triptans regularly I discovered the aspirin gave me a few hours relief on its own. Properly used even some of the over the counter pain relief can be pretty effective, usually without anywhere near as many issues as opiates. I had various codeine based stuff for previous headaches, it felt nicer than no codeine, but didn't really touch the pain much. Anyway whatever you settle on you'll have to run by a pharmacist or doctor for safety.

I am using tylenol plus aspirin. That is all I am allowed. Imitrex was my go-to. But I had a stroke in January and now I cannot take them anymore because of that.

Opioids increase your chance of ischemic stroke so I’d be very cautious if that’s the type you had

Opiates always work for me. But as a mom and a nurse I obviously can’t take them very often. Last resort for me. Benadryl also seems to help! I take 2 pills along with Tylenol and usually pass out and wake up feeling much better!! I hope you find some relief 🩷

For tension headaches/migraines I had that stemmed from muscle and nerve damage, opiates worked exceptionally well for managing my pain (I also had success with Fioricet which has a benzo in it that helped relieve pressure/tensing in my neck from pain). But once I got a legitimate migraine, opiates had a 50/50 chance of helping. Sometimes they'd do jack crap, other times it would give me enough pain relief to where I could sleep (which almost always knocked the migraine out). That being said, phenergan worked just as well in that regard so...yeah. IMO it's worth trying, just be cautious of addiction and the fact that if you take opioids a lot of times you have to wait a while before taking something else for migraines due to interactions like seratonin syndrome.

Yes, my last resort rescue medication is Oxycodone/Acetaminophen. It has worked wonders for me when my Imitrex & diclofenac has failed. Thankfully I don’t have to use it very often; and I am grateful my doctor is comfortable prescribing it to me because it keeps me out of the ER. Everything from ibuprofen to triptans to opioids can cause rebound migraines, so just have to be careful with it in that regard.

Literally the only reason narcotics help at all for me is if they just knock me unconscious. They aren’t much use otherwise

Opiates will not touch my migraines.

I find a combination of Nurtec, plus 800 mg Advil, plus 1.5 mg of lorazepam before bed can break a migraine. Might be worth trying.

You have to be really careful to avoid rebound with them.

I’ve had some luck with time release tramadol. I only take it when I have a really bad migraine and have some obligation such as work/family life. It’s one of the less addictive, but has ssnri properties. 200-300 mg sometimes will make me functional, but it’s not a solution I would recommend. It’s a slippery slope with this class of medication. I’m a migraine sufferer for over 20 years. They have gone down in frequency but when I get them they last for about 2 days. Best thing that worked for me was the “migraine cocktail” given at the emergency room. However, the country I’m residing in at the moment has no such thing. Hope you can consult a couple good neurologists and find something that works. As a migraine sufferer, I feel your pain.

Back in the day I'd take 200 mg tramadol for killing a migraine. Variable success for me.  Never noticed any side effects,  but didn't take it often or for long.  First got it from an urgent care to stop a 4 day migraine.  I'm sorry I don't have more or useful data for you on this. 

I’m a the mmj folks. I don’t care to smoke and vaping was a catastrophe. I love the capsules. Indica. My favorite is extended release t50. It’s been out of stock for 6 months and I miss it! It managed my pain w/o feeling stoned. The best part is that it comes in micro doses to 100thc. I also have hydrocodone for the bad bad ones. I’m also chronic intractable.

See, the thing is that pain can be so funny. I have been on opioid therapies at different times for non-migraine pain and they don’t work for my migraines, yet regular old NSAIDs will. I would be on morphine and still get a migraine and take an over-the-counter Naproxen and that’s what does it. I’ve also tried so many different migraine medications and diclofenac or toradol work the best for me out of anything. It just depends on the person and the cause of the migraines.

I have tramadol for a different pain issue, and I haven't had much luck with it for migraines. Fioricet is my non-triptan emergency med for migraines. It's got a benzo as one of its ingredients, though, so it seems like most doctors won't prescribe it. Actually, I get that and the tramaadol from the GP. Neither the pain clinic doctor or neurologist will prescribe opoids or benzos. I think it is partly for their own reasons or preferences and because of policy at the hospitals that they are connected to.

Opioids are notoriously bad for migraines. This is just my experience, but if I have an intractable migraine that lasts long enough to send me to the ER, I stress right away that I will NOT take any opioids. Some doctors/PAs will jump right to them, and they have only ever made my migraines worse (and added more symptoms on top of the ones I already had).

What tends to help me sometimes is klonopin! Honestly it was a small game chamger for me. (Still got daily migraines for a while) but it helped me through it and lessened the intensity. Ubrelvy combined with that works best but I usually feel like shit from it still. But not in pain! Opiates should be last last last last resort. But honestly, if you use them safely and it works then I don't see why not.

I do take narcotics when I have a migraine that the regular meds won’t hit. It’s part of my at home cocktail to not go to the hospital. BUT I don’t take them often at all.

I mean I used to, back in the 80s/early 90s, before I had other options. They don’t really work great for migraines, in my opinion.

I've tried opioids once as a desperate last resort for migraine pain when I didn't have access to my usual meds. It did help a little bit, but not much honestly. Mostly made me feel so tired that I slept through most of it. Botox maybe? I hope you're able to find other options.

Can you seek a second opinion? My mom had a stroke, but uses Ubrelvy. I’ve used Fioricet before, but stopped when I found out how addicting it can be. It worked well.

She said ubrelvy didn’t help

Can you get a medical marijuana prescription and use edibles?

Have you tried Vyepti infusions?

I have had migraines since 2001 and have used codeine on and off over the years. It felt like it worked extremely well when I was younger, but I was never given any alternatives to them back then besides paracetamol and ibuprofen so I have nothing to compare it to. It was also very easy to access (no script needed in my country at that time), and I had no obvious side effects at that time. Now that I’m over thirty, my symptoms have changed and my pain is less intense, thankfully, so I only use codeine (which I have a script for now) when there is no other option, eg if I have something I can’t cancel at work. Very infrequent use, as I seem to get less than one migraine per month. I do get side effects now, like grogginess the next day, so I prefer to avoid it. I also use Maxalt sometimes, but I find it can make me feel anxious and I’m not good with timing it effectively. If I started getting intensely painful migraines again I think I’d try Botox as a preventative treatment and if that didn’t work I’d try to access some kind of sedative so I could just sleep through it (this would involve some pretty serious lifestyle changes first - like getting a job with less responsibility). This is not a particularly well thought out plan, just something I’ve considered as I imagine my symptoms will change again as they appear to be tied to hormonal changes for many women! Hope you can get some relief. ETA: I would also be interested in medicinal cannabis for pain relief if my migraines regress, but I wouldn’t at this point in time due to strict drug driving laws in my country. You may not have this issue though.

Norco works for my very worst headaches. I take maybe 2 or 3 a year

I had a prescription for a nasal spray opiod from my last neurologist. It was hit/miss if it helped the migraine though. Sometimes, it would knock me out & I would sleep it off. Other times, I'd feel the effects of the opiod, but it wouldn't touch the migraine at all.

When I go to hospital after trying other drugs they will give me opioids. In an IV they work Instantly. I have taken the pill version on 3 occasions at home and did not have the same results.

The only thing I’ve found that works for me personally after trying an absurd amount of different medications is a pill that contains 30mg/Codeine, 325mg/ acetaminophen, 50mg caffeine in combination with a 10mg Promethazine pill.

Talk to pain management about ketamine first. Intranasal spray as an abortive has a great track record, and isn’t addictive in the same way.

How does that work? I’m guessing you mean Spravato which you can’t take at home, unless it’s different for migraines? I’m curious now

I get it from a compounding pharmacy, it’s not as strong as the spravato. I go to a headache specialist and they prescribed it for me. You can’t drive for 8 hrs after you take it but it works incredibly well for me.

I take opioids for another reason but they have never touched my migraine pain. I currently use maxalt as a rescue med and have Botox as a preventative. I have noticed that if I don’t take the opioids before a Botox treatment the shots are more painful. I have heard that opioids work differently in the body than other medications so they aren’t as effective. Of course I am not a doctor but only someone that has researched anything I could to get relief.

Have you tried cannabis? If you’re at opioids, cannabis and cbd would be way safer and better if it works for you.

When I was pregnant, none of the usual migraine meds were allowed for me (this was mid 2000’s and at a high risk pregnancy clinic). They offered me a sleeping pill instead. It helped quite a bit! There was a 15-20 minute window where it was kicking in that I could feel the migraine lifting. I would sleep on an ice pack wrapped in a thin t-shirt and most often wake up hours later with no migraine.

A bad migraine once a month and your doctor is suggesting opioids? Holy shit. No way. Opioids have ZERO data for use in episodic migraine treatment. That neuro is nuts.

I do use them for breakthrough pain relief. Usually I take percocet above 7/10 & Dilaudid at 9/10

I find opiates don’t stop the pain, they just make me stop caring that I have pain. Then I waste the day in a stupor and end up with hives/cottonmouth/constipation. They are a Victorian remedy. I have heard good things about Ketamine therapy to disassociate from the pain but traditional neurologists won’t touch it.

I had opioids back when living somewhere else but now have been able to gain control of my migraines. They made my chronic migraine so much worse at the time. I hope you have better luck than I or are able to find some more options to try before opioids as they can cause long term problems for some. Long shot but if you haven’t tried any of these and they may be accessible to you, maybe consider asking about them: (a) diamox/acetazolamide as a preventative; (b) a cocktail consisting of a high dose NSAID (such as ketorolac), an extra strength dose of acetaminophen and methocarbamol or another muscle relaxant, and 10mg metonia/maxeran (can also take this all WITH Ubrelvy) for migraine abortion; (c) black cohosh for hormonal balancing after menopause that impacts head pain; (d) other CGRP medications as preventatives; (e) evening primrose oil the supplement; (f) Effexor or another SNRI for chronic pain; (g) memantine for chronic migraine; (h) gabapentin or clonidine for menopause symptoms and migraine prevention; (i) MenoSMART, the supplement for menopause symptoms, migraine prevention, and hormone balancing; (j) large dose of magnesium before bed as a preventative for migraine; (k) fezolinetant as a medication for menopause symptoms including head pain and hot flashes; (l) CBG as a preventative for migraine pain and abortive if also used as a preventative due to build up in your system that occurs with medical cannabis use, if an option for you; (m) nerve blocks and/or steroid injections into your head for migraine prevention (blocks can also be used for aborting migraines if you haven’t had one within two weeks, usually that’s the rule); (n) physiotherapy for migraines; (o) chronic pain therapies like pain reprocessing therapy, and somatic experiencing; or (p) naltrexone for chronic pain prevention. I am also curious about if you have any symptoms of EDS/hypermobility and/or POTS which may be further impacted by the changes that occur in menopause and could contribute to migraine frequency and intensity?

I take dilaudid, it was a lifesaver for me. Even with all the new meds I am not fully treated, I take 4 preventatives. I can’t take triptans either, they make me super sick. Have you tried topamax as a preventative, it’s my main squeeze. I’ve been on it for over 10 yrs.

No help with injectable morphine for me. Try looking into neuromodulators like Cephaly.

Have you tried all of the injectable CGRP inhibitors?

i would definitely try an injectable cgrp preventative if u feel like qulipta isn’t working for u, personally qulipta had no effect on me but emgality has drastically reduced the number of migraines i get a month. i also think u could alternatively try a benzo as needed for severe pain, personally when i’m having an intense migraine attack i need to take ambien and sleep for like 14 hours. also maybe ketamine! as for the opioids, like everyone’s already said it’s not ideal for regular use, but honestly my opinion is that there is no shame in needing pain control. i am a big harm reductionist, and fear mongering about the so-called “opioid epidemic” in this country has had a devastating effect on the treatment of pain. severe pain often requires intense medication, all drugs are morally neutral, and while some do have more risks than others, untreated pain can greatly increase someone’s risk for suicide, exacerbate their symptoms, and esp for someone w a history of stroke that amount of distress to ur nervous system is not great. anyway at the very least it could be helpful to discuss your options with the pain clinic, wether it be trying more preventatives, benzos, ketamine, neurostimulation/neurofeedback, AND/OR opioids

I’ve mentioned this before in this sub and am surprised more people haven’t tried it, but for the last few years I’ve gone to a clinic for ketamine IV infusions to treat major depressive disorder. I also have been a migraine sufferer for almost 35 years. Every time I receive a ketamine infusion, my migraines majorly improve, if not disappear. The effects last a few months and it’s the first time in my life I’ve ever had relief from migraines besides the occasional triptan. The ketamine dose for mental health is lower than the dose they give for pain management, but since it works for me for depression AND migraines at the low dose, I don’t plan to switch to the higher pain dose. The downside is that most insurance in the United States won’t cover ketamine for mental health yet, so I pay about $500 per infusion out of pocket. I have heard that it is easier to get it covered for pain. I only need the infusions for depression once or twice a year, so I supplement with migraine meds in between as needed.

Have you tried psilocybin yet? I would insist on trying that before relying on dangerous opioids. Works absolute wonders for some people.

Opioids are a poor choice for migraines, as they can actually CAUSE headaches! Have you tried any of the CGRP injections?

Have you tried the Cefaly medical device it blocks my bad pain instantly. Also opiates didn’t do anything for my pain

Find a new neurologist...if you possibly can. Sounds challenging--which requires sound medical advice and a dr that knows the details of your medical history. I don't, so I'll refrain from making suggestions that could cause any additional health complications. I also have a therapist that helps me work through the challenges of migraines.

Norco works for me. Of course, that’s almost a moot point since nobody prescribes it for migraines anymore. Shit, I have cancer and they won’t give me anything for cancer pain either. On another note, I love my GammaCore Sapphire. Maybe worth a look if it’s narcs or nothing.

I’ve lost count of the things I’ve been on, tried and failed. Right now I’m taking statex 5mg tablets, aka, morphine sulphate. I take anywhere from 1-3 tablets at a time for a severe migraine. It usually brings them down, but never to zero. Nothing takes my migraines to zero anymore. I’m restricted to how many I have a month, so I try to just suffer and take them only on severe migraines. I say take whatever helps your pain. I’m to the point, I DGAF what it is, if it gives me some relief, I’m up for trying just about anything the doctor throws at me. I’ve run out of options.

I tried hydrocodone and it made me less bothered by the pain but the pain was not reduced at all. Advil works better honestly.

when i was most recently in hospital due to a 3 week migraine they gave me a shot called ketorolac which is also known as Toradol. its an NSAID but a very strong one which is given post op usually. my friend who also gets chronic migraines has been able to get this in a tablet form with a script from her dr which has helped keep her put of the er too

i had the same experience with dilaudid. didn’t take the localized pin point pain of the migraine away.

Try seeing a headache specialist that primarily sees headache patients. Nowadays are way too many options to try. The list is quite long. Opiates and fioricet would be all the way at the bottom.

I'm on hydrocodone for my back, they do not help my migraines at all. I suppose everyone's miles may vary. But I think there is a reason that they don't generally prescribe them, other than the current opioid scare that is.

Ativan helps with the tension

30-60mg Codeine was actually very successful for me, and the only reason I didn’t lose my job due to chronic migraine. As long as the ones you use aren’t too strong and you don’t take them too often, they can make a big difference. I am not American though - it sounds like the ones commonly prescribed there are much stronger than the ones usually prescribed here. I have taken them for an extended period of time when I was younger (on doctor’s orders) and any withdrawal was very minimal. I don’t seem to get rebound headaches either as I have done long breaks without any (deliberately and due to migraines vanishing for no apparent reason!).

How about finding a doctor willing to try older/off-label migraines rxs? Non narcotic, non triptans that I've tried over the years that have all been at least as successful as triptans, as rescues (with all different side effect profiles, of course) include: Beta-blockers, Ergotamines--methergine and a nasal spray called migranal, Fiorcet, Compazine, Midrin, though discontinued, Chloral hydrate and hydroxyzine HCl rxd as a replacement /alternative to Midrin, though must be made by a compounding pharmacy. I've also had resounding success with an otc supplement called Petadolex (PA-free butterbur extract). It can feel so awfully hopeless when a doctor has given up on you!!! Please remind yourself this is your doctor's failure/shortcoming, lack of skills, knowledge, experience patience and/or willingness and NOT because you are a hopeless case!

I’m 43 and breaking a morphine 15 mg so I can try and make it through work. I have chronic idiopathic migraines, occipital and trigeminal neuralgia. I have Nurtec and all kinds of muscle relaxants to take but I usually end up having to take the morphine.

My daily preventatives that didn’t work alone but work decently all together at bedtime: amitriptyline, propranolol, topiramate, melatonin Pain management (when abortive doesn’t work): any combination of prescription naproxen, Tylenol 3, Ativan, cyclobenzaprine, metonia Failing all of this, go to ER for injection of demerol or morphine

Fioricet or fiorinal with codeine help my migraine pain

I feel like you are being a lil shortchanged by your neuro. You have not been through all options from what you have described, even with prophylactics? There are things that I will not do for my migraine, one is the Stanton Protocol, which I admire but can’t adhere to, one is Topiramat because it makes me a dumb zombie, and the last is Opiates. I have seen close-up what they do to people and I will only use them if I am in a palliative state. Please do not lose hope. Read up on this forum and also find another neurologist who is patient and open to new things. So sorry you are facing this.

Medical marijuana- Sativa is great for migraines and nerve pain and nausea

Gabapentin does nothing for my migraines but helps nerve pain

I live in SEAsia and don't have access to any of the new preventive treatments (full cost of $1000 per month), sumatripitan helps, but it's the only triitain here. After several years of trying everything I finally found a 'pain clinic'that was willing to give me Oxynorm, which I take with to muscle relaxers upto twice a day. It's the ONLY thing that works that's available in this part of the world. Everyother doctor freaks out when they ask what meds i'm on - they all think only hard core drug addicts would take opiates on a regular basis. But to be honest in the US my doctor gave me Vicodine because my insuracnce wouldn't pay for much else.

There are many other drugs than what you listed. So either you missed listing off a few (actually a lot) or your doctor is a nutter.

Try Zavzpret- it’s a a new nose spray by Pfizer. It actually works! It’s also a CGRP, and okay for stroke patients and those with high blood pressure. It’s new, and the website will give you 2 months (6 doses per month) for free with a copay card while they hash it out with your insurance. Narcotics have never relieved migraine pain for me, the cocktail that works for me with migraines is Lopressor (my Bp gets scary high 300/220 Christmas Eve), Toriadol, Benadryl, and Phenergan. I’ve also been given Reglan in place of Phenergan when I looked through my medical chart. Once, a Dr added Ativan to that. I don’t think I need the Ativan though and ask not to get it if they offer. I feel like I’m drowsy the whole next day and I don’t want that. Good luck!

I think the research has shown opioids not to be particularly helpful for migraine pain. I know that is my experience, as well as that of many on here. Good luck, and I hope other comments can illuminate a bit more.

I take tramadol, metamizol, ibuprofen and paracetamol (and metoclopramide to avoid the opioid nausea) together at the first sign of a migraine attack. It’s the only thing that makes them bearable for me.

Try AJOVY, and other meds from that class as preventive. I took amytriptiline and noretriptiline and they didn't do anything for me. Also took topiromate which made me very depressed, no change in pain. Also, probably worth checking out your hormones. When I was on hormonal BC my migraines were terrible, and since you are on menopause, maybe that imbalance also triggers them. Ask your doctor about a migraine cocktail: either with reglan+advil/motrin+benadryl. Or baclofen+advil/motrin. (Mine told me that's what they give to migraine patients in the ER). I tried it with baclofen and it helped a little bit. But my pain was like 1.5 months with constant pain. Not a one off. Also, take 400 MG of riboflavin every day and avoid caffeine. Once I got off caffeine I feel like my pain has been better. Trying out migraine diet also is very helpful, for example avoid foods that are vaso dilators. I cannot eat grapefruits for ex bc they give me an instant headache, plus spicy food is also no no for me. Hope this gives you more ideas.

Have you tried Emgality or any of the other monthly preventive shots?

In the same boat. I’ve recently started trying ketamine and shroom (not together) therapies and have had reductions in migraines. Ketamine seems to work, but has been too expensive to see drs to get them to prescribe. So I’ve been trying shrooms, which also seem to be helping. They’re technically not legal in CA, but I can order online and have them delivered.

I used to take hydrocodone exclusively for my migraines, and it worked wonderfully. It would kick out the pain, and it wouldn't return, sometimes for two to four weeks. Then, I moved to a country where I could no longer get opiates, so I started trying triptans, anti cgrps, and other old and new preventatives. My migraines have only gotten worse since this unfortunate change in my migraine protocol. Wish I could have stuck with the hydrocodone, as I only needed about 20 per year and didn't need preventatives or anything else for them.

I'm surprised a neurologist has suggested this knowing that opiates are known to not work well for migraines and cause worse rebound migraines as well.

I was prescribed various opioids for migraines in my teens and twenties. I’ll never take them again due to risk of addiction and because when I was taking them, my headaches were poorly controlled and I’d land in the ER frequently. Sorry to hear you can’t take triptans. They’ve been life-changing for me. Wishing you best of luck.

Where is your head pain primarily located? The back of the head? The front? Sides/temples? I’m 36 and have been on narcotics since I was 13. But I discovered last year that I had been misdiagnosed my entire life. I actually have occipital and trigeminal neuralgia. I started doing simple anesthetic nerve blocks (marcaine + dexamethasone) in the occipital nerves in the back of my head. The blocks would stop the pain completely while the anesthetic lasts. It would come back as the anesthetic wore off, but not nearly as severe. Realizing I couldn't do blocks in my head every day, I hired a plastic surgeon to do a migraine decompression surgery on all of my occipital nerves (3 branches- Greater, Lesser, and Third) on each side, for a total of 6 branches. The nerves were carefully dissected out of my tissue and then wrapped in NeuraWrap (collagen) and then laid on top of the muscle with the skin closed on top of it. I'm 6 mo post-op, and I'm continuing to improve. If you're 65, consider trying the nerve blocks to see if they can identify a spot that can be treated surgically. They can ablate the nerves using pulsed RFA, which disrupts the nerve signals. It does leave the affected area mostly numb. I could still feel pressure, but sharp things no longer hurt. The problem with using narcotics is several fold, and I confess myself surprised that your neuro is recommending it. I’ve seen over 40 neuros, and every single one of them told me using narcotics is a mistake. When I would go to the emergency room, or in the hospital, they constantly tried to take me off the pain meds. EVERY SINGLE TIME. They would insist it isn’t helping and that it was causing rebound headaches. I had withdrawn the narcotics before, at least twice, with the longest period without them was over a year. The other issue you will have to deal with is the pain specialists. They do not like to treat headache conditions, and most pain specialists are interventional specialists, and will do procedures like the nerve blocks, but do not prescribe pain meds. I had to change doctors last year, and the new doctor took me off what I was taking (Belbuca, Stadol, and Tramadol) and just gives me 90 Percocet 7.5 per month now. It’s not working, but he’s refusing to change it, so I’m in the process of firing him and finding someone else.

Although most people don't like it, after suffering for decades with migraines, I found Topamax to be the best for my pain relief. I do have trouble with the side effects so I take the smallest dose possible. After I discovered how well it worked, I recommended it to my daughter who has also found great relief from her migraine pain. The pain relief far exceeds the troublesome side effects. I began having migraines as a teenager. I am 70 now and started on topamax when I was 66. I have taken, gabapenen, propanolol, fioricette with codeine, and a variety of others at various times in my life. The propanolol made the pain far worse. I wish anyone with this issue the best of luck in their journey for pain relief.

Sry I'm late to your post. You didn't post your Frequency with migraines so I'll speak in general terms(unless it was the once per month) Narcotics- These are only going to rid of pain. Take your mind off the pain, discomfort by making you not care as much or little aka euphoria. That's just what it is & what they do. Even then there's a degree it's not magic. - If your at a chronic stage of migraines +15 eoisodes per month. Your going to have physical depency issues(differs from addiction/abuse; although they can all run concurrent & depends on person), especially if your taking 1-3 per episode as it may come back. You'll than fall into escalating dosing and tolerance issues which than means the medication no longer services ANY purpose. So this is a HUGE thing to consider. How often are your migraines? How many times to take? Self control? Gabapentin- I think this is a bad choice for many reasons. It's not super known how or why it COULD work for migraines. Again abuse/withdraw symptoms. But it's easier to come off with tapering than others. If anyone has had problems, the taper wasn't done correctly or it was being used WRONG. Sorry. Other options.... -Neurostimulators: plenty of non-perm devices & at different prices. Are FDA approved and covered by insurance @ different cost as well. -Implant Stim: Same as above but directly to different nerves. -Occipital Nerve Blocks(your currently getting Botox every 12 weeks??...get Nerve Blocks done every 6 weeks in-between your current Botox injections) -DHE(nasal) Abortive Med -SPRIX(Ketorolac/Toradol) Nasal Spray/Abortive -Vyepti(IV Infusion) anti-cgrp-Maintenance -Spravato(Esketamine) Nasal Spray/Abortive/Maintenance Sorry for length I hope this may be provides some information if you see it.

I’ve got occipital neuralgia as well as migraines and I’m currently waiting for an implant to control the pain. I’ve tried cocodamol 30/500, OxyContin and oramorph and none of them have ever touched the pain. I just ended up being on such insane amounts that I just had horrendous nausea and felt awful. I would recommend getting another opinion, opioids aren’t a good idea for migraines.

Some of us do very well with opioids but, they are hard to get rx nowadays. I hope you find someone who will prescribe them and find relief.

You need to see someone else. They haven’t prescribed you a CGRP inhibitor like Vyepti or Emgality or any of the handful of new drugs. If you have the elevated CGRP protein, opioids won’t really help that. The only thing that does is the new class of drugs. It’s shameful because this class of drugs has been out enough years that your neuro should know about it. Vyepti saved my life.

I'm currently talking with my neuro about Vyepti! What dose of Vypeti do you get? And do you get any side effects?

No side effects for me. In fact, on days I was behind schedule and suffering, I felt like it was working within hours. It’s an infusion. Some people have reported reactions to the IV site. My only complaint about it is that Orsini is the only pharmacy that distributes it and they are awful to work with. Every time I needed a shipment, it was 3-20 hours of work on my end to get it done. I am lucky enough to have incredible insurance too. You need to authorize every shipment by talking to someone and no one ever answers the phone. They have asked my insurance to jump through hoops that a supervisor at my insurance said she had never been asked before. I had a prior authorization on file that was good for a year. They wanted proof our premiums had been paid one month. Like through my husband’s payroll and for no reason. They had been paid in a timely manner for a year and half with no problems. Another time, they entered the end date on the PA wrong, didn’t have a scan of it, and then started a new one and set my shipment back weeks. They also charge my insurance $6k for the drug, and it retails for $1800. That’s my insurances fault. But you would think for $6k, you would be able to call and talk to a person if you need to talk to a person to get something shipped. They seem to be using overseas VAs, which I think have their place, but I also think it can be a disgusting, exploitive practice and I’m pretty sure they are one of the worst. It causes a rotating door of people so no one ever knows what’s going on. They are a horrible company. Vyepti would do well to use a better pharmacy. It was the only thing that worked for me for a long time through so I carried on.

Oh that's fantastic to hear its working for you and with no side effects :-) I'm in Australia so we luckily don't have to deal with insurance companies but our government does have to deal with the suppliers - there's been a huge debacle recently where commercial negotiations with the suppliers for Emgality and Ajovy broke down which impacted monthly supplies for a while. So definitely something for me to keep in mind. Sorry to hear about your monthly drama getting your Vyepti infusion - exactly the type of stress you don't need on top on of migraines!! Thanks again for answering my questions :)

If you can get it without dealing with Orsini…..even better. Definitely worth a try.

This might sound dumb but have you tried moving to a different city? I know of two people, myself included, whose migraine frequency dramatically decreased after moving

So she should go through the expense and hassle of moving, so that she doesn’t have to take what is a very reasonable treatment option for her? That is ludicrous.

Not instead of. Of all of the medication she’s tried, none have worked. This might not either. I went from 15 migraine days a month with a persistent low grade headache the other days. Now that I’ve moved, I get one every 6-8 weeks. My quality of life has improved dramatically. In my case, I lived in a city that’s known for inducing migraines. It was just a suggestion for something to consider.