Why won’t my doctor give me a Percocet?

Most migraine sufferers have found out that narcotic painkillers, like codeine, Vicodin, and Percocet, don’t work really well for migraines. For most people, drugs like aspirin-caffeine combinations, ibuprofen-like drugs, ergotamines, and triptans work much better. But every now and then, these treatments don’t work and you need rescue therapy. And often that rescue therapy is a narcotic.

You also probably know that using any of these treatment too frequently (usually 3 or more days per week on a regular basis for about six weeks) can result in an increase in headaches called medication overuse headaches. In recent years, doctors have begun to investigate possible differences between overused medications. This research has shown some unique features of narcotics that can make then especially problematic for people with chronic migraines or other chronic pain conditions.

A paradoxical effect occurs with long-term, high-dose use of narcotics called narcotic-hyperalgesia. Hyperalgesia is an increased sensitivity (“hyper”) to pain (“algesia”). Hyperalgesia is not a false perception that something not painful is painful. Hyperalgesia means you are experiencing a painful condition and your experience is more severe because of increased nerve firing to makes you more sensitive to the pain.

Studies first conducted in rodents and later in humans show that regular use of narcotics changes how the body processes and responds to pain. Indeed, your brain can actually becomes more sensitive to pain as a consequence of chronic use. A new article that will be published in the journal Cephalalgia by Dr. Johnson and colleagues from the University of Adelaide in Australia reviews the research describing narcotic-hyperalgesia in migraine. Here’s a summary of their findings:

  • Evidence is pretty clear that narcotic-hyperalgesia occurs in laboratory rats. The results in pain patients is less clear. Humans without pain problems have been shown to develop an increased sensitivity to pain after receiving narcotic infusions, supporting that this mechanism may also be important in humans.
  • Most studies show narcotic-hyperalgesia occurs after taking high doses of pain killers.
  • Changes in nerve sensitivity and the release and reuptake of neurotransmitters in the nervous system may be responsible for this phenomenon.
  • Narcotic-hyperalgesia may occur because of changes in nerve cells that increases inflammation.

What are the take-home messages:

  • Narcotics are generally only moderately effective for migraine and may be used infrequently for rescue therapy. Usually your doctor will want to try treatment he believes have a greater chance of success first.
  • Frequent use of narcotics may result in medication overuse headache and may also increase pain firing in the brain that can also worsen your pain and make your migraines harder to treat.
  • For people who need to use daily long-acting narcotics for chronic pain conditions, try to stick with the lowest effective dose possible to minimize your risk for narcotic hyperalgesia.

So the bottom line is: if you need to use narcotics for rescue, try to stick with infrequent, low-doses. When this isn’t helping or you’re starting to need higher doses and your pain’s getting worse, be sure to talk with your doctor.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

View Comments (26)
  • plazma1
    2 years ago

    My reactions to this site are many. As a sufferer who has never found an effective and lasting Treatment Plan with a company regarded as best in the business locally (Phoenix, Arizona), I have now lost most Faith in modern medicine. I notice your correspondences date back many years from the current 2016 and am even further discouraged. Just how often do true Migraines resolve “on their own”? Can anyone really be shocked by the rise of “elephant sedatives’ as the latest street “high”?

  • Brooke H moderator
    2 years ago

    Hi Plazma1, Thank you for taking the time to share your thoughts on this topic. It certainly is one that has many sides to consider! I’m sorry that you’ve had bad experiences with modern medicine. You are certainly not alone in this unfortunately! Migraines can resolve through taking triptans, usually earlier than later – although the tricky part is not to overuse the triptans. You may be interested in learning more here:https://migraine.com/blog/are-you-an-early-jumper-or-a-waiter/. If you are interested in alternative approaches to treating migraines, such as acupuncture, chiropractics and more, you may want to look at our complementary and alternative therapies (if you haven’t already!): https://migraine.com/complimentary-and-alternative-therapies/. Wishing you hope in the difficult journey of living with migraine. Please come here anytime for support. Warmly, Brooke (Migraine.com team)

  • deborahvan-der-harst
    5 years ago

    Thank you for this extremely valuable information. I was taking hydrocodone for my most painful migraines sometimes before using Maxalt and other abortive meds. I am stopping that practice today. The last thing I need is increased sensitivity to pain. Your article is a lifesaver.

  • deborahvan-der-harst
    5 years ago

    Oh yeah, the localized pain I feel is called a nummular headache diagnosed by my neurologist. I read a study that Botox helps with that type of headache in addition to chronic migraines. I will be getting my third round of injections on June 9. I hope it helps. It is working for the migraines although I still get a doozy every now and then.

  • Nancy Harris Bonk moderator
    6 years ago

    Hi Julie,

    Just wanted to check in and see how it’s going on Cymbalta and how you are feeling?

  • Julie
    6 years ago

    Well this might be off subject or it might not be, but I finally got diagnosed with Fibromyalgia this month. So that explains some of the chronic non-stop neck, shoulder, upper-middle-lower back pain. But that could also explain some of the daily non-stop migraines as a symptom of Fibro can be migraines. I was finally prescribed Cymbalta that works on chronic deep tissue and nerve pain so I’m hoping and praying that this will cut down and reduce the migraine frequency, duration and intensity so that I will not have to rely on the abortive medications and hopefully reduce the amount of preventive medications I am taking. Cymbalta is also suppose to help restore your sleep patterns too. The Neurologist I have who is also a headache specialist that I now see said Cymbalta is also used off label for Migraine preventive but it’s also used for Fibromyalgia. So maybe those that have daily debilitating migraines like I have can ask their doctors to give Cymbalta a try? What have they got to lose?

  • deborahvan-der-harst
    6 years ago

    I take 30 mg of Cymbalta twice a day. I’m not sure how effective it is because I also take Topamax and Gabapentin as preventatives. I feel like the migraines are less frequent,but I have this constant very localized pain on the right side of my head near my part that nothing has touched. No doctor I’ve seen has any idea what’s causing the pain. It has to be something because I definitely feel it. Anyway, it takes about 4-6 weeks for the Cymbalta to fully take effect but you should start to feel better slowly over that time. If not, you can talk with your doctor. I hope it works for you.

  • Dr Marcus author
    6 years ago

    Thanks all for the spirited discussion about the pros and cons of narcotics for rescue therapy. Your comments highlight that there are often no easy answers and treatments can affect different people quite differently. That’s part of the reason treating migraine is tough — different combinations work better for some people than other. As always, it’s important to communicate with your healthcare providers what works and doesn’t work for you. You’re the best expert on your migraines so be sure to be a good advocate for your care.

  • deborahvan-der-harst
    6 years ago

    I had frozen shoulder for a year. The only way I could cope with the pain and get through physical therapy was with hydrocodone. I took it daily for almost a year. Then I had to wean myself off of it. I did it slowly enough so that I didn’t experience withdrawal symptoms. Then I started using the hydrocodone for migraine pain when nothing else worked. The next thing I knew I had rebound headaches. My new doctor gave me 2 weeks to wean myself off a fairly high dosage of the medication. I was miserable. Only then I was able to begin a new pain management regimen. It is tough when experiencing more than one type of pain with migraine pain. When I had migraines during the year with frozen shoulder, I was so depressed to experience so much pain at the same time.

    I am currently experiencing pain on the side of head that keeps increasing in intensity on a daily basis. I can’t believe that there isn’t something in my head causing that pain. One time a nerve in that area became very swollen so that I could actually feel it with my finger. I am calling my neurologist today. I need relief from this pain, but I am feeling hopeless. I just don’t think he’ll be able to do anything for me. It’s a feeling I used to have when I suffered from major depression in my 20s and 30s. Why seek help? What’s the point?

  • Dr Marcus author
    6 years ago

    deborahvan-der-harst,
    Ellen is absolutely right. Dealing with chronic pain is frustrating and there is often no quick fix. You’d mentioned in an earlier message that you work with folks at the Diamond Headache Clinic, who are top notch. My only addition to what Ellen said is that it’s important to let your docs know when you’re getting frustrating, if you feel like you’re spinning your wheels, or you are getting discouraged. We doctors may fail to read the signs that our patients are getting disheartened and sometimes we see slight positive progress that lets us know you’re about to turn a corner but may fail to let you know that. Be sure to speak up for yourself and let them know what’s going on so they can make adjustments to help improve your symptoms.

  • Ellen Schnakenberg
    6 years ago

    deborahvan-der-harst – We seek help because we need help. You need help, and you are important and you deserve to find it.

    Your situation is not hopeless. It is painful, confusing, frustrating and de-moralizing, but it is NOT hopeless <3 Please seek the help of a qualified counselor of some kind that can help you with how you are feeling about your situation. Managing Migraine and any kind of chronic illness or chronic pain takes a specialized subset of skills that a psychologist can help you with. This is not anything you are expected to learn in High School. If you are depressed, they can also help you with those feelings. Ignoring them isn't good for your mental or physical health. Depression is frequently comorbid with Migraine and needs to be addressed. Here is some information that might be helpful: http://migraine.com/living-with-migraine/migraine-and-depression/

    First I want to ask if you are happy with your board certified Migraine and headache specialist, because treatment that works is dependent upon a reliable, trustworthy diagnosis. If you don’t trust your current doctor then here is something you might want to consider: http://migraine.com/getting-help/is-it-time-for-a-new-migraine-doctor/

    If you are seeing one and haven't mentioned the swollen nerve you can touch with your finger, please do that right away. It may not be Migraine and could be something else that is easily treated when it is diagnosed appropriately. It is very common for Migraineurs to also suffer from another comorbid headache disorder or pain. I don't know your age or exactly what your symptoms are, but I am wondering if you might want to talk to your doctor about ruling something out called temporal arteritis. A swollen artery that can be seen/felt is a common symptom to go along with a specific type of pain, and the condition is often successfully treated with steroids.

    Deborah, if you suffer Migraine, you do have something wrong happening in your brain. It isn't *nothing*. It's Migraine. It is a genetic, neurologic disease for which there are no positive tests – – yet. We are diagnosed right now based on symptoms and clear imaging and lab reports. In other words, we rule other conditions out. If those labs or images weren't clear, it wouldn't be Migraine.

    You have probably seen my comment below where I discuss my own situation with shoulder problems. The pain is just awful, and I am so very sorry you have had to deal with it. It is a very fine line that we walk when we are Migraineurs with comorbid pain issues. Sometimes we have to make choices, but our lives are worth it. There aren't any easy answers. I sure wish there were.

    The most important thing is what you're doing right now – looking for answers and education. You're in the right place. You need a good relationship with an excellent Migraine and headache specialist, and that may take some doing. It is really worth it though, because they can address not only your MOH issues but also your Migraines, with skill and accuracy that another less trained doctor or neuro won't have. A regular neuro might be fine for the *average* Migraineur, but we are not average patients. Let me give you a link to a post that lists the specialists that are currently board certified: http://migraine.com/blog/looking-for-a-migraine-specialist/ Please look for your doctor there and then for the one that is nearest to you. Ask your doctor about your options and have a very frank discussion with him/her about your case to help alleviate your feelings of helplessness. Sometimes we have to work hard to get them to address these things with us because they forget that information is really the key to us getting by and having the energy to continue looking for the solution.

    I won't lie to you. It takes time and a lot of guts and gumption to get from a bad place to a place where management begins to work and you feel better. A good doctor will be there by your side to help you learn about triggers and avoid as many of them as you can manage, as well as setting you up with preventives that are helpful. There are over 100 of them and the list grows longer as more research is accomplished – – another good reason to seek help.

    Please contact me off board and let me know how you're doing, okay? I'm sending you virtual ((Hugs)) and encouragement…

  • Zev
    6 years ago

    I agree with “rebound pain”, however what do you do when your migraines are not your only issue? For example, I’ve had 5 surgeries since 05 and I’m due for two more all on my spine. Yes, it’s chronic pain and I see a pain management dr who’s next door to my neuro and migraine dr. There’s a lot going on and I’ve managed to cut down my pain meds in half just by will power, but I can’t get off of them for awhile or even 3 days a week. I’m not sure what to do here. My migraines have been under control for some time lately but I still have daily headache, ice picks and a bad case of insomnia. The headaches were the same even when I wasn’t on all of this s….tuff. Any ideas?

  • Ellen Schnakenberg
    6 years ago

    Hi Zev – This is discussed during conferences as one of the toughest issues our specialists face. Most of those of us who have transformed to chronic Migraine and who have MOH got there because we were simultaneously treating other pain issues.

    My personal experience horrified my doctor, but I don’t regret it. I had two shoulder surgeries without benefit of pain relievers. After the first surgery, my doctor got angry with me and told me this was one of the most painful surgeries a person could have, and I needed the pain relief. I tried to explain to him that the surgical pain was bad, but nothing in comparison to Migraine and MOH problems. He gave me Rx’s but they weren’t taken. That’s my choice. I was the one with the most to lose either way. Some days I made it through moment by moment, but all that was worth it in the end.

    Now I deal with joint pain that is the result of autoimmunity attacking them and damaging them. Just today I told my hubs “I would kill for a Tylenol!” Thankfully he understood that I have tough choices to make.

    We may not be able to live pain free lives. We try to do the best with what we’re given. We try to make the world a better place for those who come after us. Sometimes it’s a matter of just surviving. Either way, it’s all about the choices we make.

  • Nancy Harris Bonk moderator
    6 years ago

    Hi Zev,

    Some of us are in similar positions due to multiple painful conditions and/or diseases. I wish there was an easy answer, but there really isn’t. Trigger identification and management along with lifestyle changes are extremely helpful. But once we are in a cycle of pain, it is often hard to break.

  • deborahvan-der-harst
    6 years ago

    Narcotics don’t work for me more than 2 or 3 days a week because of the addiction issue. It’s just too easy to need or want them more often and at a higher dosage. Then I have to wean myself off them and go through withdrawal symptoms which are very unpleasant to deal with. It’s not worth it for me.

    Like Julie below, I go to the Diamond Headache Clinic and can only take rescue meds 3 days a week to avoid the rebound headaches. If that happens there are very few options available. Steroids have been most frequently prescribed in the past and now I recently found out that I have cataracts. I am only 49 years old and I have cataracts. No one warned me that cataracts could occur as a result of frequently prescribed steroids. I had LASIK and I did not enjoy it. Now have to have cataract surgery and I’m scared and not looking forward to it. First I have to wait for the cataracts to get big enough to remove. Until then I have to deal with blurred vision and difficulty reading in dim light along with driving in the dark.

    I don’t want to use steroids anymore as a rescue med so also like Julie I have been toughing out my daily migraines after I use the 3 days of Maxalt I’m allowed to use. I also have daily stomach upset or nausea. I sleep a lot to get through the pain. The pain makes it difficult for me to think clearly and consequently follow through on tasks that require multiple steps. I cry out of frustration sometimes, but not too long because crying makes my migraines much worse.

    I’ve only had migraines for a little more than 2 years and they’ve completely changed my life. I often say I want my life back. I wish some kind of medication, treatment or lifestyle change would work. So far, nothing has. I hope that menopause will end them.

  • Nancy Harris Bonk moderator
    6 years ago

    Hi deb,

    I am almost 51 and am being watched for cataracts, and was just diagnosed with Glaucoma – but did not take an abundance of steroids. Steroids seems to make my IIH worse. As I said above to Zev, lifestyle changes along with trigger identification and management are often very helpful. But once we get in a cycle of recurrent pain, it seems hard to break.

  • Julie
    6 years ago

    I know, its extremely difficult. My former Neurologist from Diamond Headache Clinic was the 1st to put me on the regimine of abortive meds no more than 4 days a week and 3 days I’m S.O.L or I run the risk too of getting in the rebound effect. I’ve been on this regimine since 2006 and my current neuro/migraine specialist is also on board with this too-but since May 2010 I get migraines daily. I cannot take OTC meds due to interactions w/several of my preventives. It’s beyond difficult to deal w/o any pain meds of any type for the 3 days I’m off my abortives. Vicoden makes me puke, Percocet makes me dizzier and incoherent and THEN it makes me puke. Tramadol had no effects as did the Oxy. It’s different for everyone.So I tough it out as best I can with meditation, ice packs and heat packs galore, darkness, quiet, lots of ear plugs and prayer. With God’s will I get by on those 3 days with some sanity intact, or I think I have some sanity left, or I’m insane enought to think I’ve survived it. I guess you need to ask my family that live with me. On the other hand they think it’s all in my head anyway, so go figure. But this migraine business is one heck of a tough road to travel and there are some major potholes in the way and we just have to fasten our seatbelts so we don’t get bounced out of the drivers seat as we navigate the road along the way. It’s one heck of a learning process that’s for sure. All I can say is good luck to everyone for finding what works for them.

  • Achinghead
    6 years ago

    Due to having several clotting tendencies which caused me to have several TIAs, I am unable to take anything with either aspirin or ibuprofin. The only over the counter pain reliever I can take is tylenol.
    The only triptan I can take is Amerg or Naratriptan. This works if I take it at the beginning of a migraine, but I can only take it 2 times a week. I also take Topamax as a preventative. I typically have a migraine 4 days a week. I find that either Tramadol or Percacet will help with the pain, but I try to only use them occasionally. I had tried Vicoden in the past, but found that after awhile it did cause rebound headaches.
    Every person is different and has different circumstances. Each of us has to find what works for us. I do agree that the least amount of narcotic pain relievers you take is best, because it will end up causing overuse headaches which are just as bad if not worse than the migraines.
    My Neurologist/Headache Specialist recommends that I take pain medication 2 days a week or no more than occasionally 3 days a week to prevent medication overuse headaches. This can be really hard when you have 4 migraines a month!!

  • Julie
    6 years ago

    but when you get involved into narcotics you get into the addictive stage and more prone to be into the rebound stage and less likely to give the other migraine medications and abortives a chance because your body craves and is use to the narcotics. Not judging just making an observation. when I was in the hospital for a week for depression I saw people in there addicted and craving their “narcotic” drug fix because their doctors said they were on it too long and were trying to wean them off and these people were going bonkers and having no part of it. 1st they were in denial they could not do without their drugs and 2nd they were in denial that they could not be taken off their medication because they wanted to be in control not the doctor and 3rd they were coping horribly and being uncontrolable and out of line. Pretty darn scary and a real eye opener. That sealed it right there for me that NO WAY anyone was putting me on any form of an addictive narcotic pain medication PERIOD. What an eye opener. I will try any and all other routes and then start over again in different cominations.

  • Julie
    6 years ago

    My Neurologist in March gave me an RX for Oxy to break a bad migraine cycle. He gave me an RX for 90 pills. I was scared to death to take them but at 1st I took them when I had those really bad ones that nothing responded to and sometimes I broke them in 1/2. They scared the heck out of me. I really don’t think they made a difference. When I saw him in late Aug 2012 I took the remaining 30 pills w/me and told him to destroy them-they didn’t work and I didn’t want them in my house. So he took them to destroy them. So if Oxy didn’t touch the pain I really don’t know what will. I was deflated and felt defeated in that time frame but I didn’t want anything addictive and that is why I was so scared to take something like that, but on the other hand was dismayed it didn’t work.

  • Julie
    6 years ago

    I Remember when my mom started getting them in the late 70’s they didn’t have much then to treat them with. Her doctor gave her Darvocet. Didn’t touch her pain and she still had to stay couped up in a dark room for a couple of days to ride out the pain. When I first got mine, I know this was a bad thing to do, but my dad brought me over a few and I took one and it didn’t help me either. I think I was given Vicoden by my doctor which was useless until Imitrex came out. They give me Vicoden for my root canal earlier this year and it made me really sick to my stomach. I only took it until the bad pain was a little more tolerable and I got rid of it. I never tried it for head pain and don’t think I want to. I had Tylenol w/Codeine when I tore my rotator cuff a few years back and it didn’t ease the pain then they told me to take 3 Motrin that would be the same as the RX strength. It was so-so but I could tolerate the pain better. I agree it’s hard to handle body pain because it’s all so different and hard to manage because one pill does not fit all. But the narcotics scare me because of the addictive part to it.

  • Dr Marcus author
    6 years ago

    Julie — it’s interesting that, although we call narcotics “pain killers,” they really don’t effectively treat all types of pain. While narcotics will help with something like kidney stone pain, musculoskeletal pain is reduced much more effectively for most people with drugs like aspirin, Tylenol, or Motrin. That’s not because kidney stone pain is more severe or “more real” — it’s because different types of pain respond differently to different classes of medications. I am old enough to remember migraine treatments before the triptans, when we relied heavily on narcotics for bad migraines. We got a lot of people sedated, but not a lot relieved of pain. Drs. Saper and Lake have conducted some nice long-term studies looking at the effectiveness of narcotics for migraine and they also find that, while effective for a handful of people, most people don’t benefit. That’s why most doctors reserve narcotics for infrequent rescue medication with therapies they think will likely be more effective haven’t worked and they’re just trying to get a small reduction in pain. If most people responded well to narcotics, they’d instead likely be a first line option for migraine. That being sad, occasional use in people who find they really do help as rescue therapy is not a bad thing and can be very helpful in preventing ER visits, etc. If you’ve been prescribed narcotics and they don’t work for your migraine, it’s definitely wise to do like you did and get them out of the house.

  • Julie
    6 years ago

    It was March 2012 he prescribed them originally. Sorry, I didn’t specify orginally.

  • fionafletcher
    6 years ago

    I have tried every migraine remedy under the sun, and the ONLY thing that helps is pethidine. Research in the above article aside, we are all different, and we respond differently to treatments. There needs to be room in prescribing guidelines for exceptions to the rule, and at the moment there isn’t. Animal studies are a joke – sheep can safely eat hemlock while a tiny amount will kill a human. People can gorge on chocolate, while this can kill a dog. The list is endless and I am NOT a rodent.

    The guidelines themselves constantly churn out phases such as ‘generally, usually, may’ etc, then suddenly we have this blanket law that applies to everyone.

    Patients themselves should be allowed to play a larger part in managing their chronic pain and when nothing else works, they need to be given what they know works for them. I am an individual, not a statistic and I am tired or trying to fight the people who should be helping me when they do nothing more than churn up reports and statistics while I leave the doctors office in agony!!

  • Justanothermigraine
    6 years ago

    what I’d like to know is how and why do so many doctors assume we can get through the day without relief from pain? I’m not saying all of the pain. I don’t think that is possible on any medication for more than 15 mins and there are always side effects. I stay in my room crying in pain as my husband shakes his head and is stuck with three small kids again. No one gets it and I’m afraid I’ll end up alone. If I take a vicodin, I get my husband,kids, family and job. Why don;t don’t doctors understand this? When I’m in constant pain I’m good for nothing, for nobody and might as well be dead. I wish doctors would understand that a life on heavy pain meds might be better than loosing your life to constant daily debilating pain. the kind of pain that friends and family leave you over. the kind of pain that causes you to not work enough hours to get disability. at the mercy of family shelling out more and more money and for what? no answers and more pain. and the doctors say no relief for more than 3 days a week…ok so the other days I’ll just watch my life fall apart because i simply can;t cope with the pain. ok…see you doc, in another month. Maybe then we can try one more non-pain relieving drug for another month.how about a non-generic that costs as much as my mortgage which i can;t afford?

  • Serena Jacobson
    6 years ago

    Amen!!! I can’t have many so call migraine medications, like all triptans. I sometimes need percocet and ketoralac just to get through the day.

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