Medicines to avoid in migraine attacks

Morphine and related opioid pain relievers, such as pethidine, codeine, oxycodone, and buprenorphine should rarely, if ever, be used in the treatment of migraine, and even then only under specialist supervision. They can aggravate nausea and vomiting and are potentially addictive.

Many pharmacy-only pain relievers contain paracetamol, aspirin or ibuprofen in combination with low doses of codeine. These medicines are frequently promoted for the relief of strong pain, but there is no evidence to suggest they are any more effective for migraine than simple pain relievers. The addition of codeine only increases the risk of side effects and medication overuse headache.

  • British Association for the Study of Headache. Guidelines for all health professionals in the diagnosis and management of migraine, tension-type-type headache, cluster headache and medication overuse headache. Hull: BASH, 2010. (accessed 13 December 2011)
  • Neurology Writing Group. Therapeutic Guidelines: Neurology, Version 4 Updated November 2011 [eTG complete CD-ROM]. Melbourne: Therapeutic Guidelines Ltd, 2011.
  • Rossi S, ed. Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd, 2012.
  • Evers S, Afra J, Frese A, et al. EFNS guideline on the drug treatment of migraine - a revised report of an EFNS task force. European Journal of Neurology 2009;16:968-81.