Chronic Migraine Management and Opioid Use

This assignment involves analyzing the effectiveness of tramadol in managing chronic migraines while considering ethical constraints. It also discusses the long-term side effects of opioids like serotonin syndrome and seizures. As a care provider, conveying accurate information to patients about these risks is essential for informed decision-making.

Running head: ETHICS OF OPIOID USE IN MIGRAINE
Ethics of Opioid use in migraine
Name of the student:
Name of the university:
Author note:

1ETHICS OF OPIOID USE IN MIGRAINE
Migraine can be defined as one of the most frequently observed public health priority that
has engulfed almost all of the different age groups that struggle with the different kinds of the
migraine depending on the age group of the patients and the trajectory of the migraine that they
are suffering from. However, despite the increased administration of the non-pharmacological
pain management techniques and the non-steroidal drugs that can be administered to the patients,
the chronic migraine is often not able to be managed by the mild non-pharmacological and non-
steroidal means (Natoli et al., 2010). That is the reason the administration of the different
narcotics has still not diminished, especially the opioids. This assignment will attempt to
discover the ethics of usage of opiates in management of chronic migraine and reflect on the
different factors associated with the situation.
First and foremost, it has to be mentioned that for the definition and recognition of the
chronic migraine can be a very difficult aspect due to the complex and overlapping clinical
features that this health adversity is associated with. According to the international headache
society, an episode of chromic migraine can be defined as the occurrence of consistent and
persistent head ache for the time period of more than fifteen days per month over a three month
period with eight or more days of acute migraine pain. On a more elaborative note, it can be
stated that any individual suffering with chronic migraine is suffering with this acute head ache
for more than half of the month all throughout the year. In term of incidence rate and prevalence
of the disease, it had to be mentioned that in case of the Australia close to 345,800 people
approximately are suffering from some form of chronic migraine. Along with that it has to be
mentioned as well that about 80% among the vast figure of people suffering from this disease do
not receive prompt and effective diagnosis and treatment management (Ferrari, Baraldi &
Sternieri, 2015).

2ETHICS OF OPIOID USE IN MIGRAINE
On a similar note, it can be stated that the misdiagnosis and later diagnosis of the chronic
migraine often leads to the signs and symptoms becoming too far along for the mild non
pharmacological and non- steroidal medications to work properly. Hence the need for the
narcotic medications has been high in these patients to attempt to control the intensity of the pain
that these patients are suffering with. Among the different narcotics that are generally used in
such cases, the opioids are the most frequently found alternative to non-steroidal drugs
(Papaleontiou et al., 2010). Along with that it has to be mentioned that the patients often use
opiates as over the counter medication for the headache without the discretion of a certified
medical practitioner. This further escalates the detrimental impacts of the opioids based drugs on
the body of the patient.
Elaborating on the detrimental impacts of the use of the opioids based drugs for migraine or
chronic migraine. There are a horde of different issues that the patients can suffer from.
According to the research it has to be mentioned that the opioids pro-nociceptive, and their
unprecedented use can easily lead to various harmful pathophysiologic changes. Along with that
it has to be mentioned that there is little to no evidence present in the literature about and clinical
randomized control trail or other case control studies proving the safe usage or pain free results
for the treatment program of chronic migraine with the opioids. The most reliable and relevant
research indicates that the use of the medication can yield very temporary and minimal
effectiveness on the migraine (Tepper, 2012).
Furthermore, according to the research, it can be mentioned that the adverse effects of the
opioids quick and easily become permanent. A few adverse effects of the opioid use include
Decreased gray matter, release of calcitonin gene-related peptide, dynorphin, and pro-

3ETHICS OF OPIOID USE IN MIGRAINE
inflammatory peptides, and activation of excitatory glutamate receptors (Tepper, 2012). Hence,
there are various ethical considerations of the use of opioids for the chronic migraine patients.
However, tramadol, an atypical opioids is a narcotic analgesic that is being increasing used in
the pain management. The effectiveness of the intravenous tramadol has been found to be highly
efficient in the management of the diseases with acute pain like in chronic migraine. It has to be
mentioned in this context that the effectiveness of the tramadol is facilitated by the cumulative
and targeted action of the two enantiomers and the metabolites, M111,12. Elaborating more on the
mode of action on this particular opiate, it has to be mentioned that the negative enantiomer of
the tramadol compound inhibits norepinephrine reuptake, and on the other hand, the positive
enantiomer functionally interacts with p-opioid receptors and in turn increases synaptic serotonin
concentrations. Hence the effectiveness of the medication in case of relieving pain is effective,
however, the ethical constraints of opioid usage still apply in the usability of the tramadol in case
of the chronic migraine (Alemdar, Pekdemir & Selekler, 2007).
There have been many research has stated that Tramadol has a mu binding affinity that is
6000 times lesser than that is observed in case of the normal opiates like morphine. Hence this
particular drug has also been stated as the partial mu agonist in most cases with the minimal side
effects when considered with opiates. Although, despite the lesser impact the side effects of
tramadol cannot be ignored either, hence the FDA approval for the labelling for the medicine
includes standard warning for risk of seizure and serotonin syndrome (Maumus, 2015).
Reflecting on my own professional practice, I can state long term side effects of such opiates
like the serotonin syndrome or seizure cannot be taken lightly by the health care providers.
Although as a care provider, the pain and distress of the patient suffering from chronic migraine,
must also have precedence in clinical decision making. Hence, in my practice, I would ensure

4ETHICS OF OPIOID USE IN MIGRAINE
that conveyance of accurate information regarding the possible side effects and its long term
impact on the health and wellbeing is appropriately and effectively provided to the patients. So
that the patients can have the choice of the decision making when they opt for opiate or non
opiate medication when struggling with chronic migraine.

5ETHICS OF OPIOID USE IN MIGRAINE
Reference:
Alemdar, M., Pekdemir, M., & Selekler, H. M. (2007). Single-dose intravenous tramadol for
acute migraine pain in adults: a single-blind, prospective, randomized, placebo-controlled
clinical trial. Clinical therapeutics, 29(7), 1441-1447.
Buse, D. C., Pearlman, S. H., Reed, M. L., Serrano, D., Ng‐Mak, D. S., & Lipton, R. B. (2012).
Opioid use and dependence among persons with migraine: results of the AMPP
study. Headache: The Journal of Head and Face Pain, 52(1), 18-36.
Ferrari, A., Baraldi, C., & Sternieri, E. (2015). Medication overuse and chronic migraine: a
critical review according to clinical pharmacology. Expert opinion on drug metabolism &
toxicology, 11(7), 1127-1144.
Maumus, M. (2015). Bioethics in Practice-The Ethics of Opiate Use and Misuse from a
Hospitalist's Perspective. The Ochsner Journal, 15(2), 124-126.
Natoli, J. L., Manack, A., Dean, B., Butler, Q., Turkel, C. C., Stovner, L., & Lipton, R. B.
(2010). Global prevalence of chronic migraine: a systematic review. Cephalalgia, 30(5),
599-609.
Papaleontiou, M., Henderson Jr, C. R., Turner, B. J., Moore, A. A., Olkhovskaya, Y., Amanfo,
L., & Reid, M. C. (2010). Outcomes associated with opioid use in the treatment of
chronic noncancer pain in older adults: a systematic review and meta‐analysis. Journal of
the American Geriatrics Society, 58(7), 1353-1369.
Tepper, S. J. (2012). Opioids should not be used in migraine. Headache: The Journal of Head
and Face Pain, 52(s1), 30-34.

6ETHICS OF OPIOID USE IN MIGRAINE
Veal, F. C., Bereznicki, L. R., Thompson, A. J., & Peterson, G. M. (2015). Use of opioid
analgesics in older Australians. Pain Medicine, 16(8), 1519-1527.