In addition, barbiturates should never be used in patients suffering from depression, and should be used cautiously in elderly patients or prior to driving or using heavy machinery. The drug is generally well tolerated, although drowsiness and nausea may occur. Because of its adrenergic properties, the drug is contraindicated in patients with severe hypertension, glaucoma or in those taking monoamine oxidase inhibitors. Opioid analgesics have a controversial role in the management of acute migraine, although surveys suggest that opioids, such as codeine, meperidine and oxycodone are commonly prescribed for treatment of migraine. In addition, opioids in combination with antiemetics and antihistamines are commonly used in emergency departments to treat migraine.
Codeine is the opioid most commonly used.
Intranasal butorphanol is a mixed agonist-antagonist, which has a lower potential for drug abuse. When used as a rescue medication in patients with nocturnal headaches, the impact of side effects, such as orthostasis and sedation are not as problematic. Opioids may also be an alternative in patients with menstrual migraine that does not respond to standard abortive agents. More potent narcotic analgesics, such as oxycodone or meperidine are available in combination with simple analgesics. Their use should be limited to reliable patients with severe migraines that are unresponsive to other analgesics, ergots and serotonin agonists.