2008 medscape article about opioid overuse

http://www.medscape.com/viewarticle/580812_5

I think we already knew this...

Migraine is a complex disorder that invariably involves multiple transmitter pathways and the prominence of any one particular pathway may differ substantially between patients. There is evidence of an important role for dopamine, serotonin, glutamate, orexin, nitric oxide, CGRP, and others in the pathogenesis of migraine. It is therefore unlikely that a drug which targets any single receptor type or subtype will provide robust efficacy for all migraine sufferers or prevail as the treatment of choice.

Interesting summary...

There is preliminary evidence that opioid use in migraine sufferers renders them less responsive or refractory to acute therapy with triptans and parenteral non steroidal anti-inflammatory drugs, and it is therefore reasonable to postulate that in susceptible migraine sufferers, chronic administration of opioid may render them refractory to the conventional preventive medications clinicians use in practice.

My comments...

In my case, triptans and other drugs have had a marginal track record. They cause more side effects than relief. The exception is Imitrex Injectable and only when the migraine is at a level of 7-9. I still need to follow up with caffeine and Vicodin.

The last paragraph that you pulled was the one that interested me the most. I had 3 back surgeries in '05 and was on painkillers most of that year. Also took a low dose of codeine before the surgeries 3 times a week. Sometime after the surgeries I became resistant to triptans and now even a small dose of opioids will cause a headache and sometimes a migraine.

In my case triptans have NEVER worked. I was involved in the Imitrex study way back in the day. Since then I've tried frova, maxalt, treximet and a handful of others. Nothin', do not pass go.