Some individuals may require opioid treatment when:

1. Other drugs have failed to work effectively in relieving migraines
2. Headache recurs within 24 hours of initial treatment
3. Primary abortive treatments are simply not best for those individuals

Alternative ways to take opioids are also available, including nasal sprays or IVs, which often provide quicker pain relief and help to avoid taking pills when individuals are feeling nauseous and/or vomiting. See Table 6 for a list of opioids that are available and their route of administration.

Table 6. Opioid Pain Medications12
Drug	Route of administration
Codeine in combination with aspirin, acetaminophen (ie, Tylenol® ), or other medications	Oral Subcutaneous (SC) (shot under the skin) Intramuscular (IM) (shot into the muscle) Rectal
Hydrocodone	Oral
Oxycodone	Oral Rectal
Morphine	Oral IV SC IM Rectal Epidural (shot near the spinal cord to be absorbed by the nerves around the spinal cord) Intrathecal (shot into the spinal cord)
Hydromorphone	Oral IV SC IM Rectal
Oxymorphone	SC IM IV Rectal
Levorphanol	Oral SC
Meperidine	Oral IV SC IM Rectal
Fentanyl	Oral IV SC IM Transdermal (applied on the skin)
Methadone	Oral SC IM
Propoxyphene	Oral
Butorphanol (Stadol NS® )	Nasal

Some people may fear taking opioids because they think they will become addicted. It is important to note that, when used appropriately, opioids can provide needed relief and reduce pain during migraine attacks without making individuals become addicted or dependent upon them. Individuals should not suffer needlessly or remain undertreated when effective opioid medication is available.