Norsk
Norwegian Neurological Association

Avoid prescribing opioid/codeine preparations or benzodiazepines for headache

31. JULI 2025

Rationale:

Opioids and benzodiazepines are associated with drug dependency and the development of drug tolerance. Opioids can also increase pain sensitivity and trigger medication overuse headaches.  
If first-line treatment with paracetamol with or without ibuprofen is ineffective for episodic migraine, the next step should be nonsteroidal anti-inflammatory drugs (NSAIDs) such as diclofenac or tolfenamic acid. If NSAIDs are ineffective, triptans should be considered (e.g., sumatriptan, eletriptan, frovatriptan).  

References:

  • Amundsen S, et al. Farmakologisk behandling av migrene Norsk Farmaceutisk Tidsskrift, 2015.
  • Becker WJ. Acute Migraine Treatment in Adults. Headache. 2015.
  • Charles A. Migraine N Engl J Med. 2017
  • Bendtsen L et al. EFNS guideline on the treatment of tension-type headache - report of an EFNS task force. Eur J Neurol 2010