Pain killers

What about strong pain killers? 


This is a very common question for cluster headache patients, and the answer is actually not about your GP ignoring you — it’s because strong painkillers simply do not work for cluster headaches, and in some cases, they can make things worse or even dangerous.

Here’s the real, medically accurate explanation your GP would give if they had time to explain it properly.

 1. Strong painkillers do not affect the cluster headache pathway

Cluster headaches are not like:

  • migraines
  • tension headaches
  • injury pain
  • inflammatory pain
  • nerve compression pain

CH pain comes from a trigeminal–autonomic reflex loop driven by the hypothalamus.

This loop is totally unaffected by:

  • morphine
  • codeine
  • oxycodone
  • tramadol
  • endone
  • fentanyl
  • hydromorphone
  • ketorolac
  • NSAIDs

Doctors have known for decades:

❌ Opioids do not reduce the pain

❌ Opioids do not shorten the attack

❌ Opioids do not abort the attack

Even IV morphine in hospital cannot touch a cluster attack for most people.

This is why strong painkillers are not part of any CH guideline worldwide.


2. Opioids actually slow your breathing — a huge problem for CH

Cluster brains are extremely sensitive to oxygen levels.

Anything that causes even a tiny drop in respiratory rate can trigger attacks or worsen them, especially at night.

Opioids cause:

  • slower breathing
  • shallower breathing
  • CO₂ retention
  • slight oxygen drop

This is the opposite of what a CH brain needs.

This is why neurologists and headache specialists say:
“Opioids are contraindicated in cluster headache.”


3. Opioids increase the chance of rebound headaches

Cluster headaches are NOT rebound headaches —
but opioids can destabilise the trigeminal system and lead to:

  • more frequent attacks
  • worse shadows
  • more severe attacks
  • sleep disturbance → more REM attacks

So even if an opioid felt like it took the edge off, it may make later attacks worse.


4. They delay proper treatment

If your GP gave you endone or oxycodone, you might use:

  • opioids
    instead of
  • oxygen
  • triptans
  • steroids
  • preventives

And this delays the correct treatment that actually works.

Doctors are taught clearly:

Never treat cluster headaches with painkillers.
Treat them with abortives and preventives.

5. Some GPs also worry about long-term risks

Not because they think you’re drug-seeking — simply because cluster headaches can push people to use opioids daily, which very quickly leads to:

  • tolerance
  • dependence
  • rebound headaches
  • withdrawal headaches
  • worsening sleep (which worsens CH)

So they avoid going down that path entirely.


 6. The ONLY effective treatments for CH attacks are:

✔ High-flow oxygen (12–15 L/min)
✔ Sumatriptan nasal spray (Imigran) (discontinued in Australia)
✔ Zolmitriptan nasal spray
✔ Subcutaneous sumatriptan (discontinued in Australia)
✔ Ketamine nasal spray (an emerging option)
✔ Ice + cold air (in many people)
✔ Energy drinks (taurine + caffeine)
✔ Occipital nerve block (preventive)


Opioids are not on the list because they simply do nothing in the CH pain pathway.