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Can I take tramadol for headache?

Tramadol is not a first-line treatment option for headaches, but may be prescribed in some cases. Here’s what you should know.
By | Oct. 15, 2024
Man with his hand on his head: Can you take tramadol for a headache?

Key takeaways

  • Tramadol is an opioid medication used to treat moderate-to-severe pain.

  • Opioids, including tramadol, are regarded as last-resort medications for headaches due to their risk of rebound headaches and potential for abuse. They are typically reserved for refractory migraines only and should not be used to prevent headaches.

  • Tramadol can cause serious side effects and interact with several different drugs. Because of these risks, consulting with a healthcare provider about the best treatment options is important.

  • There are several tramadol alternatives available, some of which are available over the counter.

In this article:

According to American Family Physician, two-thirds of people experience headache disorders in their lifetime. There are many different types of headaches, and treatments are available to treat and potentially prevent them. Treatments may include over-the-counter (OTC) drugs, such as Advil (ibuprofen), or prescription medications, such as Imitrex (sumatriptan). 

In some cases, especially severe ones, people may wonder if opioid medications, such as tramadol, are a good option for headaches. Tramadol–which is commonly referred to by its brand name Ultram–is a generic opioid medication that’s approved by the Food and Drug Administration (FDA) for moderate-to-severe pain that’s unmanaged by alternative treatments. It’s classified as a Schedule IV controlled substance due to its potential for misuse, abuse, and addiction. While tramadol is an effective treatment option for pain management, opioids are generally regarded as a last resort treatment for headaches. 

Will tramadol help with a headache?

Opioids, such as tramadol, are moderately effective for headache treatment. However, according to American Family Physician, they aren’t considered first-line treatments and should be reserved for refractory, or difficult-to-treat, migraines. Even in cases of refractory migraine, opioids should be used sparingly due to their risks of medication overuse headache (MOH)–or rebound headache–and abuse. They also have no utility in headache prevention. According to the American Headache Society, opioids are considered a last resort, and routine use of opioids can often cause more frequent and severe headaches. Regular use can also lead to opioid dependency, which requires a complicated detoxification process that may, in turn, worsen headache symptoms. 

How does tramadol work for headaches?

Tramadol is an opioid agonist that relieves pain by binding to opioid receptors in the central nervous system (CNS). This reduces the amount of pain you feel. Tramadol is unique from other opioids because it also increases norepinephrine and serotonin levels in the brain, which are chemicals involved with pain perception. 

As an opioid, tramadol is considered a nonspecific headache medication because it works for many types of pain, not just headaches. Other examples of nonspecific migraine drugs are nonsteroidal anti-inflammatory drugs (NSAIDs) and butalbital-containing medications. Migraine-specific medications, such as triptans and ergotamine-containing drugs, are typically recommended for people with moderate to severe headache-related disability. Healthcare providers usually prescribe simple, nonspecific analgesics, such as Tylenol (acetaminophen) and NSAIDs, as first-choice treatments for mild to moderate migraine attacks, while triptans are first-line treatments for moderate to severe migraines. 

How long does it take for tramadol to work for headaches?

According to its prescribing information, tramadol relieves pain within one hour of being taken, and its effects peak after about two to three hours. Although it’s not commonly prescribed for headaches, you can expect tramadol to relieve headaches within a similar timeframe. 

Tramadol dosage for headaches

Due to its risk of overdose, healthcare professionals typically prescribe tramadol at the lowest effective dose for the shortest time needed. If needed, they will increase the dosage slowly every few days until it provides adequate pain relief. The typical starting dosage for general pain is 50 to 100 mg, as needed once every 4 to 6 hours, and the maximum dosage is 400 mg per day. Tramadol may be taken with or without food. 

In a randomized, placebo-controlled trial of over 300 participants, researchers studied the effect of a combination pain medication containing tramadol and acetaminophen on the management of acute migraine pain. They found that participants who took a total daily dose of 75 mg of tramadol and 650 mg of acetaminophen experienced reduced pain, light sensitivity, and sound sensitivity related to migraine headaches in comparison to those who took a placebo (sugar pill). While these researchers evaluated the effects of a combination medication containing tramadol/acetaminophen, it’s helpful to note the total dose of tramadol found to provide headache relief was 75 mg per day. 

Tramadol interactions and side effects

Like many other prescription medications, tramadol can interact with other drugs. These interactions can increase the risk of side effects or make tramadol less effective. Here are some of the common tramadol drug interactions. 

  • Central nervous system (CNS) depressants. As an opioid analgesic, tramadol is a CNS depressant (a drug that slows brain activity) that can cause severe drowsiness and respiratory depression (slowed breathing). If combined with other CNS depressants, such as sleep medications or benzodiazepines, the risk of severe breathing problems and sedation may be increased, which can be life-threatening. Therefore, it’s typically not recommended to take tramadol with other CNS depressants unless the combination is the only or best option. 
  • Medications that increase serotonin levels. Tramadol can also interact with other medications that increase serotonin levels. Common examples include selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and triptans. Taking tramadol with these medications may increase the risk of serotonin syndrome, which is a potentially life-threatening condition caused by excessive levels of serotonin. 
  • Medications that affect how tramadol is broken down in the body. Certain medications can affect how quickly tramadol is broken down in the body. This can increase the risk of side effects from tramadol or make the drug less effective. Examples of these drugs include certain HIV medications, certain antidepressants, and antifungal medications.

Like all opioids, tramadol can cause serious side effects. According to the prescribing information, these may include:

  • Serotonin syndrome 
  • Seizures
  • Suicidal thoughts or behavior
  • Respiratory depression
  • Hormone problems
  • Low blood pressure
  • Serious allergic reactions
  • Withdrawal symptoms

More common side effects of tramadol include:

  • Dizziness
  • Nausea
  • Constipation
  • Headache
  • Sleepiness
  • Vomiting
  • Itchiness 

Tramadol alternatives

According to the American Family Physician, tramadol is a last resort medication for headaches. Healthcare providers typically don’t prescribe tramadol unless your headache is difficult to treat or unresponsive to other medications. Fortunately, there are several alternatives to tramadol for headache relief, including over-the-counter (OTC) and prescription medications. 

Tramadol alternatives that are considered first-choice treatments for headaches include:

  • NSAIDs, such as Advil (ibuprofen) or Aleve (naproxen)
  • Tylenol (acetaminophen)
  • Triptans, such as Imitrex (sumatriptan) and Zomig (zolmitriptan)
  • Combination drugs, such as Excedrin Migraine (acetaminophen/aspirin/caffeine) and Treximet (sumatriptan/naproxen)

Other alternatives regarded as second-choice options according to American Family Physician include: 

Ultimately, it’s best to consult your healthcare provider regarding tramadol alternatives. They can discuss which alternative is best for you based on each medication’s potential risks and benefits. They’ll likely consider your medical history, current medications, and the severity of your condition before deciding on a medication. 

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