By strong painkillers, most people mean the ones that contain opiates [1]. The most common opiate included in the combination drug analgesics is codeine. Although such medications are in some ways good painkillers, there are reasons to try to avoid them in migraine [2].
For one thing, they don’t usually work as well as the triptans [3] and DHE for severe attacks, and NSAIDs may work as well or better for less severe attacks. Furthermore, the opiates are potentially addicting if used frequently.
Some migraine patients have a lot of anxiety, and may end up at times taking the opiates to treat anxiety rather than the head pain. Finally, migraine is somewhat special among pain conditions in that the opiates may make the pain condition worse, with the development of more and more frequent headaches if the opiates are being taken too often.
In short, all in all there are better options available for most people with migraine. If you must use the opiate containing combination analgesics, perhaps because you have contraindications to the more effective migraine medications, because nothing else works, or because they are so inexpensive, then it is important to not use them too frequently.
If you end up using them on 10 days a month or more, it is clearly time to talk to your doctor about other alternatives for you migraine.
People with migraine should be aware that some combination analgesics in Canada that are available without a prescription do contain small amounts of codeine, and the above recommendations apply to those as well.
Such medications can cause a lot of problems for migraine sufferers if they are taken too often. In many countries in the world codeine containing medications are not available without a prescription. However, in Canada they are still available, so if in doubt, talk to your pharmacist or doctor about what exactly is in the pills you are taking.