About all

Tramadol and headaches: Side effects of tramadol – NHS

Side effects of tramadol – NHS

Like all medicines, tramadol can cause side effects, although not everyone gets them. Talk to your doctor or pharmacist if the side effects listed below bother you or do not go away.

Very common side effects

Very common side effects of tramadol happen in more than 1 in 10 people and include:

  • feeling sick
  • feeling dizzy

Common side effects

These common side effects of tramadol happen in more than 1 in 100 people. There are things you can do to help cope with them.


Make sure you rest, and drink plenty of fluids. It’s best not to drink alcohol with tramadol as you’re more likely to get side effects, like feeling sleepy. Ask your pharmacist to recommend a painkiller. Headaches should usually go away after the first week of taking tramadol. Talk to your doctor if they last longer than a week or are severe.

Feeling sleepy, tired, dizzy or “spaced out”

These side effects should wear off within a week or two as your body gets used to tramadol. Talk to your doctor if they carry on for longer. Do not drink any alcohol as this will make you feel more tired.

Feeling or being sick (nausea or vomiting)

Stick to simple meals and do not eat rich or spicy food. It might help to take your tramadol after you’ve eaten a meal or snack. If you’re being sick, try small frequent sips of water. Speak to a pharmacist if you have signs of dehydration, such as peeing less than usual or having dark, strong-smelling pee.

If tramadol continues to make you sick, or feel sick, tell your doctor. They may be able to prescribe a medicine which can also protect your stomach. If tramadol makes you vomit or have severe diarrhoea for more than 24 hours, your contraceptive pills may not protect you from pregnancy. Check the pill packet to find out what to do.


Try to get more fibre into your diet such as fresh fruit and vegetables and cereals. Also try to drink several glasses of water, or another non-alcoholic drink, every day. If you can, it may also help to do some gentle exercise like swimming or going for a short walk.

Speak to your doctor about medicine to help prevent or treat constipation caused by tramadol if your symptoms do not go away.

Dry mouth

Try chewing sugar-free gum or sucking sugar-free sweets. Your doctor may also prescribe an artificial saliva substitute to keep your mouth moist. This comes as a spray, gel or lozenge.


Try wearing loose clothing, using a strong anti-perspirant and using a fan, if possible. If this does not help and you find it unbearable, speak to your doctor as you may need to be treated with a different type of painkiller.

Low energy

Speak to your doctor as they may be able to adjust your dose or give you a different painkiller.

Serious side effects

Serious side effects happen in less than 1 in 100 people.

Call your doctor or call 111 now if you:

  • feel dizzy, tired and have low energy – these can be a sign of low blood pressure
  • have hallucinations (seeing or hearing things that are not there)
  • feel confused
  • feel very sleepy
  • have trouble peeing or you cannot pee at all

Immediate action required: Call 999 or go to A&E now if you or your child:

  • have a seizure or fit
  • have breathing difficulties or short shallow breathing

Serious allergic reaction

In rare cases, it’s possible to have a serious allergic reaction (anaphylaxis) to tramadol.

Immediate action required: Call 999 now if:

  • your lips, mouth, throat or tongue suddenly become swollen
  • you’re breathing very fast or struggling to breathe (you may become very wheezy or feel like you’re choking or gasping for air)
  • your throat feels tight or you’re struggling to swallow
  • your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
  • you suddenly become very confused, drowsy or dizzy
  • someone faints and cannot be woken up
  • a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)

You or the person who’s unwell may also have a rash that’s swollen, raised, itchy, blistered or peeling.

These can be signs of a serious allergic reaction and may need immediate treatment in hospital.

Other side effects

These are not all the side effects of tramadol. For a full list, see the leaflet inside your medicine packet.


You can report any suspected side effect using the Yellow Card safety scheme.

Visit Yellow Card for further information.

Page last reviewed: 19 January 2022

Next review due: 19 January 2025

Tramadol/acetaminophen for the treatment of acute migraine pain: findings of a randomized, placebo-controlled trial

Randomized Controlled Trial

. 2005 Nov-Dec;45(10):1317-27.

doi: 10.1111/j.1526-4610.2005.00264.x.

Stephen D Silberstein 
, Frederick G Freitag, Todd D Rozen, David B Kudrow, David J Hewitt, Donna M Jordan, Alan C Fisher, Norman R Rosenthal; CAPSS-223 Investigators



  • 1 Jefferson Medical College, Philadelphia, PA, USA.
  • PMID:


  • DOI:


Randomized Controlled Trial

Stephen D Silberstein et al.


2005 Nov-Dec.

. 2005 Nov-Dec;45(10):1317-27.

doi: 10.1111/j.1526-4610.2005.00264.x.


Stephen D Silberstein 
, Frederick G Freitag, Todd D Rozen, David B Kudrow, David J Hewitt, Donna M Jordan, Alan C Fisher, Norman R Rosenthal; CAPSS-223 Investigators


  • 1 Jefferson Medical College, Philadelphia, PA, USA.
  • PMID:


  • DOI:




To compare tramadol/acetaminophen (APAP) and placebo for the management of acute migraine pain.


Tramadol/APAP tablets reduced moderate-to-moderately severe acute pain in controlled studies of other painful conditions.


This randomized, double-blind, placebo-controlled, parallel group study enrolled adults with migraine pain as per International Headache Society criteria. Subjects took tramadol/APAP (total dose, 75 mg/650 mg) or placebo for a typical migraine with moderate-to-severe pain. Severity of pain and migraine-related symptoms were recorded before study medication and at 0.5, 1, 2, 3, 4, 6, and 24 hours after study medication.


Efficacy analyses included 305 subjects (154 tramadol/APAP and 151 placebo). Treatment response was higher for tramadol/APAP than a placebo at 2 hours after dosing (55.8% vs. 33.8%, P < .001) and at every other assessment from 30 minutes (12.3% vs. 6.6%) through 6 hours (64.9% vs. 37.7%) (all P< or = .022). Subjects in the tramadol/APAP group were more likely than those in the placebo group to be pain-free at 2 hours (22.1% vs. 9.3%), 6 hours (42.9% vs. 25.2%), and 24 hours (52.7% vs. 37.9%) (all P< or = .007). Two hours after dosing, moderate-to-severe symptoms that were less common for tramadol/APAP than placebo included photophobia (34.6% vs. 52.2%, P= .003) and phonophobia (34.3% vs. 44.9%, P = .008), but not migraine-related nausea (38.5% vs. 29.4%, P= .681). Treatment-related adverse events included nausea, dizziness, vomiting, and somnolence.


Tramadol/APAP reduces the severity of pain, photophobia, and phonophobia associated with migraine headache, but does not reduce migraine-associated nausea. Tramadol/APAP might be an appropriate option for the management of moderate-to-severe migraine headache.

Similar articles

  • Tramadol 37.5-mg/acetaminophen 325-mg combination tablets added to regular therapy for rheumatoid arthritis pain: a 1-week, randomized, double-blind, placebo-controlled trial.

    Lee EY, Lee EB, Park BJ, Lee CK, Yoo B, Lim MK, Shim SC, Sheen DH, Seo YI, Kim HA, Baek HJ, Song YW.

    Lee EY, et al.
    Clin Ther. 2006 Dec;28(12):2052-60. doi: 10.1016/j.clinthera.2006.12.019.
    Clin Ther. 2006.

    PMID: 17296461

    Clinical Trial.

  • Single-dose intravenous tramadol for acute migraine pain in adults: a single-blind, prospective, randomized, placebo-controlled clinical trial.

    Alemdar M, Pekdemir M, Selekler HM.

    Alemdar M, et al.
    Clin Ther. 2007 Jul;29(7):1441-7. doi: 10.1016/j.clinthera.2007.07.017.
    Clin Ther. 2007.

    PMID: 17825695

    Clinical Trial.

  • Randomized study of tramadol/acetaminophen versus placebo in painful diabetic peripheral neuropathy.

    Freeman R, Raskin P, Hewitt DJ, Vorsanger GJ, Jordan DM, Xiang J, Rosenthal NR; CAPSS-237 Study Group.

    Freeman R, et al.
    Curr Med Res Opin. 2007 Jan;23(1):147-61. doi: 10.1185/030079906X162674.
    Curr Med Res Opin. 2007.

    PMID: 17257476

    Clinical Trial.

  • The ‘Act when Mild’ (AwM) study: a step forward in our understanding of early treatment in acute migraine.

    Goadsby PJ.

    Goadsby PJ.
    Cephalalgia. 2008 Sep;28 Suppl 2:36-41. doi: 10.1111/j.1468-2982.2008.01689.x.
    Cephalalgia. 2008.

    PMID: 18715331


  • Combination analgesia in 2005 – a rational approach: focus on paracetamol-tramadol.

    Schug SA.

    Schug SA.
    Clin Rheumatol. 2006;25 Suppl 1:S16-21. doi: 10.1007/s10067-006-0202-9. Epub 2006 Jun 2.
    Clin Rheumatol. 2006.

    PMID: 16741784


See all similar articles

Cited by

  • Acute Treatments for Episodic Migraine in Adults: A Systematic Review and Meta-analysis.

    VanderPluym JH, Halker Singh RB, Urtecho M, Morrow AS, Nayfeh T, Torres Roldan VD, Farah MH, Hasan B, Saadi S, Shah S, Abd-Rabu R, Daraz L, Prokop LJ, Murad MH, Wang Z.

    VanderPluym JH, et al.
    JAMA. 2021 Jun 15;325(23):2357-2369. doi: 10.1001/jama.2021.7939.
    JAMA. 2021.

    PMID: 34128998
    Free PMC article.

  • Consensus of the Hellenic Headache Society on the diagnosis and treatment of migraine.

    Kouremenos E, Arvaniti C, Constantinidis TS, Giannouli E, Fakas N, Kalamatas T, Kararizou E, Naoumis D, Mitsikostas DD; Hellenic Headache Society.

    Kouremenos E, et al.
    J Headache Pain. 2019 Dec 13;20(1):113. doi: 10.1186/s10194-019-1060-6.
    J Headache Pain. 2019.

    PMID: 31835997
    Free PMC article.

  • Migraine Treatment: Current Acute Medications and Their Potential Mechanisms of Action.

    Ong JJY, De Felice M.

    Ong JJY, et al.
    Neurotherapeutics. 2018 Apr;15(2):274-290. doi: 10.1007/s13311-017-0592-1.
    Neurotherapeutics. 2018.

    PMID: 29235068
    Free PMC article.


  • [The role of opioids in the treatment of primary headache disorders].

    Totzeck A, Gaul C.

    Totzeck A, et al.
    Schmerz. 2014 Apr;28(2):135-40. doi: 10.1007/s00482-013-1380-4.
    Schmerz. 2014.

    PMID: 24500765


  • Analgesic activity of fixed dose combinations of paracetamol with diclofenac sodium and paracetamol with tramadol on different pain models in healthy volunteers – A randomized double blind crossover study.

    Tripathi S, Shah R, Sharma DC.

    Tripathi S, et al.
    J Anaesthesiol Clin Pharmacol. 2012 Oct;28(4):465-9. doi: 10.4103/0970-9185.101912.
    J Anaesthesiol Clin Pharmacol. 2012.

    PMID: 23225925
    Free PMC article.

See all “Cited by” articles

Publication types

MeSH terms


TRAMADOL – fast and effective relief from pain

There is hardly a person who is not familiar with the feeling of pain. Even the ancient Greeks said: “Pain is the watchdog of health.” Indeed, it is pain that warns the body of imminent danger.

Today, a large number of painkillers of foreign and domestic production are presented on the pharmaceutical market. Among them is TRAMADOL, the production of which was recently mastered by the Kharkiv OJSC “Pharmaceutical Firm “Health”.

TRAMADOL produced by this enterprise is produced according to domestic technology using an imported substance (tramadol hydrochloride) from Heumann Pharma Gmbh (Austria).

TRAMADOL is a highly effective non-narcotic centrally acting analgesic intended for oral administration in acute or chronic pain of various etiologies. TRAMADOL belongs to the class of moderately toxic drugs and is well tolerated.

Being an opiate receptor agonist-antagonist, the drug has a pronounced analgesic activity. Its action occurs 20 minutes after administration and lasts up to 5 hours.

The drug effectively eliminates moderate pain in the postoperative period, with injuries, biliary colic, myocardial infarction, during painful diagnostic procedures. In addition, TRAMADOL has an antitussive effect.

When taken in therapeutic doses, TRAMADOL does not cause respiratory depression and does not affect intestinal motility.

The drug is produced in gelatin capsules of 0.05 g. Adults and children over 14 years old are prescribed 1 capsule with a small amount of liquid.

During treatment with TRAMADOL, some precautions should be observed: avoid driving a car and performing potentially hazardous activities that require increased attention or speed of mental and motor reactions.

Patients with impaired liver or kidney function should start treatment with the drug with minimal doses. Special care must be taken when taking TRAMADOL when prescribing it to patients with drug and alcohol addiction.

More than 20 years of clinical experience in the use of tramadol preparations abroad and in Ukrainian clinics testifies to the compliance of the drug with modern requirements for an effective and safe drug to eliminate pain.

It should be noted that TRAMADOL produced by the Pharmaceutical Company Zdorovye is affordable for a wide range of consumers. Its cost is lower than that of foreign analogues.

For more information
and for purchasing
, please contact:
JSC “Pharmaceutical Firm “Health”
61013, Kharkiv, st. Shevchenko, 22
Tel.: (0572) 14-97-16
Fax: (0572) 12-05-88

unique dual mechanism of action implemented in the central nervous system (CNS).


Tramadol is a centrally acting analgesic
with a unique dual mechanism of action implemented in the central nervous
system (CNS). It has an agonistic effect on opiate receptors
and prevents the reuptake of neurotransmitters. Tramadol is also weak
binds to µ-opiate receptors, blocking the transmission of pain signals in
brain. Tramadol effectively controls postoperative pain, however
not suitable for use as an adjuvant to anesthesia in
associated with weak sedative properties.


  • Moderate or severe pain
  • Pain
  • Acute musculoskeletal pain

Tramadol is a centrally acting opioid analgesic. Although its mechanism of action is not fully understood, based on animal studies, at least two complementary mechanisms are possible: binding of the parent substance and the M1 metabolite to μ-opioid receptors and weak inhibition of norepinephrine and serotonin reuptake. The opioid activity is due to the low affinity of the parent compound and the high affinity of the O-demethylated metabolite M1 for μ-opioid receptors. The relative role of tramadol and M1 in human pain relief is determined by the plasma concentration of each substance. Tramadol inhibits the reuptake of norepinephrine and serotonin in vitro , similar to other opioid analgesics. These mechanisms may play an independent role in the overall analgesic effect of tramadol.


Adults: 50-100 mg orally every 4-6 hours
needed for pain relief

Children: 1-2.5 mg/kg orally every 8 hours when
necessary for pain relief


Absorption of tramadol is 34%±34. Volume of distribution
is 2.71 l / kg, binding to plasma proteins – 20%. With urine
30% of the drug is excreted (in unchanged form), 60% (in the form of metabolites),
the plasma half-life is 6.3 hours.

  • Hypersensitivity to opioids
  • Situations where opioids are contraindicated, including acute
    intoxication with the following substances: alcohol, sleeping pills,
    centrally acting painkillers, opioids or psychotropic
    drugs. In such patients, the drug may exacerbate CNS depression and
  • Combination of tramadol and MAO inhibitors (either in
    within 14 days after discontinuation of such therapy) is contraindicated
  • Concomitant use of CYP2D6 and/or CYP3A4 inhibitors,
    e.g. quinidine, fluoxetine, paroxetine and amitriptyline (inhibitors
    CYP2D6), ketoconazole and erythromycin (CYP3A4 inhibitors) may reduce
    metabolic clearance of tramadol, increasing the risk of serious
    adverse events, including seizures and serotonin syndrome
  • Patients taking carbamazepine may experience
    significantly weaker analgesic effect of tramadol hydrochloride

Common (> 1/10, < 1/100):

  • Abdominal disorders (diarrhea, constipation,
    nausea or abdominal pain)
  • Depression
  • Skin disorders (itching, rash or sweating)
  • Generalized pain or pain in the muscles and joints

Uncommon (> 1/100, < 1/100 0):

  • Joint swelling
  • Change in body weight
  • Severe headache
  • Fall
  • Confusion
  • Severe cough

Very rare (< 1/10000):

    9 0064 Blistering under the skin
  • Blood in urine
  • Chest pain
  • Seizures
  • Seizures
  • Dark urine
  • Fainting
  • Numbness of extremities
  • Icteric coloration of eyes and skin
  • Pre-existing diseases of the kidneys, liver, epilepsy,
    history of lung disease, drug dependence or allergy
  • Pregnancy and breastfeeding
  • Use of drugs such as
    tranquilizers, sleeping pills or other pain medications containing
  • Acute diseases of the abdominal organs
    cavities subject to clinical evaluation
Clinical data
      • Tramadol is a centrally acting analgesic,
        which is similar in structure to codeine and morphine. Its effect in
        relief of the postoperative share is comparable to that
        pethidine. The analgesic effect of tramadol is increased in combination with
        non-opioid analgesics. Tramadol is effective and well tolerated
        patients when used to relieve pain after trauma, renal or
        hepatic colic or during childbirth. The drug is also used to treat
        chronic pain of malignant or non-malignant origin, in
        features in neuropathic pain. Tramadol is less likely to cause constipation and
        dependence compared to powerful opioids in similar analgesics
      • The effectiveness of tramadol in the treatment
        moderate or severe postoperative pain has been shown in outpatient and
        surgical conditions. Unlike other opioids, tramadol does not
        has clinically significant effects on respiratory and cardiovascular
        indicators. This drug may be particularly suitable for patients with
        impaired cardiopulmonary function, including elderly patients, patients with
        obese and smokers, for patients with impaired liver or kidney function, and
        also for patients who are receiving non-steroidal anti-inflammatory drugs
        (NSAIDs) are not recommended or should be used with caution. Tramadol
        for parenteral or oral administration has proven to be effective and
        tolerance for anesthesia during operations.
      • Tramadol is effective for the treatment
        various types of moderate to severe acute and chronic pain, including neuropathic
        pain, back pain, osteoarthritis and uncontrolled pain. The
        the drug also causes fewer side effects that are characteristic of opioids,
        including nausea, drowsiness, vomiting, dry mouth and constipation. Although the study
        literature data showed the presence of an immunostimulating effect
        tramadol, some studies also suggest that
        that the immunosuppressive effect of tramadol is less pronounced compared with
        morphine. Due to pharmacological properties, tramadol is more
        more suitable for patients with gastrointestinal and renal disorders than NSAIDs. Apart from
        proven clinical efficacy, tramadol is a safe drug,
        because it causes respiratory depression to a lesser extent, cardiovascular
        side effects, abuse and dependence compared to others