When to Use Opioids in Chronic Headaches

Afraid the “College” will get on your back for giving opioids to someone with chronic headaches? Can’t get your doctor to listen that you have no quality of life with your headaches? Well here are some guidelines (Not rules – so can be stretched) that might help you in selected cases

Chronic Daily Headache:Transformational Migraine,Chronic Migraine, and Related Disorders
Joel R. Saper, MD
Current Neurology and Neuroscience Reports 2008, 8:100–107 – their criteria

The expectation that one can treat medication overuse headaches outside a pain clinic is perhaps unrealistic- it requires stopping the medication – one would have to keep one’s phone off the hook! It is now realized some cases of medication induced headaches do NOT get better once you stop opioids. I had one patient (prior to me seeing) left in a fetal position while her parents took care of her child – for months until they gave up and gave her her opioids back.

I have used a variety of procedures including IV Dihydroergotamine/Metoclopramide/Dexamethasome every 8 hours (best I can think of is two IV doses in office am and afternoon and intranasal and oral for the night dose  – as trying to do this in emergency is worthless). I will work neck cervicogenic, scalene, first rib, occipital neuralgia, trochear, corrugator and TMJ factors out some first. A diary is essential.
I would be interested in what others thought of this criteria…

cgdamenoutlet cgdamenoutlet

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One Response to When to Use Opioids in Chronic Headaches

  1. rusty says:

    age>30????? its a terrible your age is a labeling master status
    I don’t mean to sound Narcissistic but you obviously went to college to be a doctor….
    …Imagine having to stop this wonderfull= college, of infinite learning and possibilities, maybe even trying to become a doctor, because your headaches are so bad you start trying to cut the pain out…physically starting to try& cut it out because that hurt less than the tissue…
    AND now due to my age I can not recieve the only thing that allows me to get up and withstand the morning glare…but your practice is flawed…I had no idea these were my criterions….
    The best advice you might as well give your patients is to stop hoping a piece of ice falls on them from an airplane on approach…but tell them to get closer to the runway

    1) These are only guidelines
    2) I did not make up these guidelines – they are quoted from an article

    I do agree they seem unfair article

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