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…