Overuse of Opioids for Headache Treatment in U.S. EDs

This is important for our chronic pain providers to be aware of this problem.

Authors: Mazer-Amirshahi M et al., Am J Emerg Med 2014 Sep 32:1068

Nationwide, opioids were administered at 35% of ED visits for headache in 2010.

Treatment of primary headache disorders (migraine, tension headache) with opioids is not recommended and is more likely to do harm than good. Researchers reviewed data from the National Hospital Ambulatory Medical Care Survey from 2001 to 2010 to assess trends in opioid use at emergency department (ED) visits with headache listed as a reason for the visit.

The percentage of ED visits for headache during which opioids were administered increased from 21% in 2001 to 35% in 2010.

Comment
Using an opioid to treat tension or migraine headache is not good medicine. Opioids are not recommended, because primary headaches are recurrent, and these agents cause rebound symptoms and are associated with addictions that can be very difficult to manage. Avoid opioids and butalbital (a barbiturate in the Fiorinal family of drugs) when treating primary headache disorders. Treatment guidelines clearly establish the primacy of other medications (sumatriptan, caffeine, nonsteroidal anti-inflammatory drugs, antiemetics) over opioids.