The Role of Opioid Therapy in Managing Chronic Daily Headache*

Vol. 2, No. 21 ■ November 2002 Opioids have long been used to treat intractable headache, although not every practitioner is willing to use these agents. Because of their addictive nature, opioids can be a medicolegal minefield, with the recent oxycodone controversy a current example. However, groups such as the American Pain Society and the American Academy of Pain Medicine (AAPM) have worked legislatively with the American Medical Association to garner increased funding from Congress for research and treatment. The Decade of Pain Control and Research began January 1, 2001, with passage of HR3244 (Title VI, Sec. 1603). The AAPM has also worked with the Federation of State Medical Boards to create a clinical guideline for the appropriate use of opioid medications in treating pain. AAPM is also developing an educational program for primary care professionals on pain assessment, opioid use, detection of addiction, and prevention of diversion. Organizations such as the National Committee for Quality Assurance and Joint Commission on Accreditation of Healthcare Organizations are working toward evidence-based measures of pain treatment. Indeed, pain has become the “fifth vital sign.” The following is a summary of a roundtable discussion among 3 renowned experts on migraine and pain management. They share their clinical pearls on chronic opioid use in chronic daily headache (CDH).