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Case studies

A 54-year-old woman with migraine and recently escalating opioid use

Michael Eller, Ian Thong

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Abstract

A neurologist and a GP/pain medicine specialist discuss their own aspects of care of this middle-aged woman with migraine who has recently escalated her opioid use and is also taking benzodiazepines.

Key Points

  • Opioids should be avoided in migraine therapy.
  • Opioids can alter the biology of migraine over time, making migraine symptoms more frequent and intense.
  • An inpatient approach may be warranted to wean patients off opioids and benzodiazepines and break a drug overuse headache cycle.
  • Pain management is multidimensional and the psychosocial, environmental and biomedical aspects are equally important.
  • Dependence and addiction are psychosocial as well as neurobiological.
  • Shared care with a pain or addiction specialist may ease the burden of managing patients who are addicted to opioids; such patients often benefit from a comprehensive care plan.

    Picture credit: © Hattie Young/SPL

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