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.
- 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