This case highlights some clinical issues arising from the rescheduling of codeine. A pain physician, an addiction medicine specialist and a neurologist discuss their own particular aspect of care of this patient who has chronic recurrent headache and has been self-medicating with over-the-counter codeine.
- A clear diagnosis of the cause of disabling headache is a vital first step. The most likely cause in this patient is migraine.
- A wide range of highly effective treatment options for migraine prevention and acute treatment are now available.
- Medication overuse headache is a superimposed complication of an underlying headache disorder, and opioids will need to be discontinued in this patient.
- Management requires patient education, supportive care and symptomatic or substitution medication.
- The rescheduling of codeine will present challenges in primary care but equally will contribute to the reduction of harm that opioids have on the community.