Page 319 Acute Pain Management
P. 319






Opioids and acute headache
Although
opioids
are
commonly
used
for
the
emergency
treatment
of
headache
(Vinson,
2002),

they
cannot
be
recommended
for
use
on
a
regular
basis
because
of
the
risk
of
dependency

and
other
opioid‐related
adverse
effects.
The
Australian
Association
of
Neurologists

recommended
that
opioids
should
not
be
used
for
migraine
unless
the
patient
is
unresponsive

to
all
other
measures
or
where
the
use
of
ergot
agents
and
triptans
is
contraindicated
(Lance
et

al,
1997).
Pethidine
in
particular
should
be
avoided
in
the
treatment
of
headache,
due
to

evidence
of
poor
efficacy
compared
with
other
migraine
treatments
(Friedman
et
al,
2008

Level
I)
and
a
higher
risk
of
opioid
dependency.



Key
messages


Tension‐type
headache

1.
 Acupuncture
is
effective
in
the
treatment
of
tension‐type
heachache
(N)
(Level
I
[Cochrane

Review]).

2.
 The
addition
of
caffeine
to
aspirin
or
paracetamol
improves
analgesia
in
the
treatment
of

episodic
tension‐type
heachache
(U)
(Level
I).

3.
 Simple
analgesics
such
as
aspirin,
paracetamol
or
NSAIDs,
either
alone
or
in
combination,

are
effective
in
the
treatment
of
episodic
tension‐type
heachache
(U)
(Level
II).

Migraine

4.
 Triptans
are
effective
in
the
treatment
of
severe
migraine
(U)
(Level
I).

5.
 Aspirin‐metoclopramide
is
effective
in
the
treatment
of
mild‐to‐moderate
migraine
(U)

(Level
I).

6.
 Parenteral
metoclopramide
is
effective
in
the
treatment
of
migraine
(U)
(Level
I).

7.
 Over‐the‐counter
medications,
including
combined
paracetamol‐aspirin‐caffeine

preparations,
are
effective
in
the
treatment
of
migraine
with
mild‐to‐moderate
symptoms

and
disability
(N)
(Level
I).

8.
 Effervescent
aspirin,
ibuprofen
or
dipyrone
are
effective
in
the
treatment
of
migraine
(N)

(Level
I).

9.
 In
children
or
adolescents
with
migraine,
ibuprofen
or
intranasal
sumatriptan
(over
12
 CHAPTER
9

years
of
age)
are
effective
treatments
(N)
(Level
I).

10.
Pethidine
is
less
effective
than
most
other
migraine
treatments
and
should
not
be
used
(N)

(Level
I).

11.
Parenteral
prochlorperazine,
chlorpromazine
or
droperidol
are
effective
in
the
treatment

of
migraine,
especially
in
the
emergency
department
(N)
(Level
II).

12.
Paracetamol
is
effective
in
the
treatment
of
mild‐to‐moderate
migraine
(U)
(Level
II).

13.
A
‘stratified
care
strategy’
is
effective
in
treating
migraine
(U)
(Level
II).

Cluster
headache


14.
Parenteral
triptans
(sumatriptan
or
zolmitriptan)
(S)
or
oxygen
therapy
(U),
are
effective

treatments
for
cluster
headache
attacks
(Level
II).








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pain
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