Diagnosis of Addiction, Substance Use, and Headache

Abstract

A large proportion of patients who visit headache specialists suffer from chronic headache disorders, many of which are refractory to conventional therapy. In addition to the epidemic of common analgesic overuse, many patients medicate themselves with controlled substances, such as opioids, benzodiazepines, barbiturates, and other sedative hypnotics. Some of these medications have been prescribed by practitioners for either a pain-related or a comorbid condition, while some medications have been obtained illegally, without the knowledge of their doctors.

In order to properly treat these patients, and to effectively eliminate unnecessary medications, the practitioner must be aware not only of all of the patient’s comorbid medical conditions but also of all the medications the patient uses. This includes prescription analgesics, nonprescription analgesics, and illegal agents. With the current spate of both prescription and recreational opioid-related drug overdoses and suicides, it is incumbent on the headache doctor to be cognizant of aberrant drug-related behaviors. The headache physician should know where and how to obtain help for patients at risk of, or exhibiting, addictive behaviors. This chapter discusses these therapeutic options.