Opioids: the role in headache pharmacotherapy.

Optimal acute opioid management involves a continual awareness of the potential for development of MOH. Both the clinician and patient should be aware of the IHS MOH diagnostic criteria. Prophylactic medications should be initiated for patients having two headache days per week. Reduction in headache risk factors should include behavioral modification approaches to headache control earlier in the natural history of migraine. DSO therapy may provide significant long-term relief to a small percentage of patients suffering from intractable chronic daily headaches. A one-month DSO trial may provide a fair indication whether long-term DSO will be of benefit in the otherwise intractable cases.