title: Opioid Treatment of Migraine: Risk Factors and Behavioral Issues.
abstract: Migraine can impact every aspect of a person's functioning. Psychological comorbidities, cognitive constructs, and behavioral responses to pain greatly impact the perception of migraine pain, treatment efficacy and outcome, and overall quality of life and functioning. Current considerations for migraine treatment emphasize the utility of the biopsychosocial model in understanding and treating migraine, noting both the importance of addressing psychological factors such as cognitive beliefs as well as psychiatric comorbidities. The guidelines for migraine treatment implicate opioid therapy as a second or third tier treatment. Guidelines and recommendations for the safe use of opioid medications among patients with chronic pain emphasize the importance of screening prior to prescribing opioid medications. Chronic opioid therapy has been shown to further levels of disability, decrease quality of life, and correlate to psychiatric comorbidities, concerns that are already present in migraine patients. While opioid treatment provides an alternative for persons with contraindications for alternative migraine treatments, it is critical that opioids be used sparingly and exclusively in conjunction with comprehensive assessment and integration of psychological treatment.
authors.affiliation: Integrated Behavioral Associates, 169 Libbey Parkway, Weymouth, MA, 02189, USA. mstone@cfpsych.org.|South Shore Medical Center, 143 Longwater Drive, Norwell, MA, 02061, USA. mstone@cfpsych.org.
authors.forename: Melissa T
authors.initials: MT
authors.lastname: Stone
authors.affiliation: Boston PainCare Center, Waltham, MA, USA.|Tufts School of Medicine, Waltham, MA, USA.|Shriners Hospital for Children-Boston, 85 First Avenue, Waltham, MA, 021451, USA.
authors.forename: Valerie
authors.initials: V
authors.lastname: Weed
authors.affiliation: Dept. of Diagnostic Sciences, Craniofacial Pain, and Headache Center, Tufts University School of Dental Medicine, Boston, MA, USA.|Lecturer in Anesthesia, Critical Care and Pain Medicine/Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, 1 Kneeland Street, Boston, MA, 02111, USA.
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Kulich
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy / Q000523:psychology; D006801:Humans; D008881:Migraine Disorders / Q000188:drug therapy* / Q000523:psychology; D017410:Practice Guidelines as Topic; D012307:Risk Factors
chemical_list: D000701:Analgesics, Opioid
keywords: Addiction; Headache; Migraine; Opioids; Risk; Screening