Harms associated with codeine-based treatments for headache include medication overuse headache and accidental overdose. Suggested management of patients with headache and codeine dependence includes education about harms of codeine, codeine withdrawal with bridging therapy if required, preventive medications and acute treatment for the primary headache disorder, and advice on lifestyle measures.
- Opioid use for episodic migraine is one of the greatest risks for transformation to chronic migraine.
- Lifestyle measures are integral to chronic headache management.
- Codeine is usually withdrawn gradually, with use of a bridging strategy if required.
- Starting a preventive medication is usually recommended at the same time as withdrawing codeine.