Opiate Use for Headache in the Emergency Department Is a Risk Factor for Continued Use

A recent study reveals that prescribing opiates for headache in the emergency department significantly increases the risk of long-term opioid use and related adverse events.

In a study published April 2025, but released on the internet before that, investigators looked at the use of opioids in the treatment of headache and the risk of opiate-related adverse events over a 1-year period.

They reviewed over 234,308 visits for headache over 10 years. Approximately 5.7% of those patients (13,375 patients) received opiate prescriptions and they were propensity matched* to a similar number of patients who did not get opiate prescriptions. Subjects with a history of previous opiate use disorder or cancer were excluded.

*(Researchers construct an artificial control group by matching each treated subject with a non-treated subject with similar baseline characteristics.)

The 1-year primary outcome of the experiment was a combination of three measures after the emergency department visits, long-term prescription opioid use, an opioid-related ED visit or hospitalization, or starting on new opioid agonist therapy (such as methadone or buprenorphine).

Results

There was a 65% increased risk of having the 1-year primary outcome in the opiate prescription group compared to the non-opiate treated group (8.6% compared to 5.8%).

There was a 77% increased risk of long-term opiate prescription use in in the opiate group over the controls (7.7% compared to 4.8%).

Of even more of a concern was that subjects who were classified as opiate naïve (no opiate prescriptions in the previous year), had a 216% increased risk of meeting the primary outcome of long-term prescription opioid use, an opioid-related ED visit or hospitalization, or starting on new opioid agonist therapy compared to those not given an opiate prescription.

They also reported that short-term opiate prescriptions were found not to be a problem. The issue was in opiate prescriptions of more than 7 days duration which increased the risk of meeting the primary outcome by 284% over controls. As the daily dosage of opiate in the prescription increased, the risk of meeting the primary outcome also increased incrementally.

The authors stated that in their data set for every twenty-nine patients treated with opiates, one would go on to have an opiate problem, as defined by the primary outcome. They also noted that 13.7% of patients given an opiate prescription returned to the emergency department with headache complaints within 7 days compared to only 9% of non-opiate treated patients, which may indicate opiates are not as effective as other medications and might be more likely to result in rebound headaches.

Comments:

This article is reinforcement of the concept that opiates for certain people, even one prescription, can be problematic. It is also a reminder to health care providers that when treating headaches, other available medications should be tried first and if a prescription for opiates is required it should be of short duration and the lowest effective dosage.

For an historical look at an addictive drug, click here to read an article about The History of Heroin, the “Nonaddictive” Substitute for Morphine.

Reference

Hayward J et al. Risks associated with opioid prescriptions for headache in the emergency department. The American Journal of Emergency Medicine. Volume 90, 2025, Pages 109-114. Retrieved from: https://www.sciencedirect.com/science/article/pii/S0735675725000361