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Sustained-release Morphine Sulfate (Kadian)
for Severe Chronic Daily Headache
Lawrence Robbins, M.D.
Posted Feb 2001
L. Robbins, Cephalalgia, May 2000

Background: Approximately 50% of patients with chronic daily headache (CDH) respond to preventive medications. For those with severe, refractive CDH, these options are limited. The use of opioids for nonmalignant pain is controversial. Previous studies with methadone or CR oxycodone have been promising. The patients in this study had all failed standard medications.

Methods: A group of 67 patients, ages 22-62, with the diagnosis of refractive CDH were interviewed after 6 months of therapy. Almost half stopped Kadian before 6 months. The average dose was 20 mg. twice daily. Of the 36 patients remaining, 26 continued on 20 mg. twice daily, seven remained on 20 mg. daily and three were increased to 50 mg. daily.

Efficacy: Over a third of patients had no relief, nine had mild relief, 14 had moderate relief and 20 had excellent relief. Of those with a history of anxiety, 11 reported no relief, five reported mild relief, six reported moderate relief and seven reported excellent relief. Of those with a history of depression, 10 reported no relief, eight reported mild relief, six reported moderate relief and 12 reported excellent relief.

Conclusion: This study shows that SR morphine can be helpful in the long term treatment of severe, refractory CDH patients, and may provide an otherwise unobtainable improvement in qualify of life.