Category: Adult Analgesia

Analgesia – opioids and headache contraindication

Question #: 479


Why is headache a contradiction for morphine and fentanyl


The headache contraindication for morphine and fentanyl administration is for isolated headache only. Narcotics are not the treatment of choice for an acute episode of chronic headaches (i.e. cluster/migraines), and can cause rebound.

For sudden onset ≥ 7/10 head pain with no history, these medications may be harmful (e.g. a bleed may lead to increased risk of adverse drug-related events). Narcotics can also blunt a serious headache, adding an extra human factor risk, possibly leading to an adverse event (ex: risk of not taking the headache as seriously after handover to a different health care team).

For trauma or other acute complaints with concurrent headache, narcotic treatment can still be considered. For situations that fall outside of the Analgesia Medical Directive where the paramedic believes the patient may benefit from online medical direction that falls within the prescribed paramedic scope of practice, Base Hospital Physician consultation is an option.

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