Seeing it in the history
Ask how many days in the past 30 each painkiller, triptan, or codeine combination was used. “Sometimes” is not enough. A headache calendar corrects the number. People often think the drug has stopped working, while the days of use are what keep the illness going.
Principles of withdrawal
Stopping or sharply limiting the acute drug is the main treatment, and headache may be briefly worse for a week or two. Prevention for the underlying migraine starts at the same time. Opioids and codeine combinations have no role as prevention. Say in advance when the next visit is, so the person is not left mid-course.
These pages are written for health professionals. They do not replace a history, examination, or clinical judgment. Treatment is decided for each patient individually.