8.3.2 Opioid-withdrawal headache

Identification: Female patient, 45 years old, with a history of chronic migraine (ICHD-3 code 1.3) for 10 years. Reports daily use of tramadol (100 mg/day) for 6 months for headache relief, without regular medical supervision. Current History: 3 weeks ago, she abruptly discontinued the opioid on her own. Since then, she has experienced daily, bilateral headaches, either pressing or pulsatile, of moderate to severe intensity, worsening rapidly after discontinuation. The headache is temporarily relieved with the reintroduction of the opioid but returns within 24 hours. Denies other symptoms (nausea, photophobia, or phonophobia beyond the usual). Complementary Exams: Brain MRI without alterations.