The objective of this literature review is to evaluate the efficacy of opioids for the treatment of headaches, particularly migraines, in the emergency department (ED). Despite safer alternatives, opiates are routinely used as an abortive treatment for migraine headaches. The studies reviewed demonstrate that opiates are less effective in terminating acute headaches and result in prolonged ED visits. Dopamine receptor antagonists, such as metoclopramide and prochlorperazine, were the most efficacious in terminating migraines in the studies examined.