Pain is a common problem seen in all areas of healthcare including the emergency department (ED). Chronic pain is a condition that requires specialized management. EDs provide episodic care and are often faced with the challenge of managing patients with chronic pain. Some of these patients present with drug-seeking behaviors that make it difficult to provide appropriate care for their condition. This article presents a case of a patient with chronic migraine headache, and the ethical issues surrounding her management in an ED, with focus on the patient's autonomy, and the concepts of nonmalficence, beneficence, and informed consent. This article concludes with recommendations for ED to appropriately and safely manage patients with chronic pain.