This chapter discusses pain and palliative care in head and neck cancer, where palliative medicine means the active total care of patients whose disease is not responsive to curative treatment. Palliative medicine is the study and management of patients with active, progressive, far advanced disease in whom the prognosis is limited and the focus of care is the quality of life. Patients with head and neck cancers have specific as well as general problems, due to tumor mass, biology of the tumor and its expression, which include fatigue, anorexia cachexia, weight loss, depression, anxiety and dyspnea. In a majority of patients with head and neck cancer, a combination of somatic and neuropathic pain is common. The clinician should evaluate psychosocial factors such as, anxiety, depression, and loss of independence, family problems, financial difficulties, social isolation and fear of death. Opioid medications form the basis for the management of cancer pain, regardless of the pathophysiology of pain.