Taking the Pain Out of Migraine Treatment
Treating Migraines as They Come May Lead to Medication Overuse
Dec. 4, 2003 (New York) -- People who treat their migraine
attacks as they strike rather than using preventive therapy may unwittingly be
making matters worse by overusing pain medications.
New research shows that people who suffer from migraines may
actually increase the frequency and severity of their headaches by taking too
much of medications designed to provide immediate pain relief from migraine
attacks, such as triptans (including Imitrex, Zomig, and others), opioids, or
combination pain relievers, which can lead to medication overuse headache.
"Medication overuse is very different than addiction, it's
not like alcoholism or drug addiction," says Stephen Silberstein, MD,
director of the Thomas Jefferson Headache Center at Thomas Jefferson University
Hospital in Philadelphia. "These people are motivated by a desire to
relieve pain and dysfunction and to get back to the activities of their daily
lives, not to get a high from drugs."
Silberstein spoke today at a briefing on neurological disorders
sponsored by the American Medical Association in New York.
Researchers say that 53% of people with migraines meet the
criteria for preventative treatment based on the frequency and severity of
their headaches, but only 5% actually use it to manage their migraines.
"We have to recognize that there are preferred modes of
treatment for migraine and treatment evolves over time," says Timothy
Pedley, MD, chairman of the department of neurology at Columbia University in
New York City, who moderated the briefing. "People who are being treated
according to something that was current a decade ago are sadly out of
Medication Overuse and Migraines
Silberstein says medication overuse is the most common problem
among migraine patients. These people have often not responded to treatment,
and in an attempt to treat themselves, they actually make the problem
According to new guidelines issued by the International
Headache Society, medication overuse among migraine sufferers is defined
- Use of opioids, triptans, or combination pain relievers for more than 10
days per month, or
- Use of simple pain relievers, such as aspirin or ibuprofen, more than 15
days per month
Rather than treating migraine attacks as they occur,
Silberstein says the focus in migraine treatment has now shifted to preventing
migraine attacks altogether.
Preventive therapy involves taking medication daily to prevent
migraines vs. using drugs only occasionally to treat attacks.
"The goals of prevention are to reduce the frequency,
severity, and duration of attacks," says Silberstein. "The other thing
we believe is that it improves the responsiveness to acute treatments."
Silberstein says research also shows that preventive therapy
actually reduces overall medication and health-care costs in addition to
lowering the risk of medication overuse.
For example, a recent study showed that preventive therapy
dramatically reduced acute medication use, doctor's office and emergency room
visits, and the use of CT (computerized tomography) and MRI (magnetic resonance