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Taking the Pain Out of Migraine Treatment

Treating Migraines as They Come May Lead to Medication Overuse
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WebMD Health News

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 "People who are being treated according to something that was current a decade ago are sadly out of date."

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 worse.

According to new guidelines issued by the International Headache Society, medication overuse among migraine sufferers is defined as:

  • 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 imaging) scans.

 

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