Too Few Get Best Migraine Drugs
Survey: Potentially Addictive Drugs Too Often Prescribed for Migraines
Migraine Treatment -- Addictive Drugs Sometimes Needed continued...
Neither opioids nor barbiturates are FDA-approved treatments for migraine. Opioids include morphine, codeine, and related medications. Drugs that contain opioids include OxyContin, Darvon, and Vicodin. The barbiturates family of drugs includes butalbital (Fiorinal, Fioricet), which has often been prescribed for migraine patients.
Few doctors still prescribe opioids or barbiturates as first-line migraine treatments. But when a first treatment fails, the survey shows that 25% of general practitioners -- but only 7% of neurologists -- prescribe the drugs as second-line treatments.
This doesn't mean that these potentially addictive drugs should never be used. Triptans don't work for everyone -- and people at risk of heart disease or stroke can't take them.
"There may be patients using opiate medications to manage their headaches in a very appropriate way," Penzien says. "It should not be a first-line choice -- but the truth is, there is a substantial minority of patients for whom triptans have no effect or have too many side effects. Triptans are a godsend to many patients, but they are not the entire answer to migraine treatment."
The role of barbiturates is much more controversial -- despite doctors' decades-long history of prescribing butalbital for severe headaches.
"Butalbital has been used forever without any clinical trial evidence that it is effective," Penzien says. "The potential for dependence and withdrawal is clearly there. Barbiturates should be used only in a limited fashion, and in clearly controlled circumstances."
Grosberg agrees that while barbiturates are a controversial migraine treatment, they may be helpful for patients whose individual circumstances preclude other treatments.
"It's never good to use a cookie-cutter approach. Each patient has different needs, so treatment must be tailored to the patient," he says. "If people are having very frequent headaches, they should certainly not be prescribed opiate or barbiturate medications -- but it is important to not overuse any type of headache medicine."
Overtreatment: A Common Cause of Migraine
The average patient in the survey reported five migraine headaches a month. That puts them at risk of what doctors call "rebound headache" -- headaches caused by too-frequent doses of headache medicine.