Too Few Get Best Migraine Drugs
Survey: Potentially Addictive Drugs Too Often Prescribed for Migraines
Overtreatment: A Common Cause of Migraine continued...
"Patients really must limit acute-headache medications to no more than two days a week -- obviously except for the occasional very bad week -- to avoid rebound headache," Grosberg says.
"About 15% of our patients come in with medication-overuse headache, usually from overtreatment with opioids or barbiturates," Penzien says. "Our first job is to get patients to stop using medicines prescribed by well-meaning doctors. And for many, that is all they need. We get them over rebound headaches, and that is all they need for control."
That's because well-managed migraines become less and less of a problem.
"When you have confidence in your own ability to manage headache symptoms, they don't distress you as much," Penzien says. "Distress is one of the triggers for migraine. If you sense a migraine coming on and you think, 'Oh, I am going to spend the rest of the day writhing in bed,' it is distressing and your headache is worse. When you have a treatment you know will help, you feel more in control, and you avoid that trigger."
Penzien and Grosberg note that triptans, opiates, and barbiturates aren't the only treatments for migraine. There's also a role for over-the-counter painkillers such as ibuprofen and naproxen -- although like their prescription counterparts, these drugs can have serious side effects and should never be taken regularly without a doctor's advice.
Nondrug strategies, such as stress management and improved sleep hygiene, also play a major role in migraine control.
Patients experiencing as many headaches as the average survey patient may also benefit from another treatment strategy: prevention.
"With five headaches a month, the average patient in this survey would be well advised to consider a preventative medication to help manage their problems with rebound and side effects and reduce their need for acute-headache medications," Penzien says.
The FDA has approved two drugs for migraine prevention: Topamax, an anticonvulsant; and Inderal, a blood-pressure-lowering medication. However, doctors often prescribe any of a number of other medications not specifically approved for migraine prevention.
"None of the migraine preventives were actually invented for prevention of migraine, but for other types of conditions," Grosberg notes. "Prescription drugs used for migraine prevention include beta-blockers, calcium-channel blockers, tricyclic antidepressants, antiseizure medications, and even Botox. Nonprescription drugs include magnesium, riboflavin, and a butterbur-root extract called Petadolex."