Too Few Get Best Migraine Drugs
Survey: Potentially Addictive Drugs Too Often Prescribed for Migraines
May 18, 2007 -- Too many patients get potentially addictive, under-effective
drugs for migraine -- and too few get the most effective migraine drugs, a new
The Harris Interactive online survey, commissioned by the National Headache
Foundation, polled 502 adult migraine patients in the U.S. The survey also
polled 201 U.S. doctors who treat migraine headaches, including 101
neurologists and 100 primary care doctors.
Surprisingly, the survey shows that one in five migraine sufferers are
taking potentially addictive opioid or barbiturate medications when they get
headaches. Just more than half of migraine patients take the newer, preferred
class of triptan drugs for their headaches.
"I was surprised that triptans are not being used more than they are,
and that so many doctors are prescribing barbiturates and opiates," Brian
M. Grosberg, MD, director of the inpatient headache program at Montefiore
Headache Center, Bronx, N.Y., tells WebMD.
The survey shows that too many doctors have as much to learn as their
patients when it comes to migraine treatment, says Donald B. Penzien, PhD,
director of the head pain center at the University of Mississippi Medical
"Clinical guidelines could not be more clear: Triptans are the
first-line treatment for migraine," Penzien tells WebMD. "If doctors
were doing a better job of getting and giving education, more patients would be
starting with these drugs."
The new survey showed:
- 60% of triptan users, but only 42% of opioid/barbiturate users, say their
medicine relieves their migraines "extremely well" or "very
- 80% of doctors say they are at least somewhat satisfied with the
side-effect profiles of triptans. But only 17% of doctors say this about
opioids, and only 12% say this about barbiturates.
- Patients taking opioids and barbiturates for migraine are more likely than
those who take triptans to report that migraines "always" limit their
- An astonishing 36% of migraine patients who take opioids or barbiturates
don't know that these drugs are potentially addictive.
Migraine Treatment -- Addictive Drugs Sometimes Needed
Triptan drugs include Amerge, Axert, Frova, Imitrex, Maxalt, Relpax, and
Zomig. They are specifically approved by the FDA for the treatment of
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
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.