Opioids as Migraine Treatment Grossly Overused
There is considerable room to improve headache and migraine abortive prescribing practices.
A study analyzing racial differences in migraine prescription care found that there are nearly as many migraine patients receiving opioids as there are patients receiving level A abortive medications (i.e. triptans or dihydroergotamine).
Researchers from the University of Michigan used The National Ambulatory Medical Care Survey (NAMCS) to assess all headache visits for patient's ≥18 years of age in NAMCS from 2006 to 2013. Previous studies indicate that migraines are more prevalent among African Americans (AA) than non-Hispanic Whites (NHW) (Silberstein, S. 2007) and the researchers of this study hypothesized that there would be suboptimal migraine treatment among minority populations.
In total, their analysis included 2860 patient visits for migraines. For abortive medications, results showed that overall 18.9% of patients received all high quality abortive medication, 27% received some low quality abortive while 15.2% received opioids. Broken down by race; 15.3% of AA patients compared to 19.4% of NHW patients received all high quality medications. For some low quality medications the percentages were 21.6% and 26.7% for AA and NHW, respectively.
For preventative medication, results showed that overall 12.2% of patients received all high quality prophylaxis, 19.6% received some high and some low quality prophylaxis and 27.3% received all low quality prophylaxis.
The researchers state their findings suggest that there is considerable room to improve headache and migraine abortive prescribing practices. “Given the considerable risks of opiates and the lack of evidence of increased efficacy, opiates should be used rarely, if ever, for migraine,” they wrote.
The analysis found that less than a quarter of migraine patients received all high quality medications. The definition of high quality migraine medications was based on the American Academy of Neurology's Headache Quality Measurement Set.
Additionally, no evidence was discovered to support the hypothesis that racial differences in prescribing practices contribute to headache disparities. In fact AA patients seen in ambulatory care settings were slightly more likely to receive high quality prophylactic medications than NHW.
The investigators concluded that, “understanding what drives these prescribing patterns and improving overall migraine prescribing should be a central concern for headache care practitioners.”
Charleston IV L, Burke JF. Do racial/ethnic disparities exist in recommended migraine treatments in US ambulatory care? [published online June 26, 2017]. Cephalalgia. doi:10.1177/0333102417716933