Opioids, Barbiturates Still Widely Used in Headache Despite Cautions

WASHINGTON — Despite several specialty societies recommending caution against indiscriminate use of opioids and barbiturates as treatment for migraines, results of a survey indicate that about 20% of patients who presented at a headache center reported use of one or both of these treatments.

The findings were presented at the American Headache Society Annual Scientific Meeting in Washington, D.C.

Study investigator Mia Minen, MD, MPH, of NYU Langone in New York, told Neurology Advisor that patients are known to present to headache specialists requesting large quantities of barbiturate-containing medications and/or opioids, despite these medications having many side effects, as well as the lack of long-term data supporting their use.

The aim of the survey was to find out where headache patients are first prescribed opioids and barbiturates and to determine the characteristics of these patients. Patients were asked their headache type, comorbidities, and whether they had ever been prescribed opioids or barbiturates. If responding yes to the latter, patients were then asked about their prescribing doctor, the effectiveness of the medication, and whether they were currently on the medication.

In all, Minen and colleagues provided the survey to 244 patients, of whom 218 (89.3%) completed it. The majority of patients (83.9%) were diagnosed with migraine, with more than half of patients reported being prescribed an opioid (55.6%) or a barbiturate (56.7%). Furthermore, one in five were on opioids (19.4%) and barbiturates (20.8%) at the time of completing the survey.

Overall, 63% of patients prescribed an opioid found it effective and 64.2% of patients given a barbiturate-containing medication found it effective.

Additional data revealed the following:

• 19.5% and 19.4% of patients reported being on opioids for more than two years or less than one week, respectively
• 44% of patients previously on barbiturates had been on them for over two years
• 56.7% of patients stopped barbiturate use because they did not find it helpful, whereas 22.3% said they visited a new doctor who would not prescribe them the medication

In an analysis of prescriber data, emergency department physicians (25.4%) and family physicians (22.4%) were the most frequent prescribers of opioids, whereas general neurologists (30%) were the most frequent prescribers of barbiturates.

“Taken as a whole, these data provide a useful snapshot of the wide variety of physician specialties that might benefit from additional education about the appropriate use of opioids and barbiturate-containing medications in patients with headache,” Minen said.

She added that, according to evidence-based guidelines from the American Academy of Neurology and American Headache Society, first-line migraine medications should be nonsteroidal anti-inflammatory drugs for mild headaches and triptans for moderate-to-severe migraines. 

“There are seven different triptans and they come in different forms — pills, orally dissolving tablets, nasal sprays, and injections,” Minen said. “These are generally the best medications for first-line treatment, and they can generally be given to most patients.”

Reference

1. Minen M et al. Abstract 82896. Presented at: American Headache Society Annual Scientific Meeting 2015; June 18-21, 2015; Washington, D.C.