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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 survey shows.
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 Center.
"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:
Triptan drugs include Amerge, Axert, Frova, Imitrex, Maxalt, Relpax, and Zomig. They are specifically approved by the FDA for the treatment of migraines.
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."