Opioid and Barbiturate Prescriptions in Headache Patients
Opioid and Barbiturate Prescriptions in Headache Patients
Opioids are frequently prescribed for the treatment of chronic headache disorders such as migraine despite authoritative recommendations that they should be used sparingly in such circumstances. For example, data from Brennan show that opioids are frequently prescribed in the primary care setting. Similarly high levels of use were seen in a study of emergency department treatment of headache.
These prescribing practices are at odds with recommendations contained in the American Academy of Neurology Practice Parameter on headache and also with the Choosing Wisely recommendations from the American Headache Society. Both groups recommend that opioids and barbiturates should not be first-line treatments for recurrent, benign headache conditions. Migraine and other primary headache disorders are conditions of long duration that often begin in early adulthood. Once established, drug use patterns can be difficult to alter; in some patients their intermittent use may increase the likelihood that dependence or addiction problems will develop, or lead to the development of medication overuse headache. Data from the American Migraine Prevalence and Prevention (AMPP) study suggest that among survey respondents who were using opioids for treatment of migraine, almost 17% potentially fit DSM-IV criteria for drug dependence.
The purpose of this study was to identify patients in a specialty headache center who had ever been prescribed opioids or barbiturates for headache, and then establish which medical practitioner had originally prescribed the medications. We further sought to characterize patterns of medication use and patient perceptions of the effectiveness of these medications.
Background
Opioids are frequently prescribed for the treatment of chronic headache disorders such as migraine despite authoritative recommendations that they should be used sparingly in such circumstances. For example, data from Brennan show that opioids are frequently prescribed in the primary care setting. Similarly high levels of use were seen in a study of emergency department treatment of headache.
These prescribing practices are at odds with recommendations contained in the American Academy of Neurology Practice Parameter on headache and also with the Choosing Wisely recommendations from the American Headache Society. Both groups recommend that opioids and barbiturates should not be first-line treatments for recurrent, benign headache conditions. Migraine and other primary headache disorders are conditions of long duration that often begin in early adulthood. Once established, drug use patterns can be difficult to alter; in some patients their intermittent use may increase the likelihood that dependence or addiction problems will develop, or lead to the development of medication overuse headache. Data from the American Migraine Prevalence and Prevention (AMPP) study suggest that among survey respondents who were using opioids for treatment of migraine, almost 17% potentially fit DSM-IV criteria for drug dependence.
The purpose of this study was to identify patients in a specialty headache center who had ever been prescribed opioids or barbiturates for headache, and then establish which medical practitioner had originally prescribed the medications. We further sought to characterize patterns of medication use and patient perceptions of the effectiveness of these medications.