Prescribing Trends for Severe Headache and Migraine Signal Inappropriate Medication Use

Allison Gandey

June 28, 2010

June 28, 2010 (Los Angeles, California) — A new study assessing trends in prescribing has found that although more patients are being treated for severe headaches and migraine than ever before, they are often not receiving the right drugs.

Despite the availability of newer migraine-specific medications, investigators found the use of general pain relievers did not decrease. In fact, more opioids, nonsteroidal anti-inflammatory drugs, benzodiazepines, muscle relaxants, and barbiturates were used.

Prevalence of medication use in the last 30 days.

The results were released here at the American Headache Society 52nd Annual Scientific Meeting.

Presenter Catherine Buettner, MD, from the Harvard Medical School in Boston, Massachusetts, pointed out that opioids and barbiturates have been linked to an increased risk of chronic daily headache and are often not the right choice for patients with severe headaches or migraine.

Dr. Buettner studied 4280 people from the National Health and Nutrition Examination Survey (NHANES). Investigators conducted in-home interviews and examined participants in mobile centers. They assessed health history, habits, and comorbidities.

Researchers weighted crude prevalence estimates and adjusted prevalence odds ratios and their 95% confidence intervals to represent the US population and to account for the complex sampling design of NHANES.

They found that although nonspecific medication use continued to increase, daily use of over-the-counter and prescription nonsteroidal anti-inflammatory drug use decreased.

Table. Adjusted Odds Ratios of Nonspecific Medication Use

Drug Odds Ratio (95% CI) P Value
Muscle relaxant 2.7 (1.6 – 4.4) <.001
Opioid 1.8 (1.3 – 2.5) <.001
Daily analgesic 1.7 (1.4 – 2.0) <.001
Benzodiazepine 1.7 (1.3 – 2.1) <.001
Nonsteroidal anti-inflammatory drugs 1.3 (1.1 – 1.6) .04

CI = confidence interval

Dr. Catherine Buettner

"Even when more specific treatments became available, patients continued to be prescribed other medications," Dr. Buettner told Medscape Neurology.

Alan Finkel, MD, from the University of North Carolina at Chapel Hill, attended the poster session. "It's very disheartening," he said. "Patients clearly aren't getting the right medications."

Vijaya Patil, MD, from the Edward Hines Junior Veterans Affairs Hospital in Chicago, Illinois, said she agrees the trend is worrisome. "I see a lot of patients who have been having severe headaches for years. There does seem to be a lack of awareness about the importance of appropriate treatment," she said.

Still, Dr. Buettner said she is encouraged by the high rates of medication use among patients with severe headaches and migraine. "The good news is that headaches are being taken seriously and are being treated," she said. "Now we just need to make sure that patients are receiving the right medications."

Dr. Buettner said she plans to continue tracking these trends and will report new results as they become available.

Dr. Buettner has disclosed no relevant financial relationships.

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