Opioids and Barbiturates Still Prescribed too Often for Headache, Migraine

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Opioids and barbiturate-containing medications are not recommended for the treatment of migraine, but they are still frequently prescribed, and that practice is a matter of concern for headache experts and others.

A small study, published in the journal Headache, recently investigated opioid and barbiturate use among patients at a headache center staffed by eight physicians. Researchers found that approximately 20% of the clinic’s patients reported currently using opioids and/or barbiturates. Emergency department physicians were the most frequent first prescribers of opioids (narcotics), and general neurologists were the most frequent first prescribers of barbiturates (sedatives).

In the study, 218 patients completed a survey that assessed headache types, other health conditions, and whether they had ever been prescribed opioids or barbiturates. If they answered yes to the latter question, researchers asked about the prescribing doctor, medication effectiveness, and whether they were currently on the medication.  That data-gathering portion of the study lasted for 1 month.

The results showed that migraine was the most common diagnosis (83.9%). Notably, more than half of the patients reported having been prescribed an opioid (54.8%) or a barbiturate (56.7%). At the time of the survey, about one-fifth were taking opioids or barbiturates.  About one-quarter of the patients reported being on opioids for more than 2 years, while nearly one-third reported taking them for less than a week. Patients who were no longer taking opioids most frequently reported they stopped because the medications were not effective (30.9%) or that a new doctor who would not prescribe them (29.4%).

Among those who had taken barbiturates, nearly one-third had been on them for more than 2 years. Nearly two-thirds of patients had stopped taking them because the medication did not help them, while 17.6% said they saw a new doctor who would not prescribe them.

The Choosing Wisely health initiative, which aims to reduce wasteful medical tests and practices, stresses that for migraine, opioids and barbiturates are not as effective as other medications and they carry considerable risks, including the possibility of addiction.

The authors, led by Mia T. Minen, MD, MPH, of the NYU Langone Medical Center, conclude the results indicate more physician education should be provided.

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

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6 comment on “Opioids and Barbiturates Still Prescribed too Often for Headache, Migraine

  1. Ann Wederspahn

    How frustrating to hear, once again, that opiates are not indicated for migraine. Having lost a kidney to cancer, I’ve been told to never take any of the NSAIDs, and acetaminophen does nothing at all. Instead, I simply bear most migraines, but when they’re really bad (maybe twice a month or so) I go ahead and take a hydrocodone, tramadol or other opioid that I’ve collected over the years post-surgery or dental procedure. The triptans work but always result in a worse migraine within 24 hours–not worth the tradeoff. My neurologist hasn’t come up with any other alternatives. What’s one to do????

  2. Grace

    I feel the same way. I finally found a Dr that will prescribe me some Norco and I take it along with my Imitrex. It helps so much with my all over body pain that I get with all my migraines. I will keep taking it as long as it’s working for me. And I know that’s not what’s recommended, but it works for me. Especially if I can’t leave work.

  3. Chris

    I had op but new dr took me off to experiment but not working. I hope to see the neurologist soon to figure a better plan & hoping to get Botox if available . Extra strength tylonal not working at all. So frustrating.

  4. Erin

    This frustrates me as well. I have been to many doctors, neurologists, and even a pain clinic. I have tried every different classification of medication, including Botox. I only use an opiate as my last option, however, it is a necessary one at times. It’s either that or a trip to the ER which is just not feasible for every bad migraine. Opiates do have a purpose and can be used without being abused. I don’t love having to take them either, but have yet to find a way to not need them as a backup plan. Don’t leave people suffering because of their misuse potential.

  5. Tracy

    Crappy article. Tell us something we don’t know. You say we can’t take this and that…. so what then…. we just live with the dreadful pain for up to 3 days and feel like life is not worth it? I only use opiates when the pain becomes unbearable as i know ( like most chronic migrainers) that drugs only make things worse in the long run. The triptans put me in hospital as they make the pain and frequency much worse. Can’t take tramadol…… whats left? I sue essential oils, breathing techniques, coldpacks…. but at the end of the day, one can only stand so much pain for so long.

  6. Wendy

    I cannot take NSAIDS due to several duodenal ulcers, so the only option I have is Opiods and Barbituates. For those Docs that don’t understand that there are people who suffer with chronic migraines and have tried all existing treatments, we have no other options. Until other treatments are available, don’t demonize our only mild relief. And I do mean mild. This is counterproductive to write such an article. I’ve been told by one dr to drink wine and go to church, live with the pain. It’s not right!

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