Opioids Overused For Migraine Headache Treatment

A new study that attempted to find racial disparities in the treatment of migraine headaches found no differences and instead found that opioids are often overused for migraine headache treatment. As has been discussed on this blog and site before, the prescribing habits of opioids are under scrutiny for wisdom teeth surgery. See for example the article http://blog.teethremoval.com/what-can-a-surgeon-do-to-prevent-opioid-abuse/ and the article http://blog.teethremoval.com/painkiller-overdose-in-michigan-are-wisdom-teeth-extractions-contributing/. Now it appears that the prescribing habits of opiods for migraines should also be under scrutiny.

Existing research shows that African-Americans experience more frequent and severe migraine headaches than non-Hispanic whites. Researchers at the University of Michigan set out to explore if there was any evidence of racial disparities in treatment practices for migraines. However, instead of finding any disparities, they found opioids were being prescribed as frequently as medications that are more effective for migraine headaches.

In the study, results from 2,860 migraine visits in the U.S. between 2006 and 2013 were explored. A total of 65% of patients were non-Hispanic whites, while 10% were African-American, and another 10% Hispanic. African-Americans were 4% less likely to receive high-quality abortive agents and Hispanics were 5% less likely to receive high-quality prophylactic agents when compared with non-Hispanic whites (without any statistical significance).  A total of 15.3% of African-Americans, 19.4% of non-Hispanic whites, and 17.7% of Hispanics received a Level A abortive, an evidence-based medication intended for acute migraine treatment, such as dihydroergotamine or triptan. Overall, 38.9% of patients were not prescribed any abortive medication. Also 27% of patients being given an abortive medication were given a low-quality one instead of a high-quality one.

Roughly just over 40% of patients for each of the three groups received no prophylactic treatment or preventive medication. For all three groups, 15.2% of patients studied received a prescription for an opioid, with no significant difference among groups of patients. Other medications have been show to be more effective for treating migraine headaches than opioods so the researchers were a bit surprised by the results. Futher, opioids carry additional problems including association with medication overuse headache and comorbidities such as anxiety and depression.

The research was designed to investigate disparities in migraine occurrence and severity. The study was not able to determine the reasons for racial disparities in migraine headaches so the researchers feel that future studies are needed to help better explore this. Even so the study had an interesting result that may help doctors keep a closer eye on their prescribing habits for their patients who suffer for migraine headaches.

Source: Larry Charleston IV and James Francis Burke, Do racial/ethnic disparities exist in recommended migraine treatments in US ambulatory care? Cephalalgia, 2017.


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