New Study Confirms Opioids Are Over-Prescribed for Migraine

January 24, 2018

In the Heart of a Crisis

There’s no getting around it: the US is in the midst of an opioid crisis. Overdoses are hitting historically high levels and have become the number one cause of death for people under 50. [1] And while a number of factors have driven these increases, many that become addicted start off managing pain in entirely legitimate ways: by being prescribed drugs like Oxycontin, Percocet, and Vicodin. Given how debilitating migraine can be, there’s no doubt that migraineurs are also taking these and other medications like them on doctor’s orders.

There’s a balance that needs to be struck, of course. The needs of the patient in pain must be met, but the situation needs to be properly monitored. The danger with opioids is that they’re highly habit forming; people can easily and quickly become addicted, especially if pain comes back as it does with migraine. On top of that, while they are very effective in stopping headaches, other classes of drugs—as well as treatments that aren’t pharmaceutically based—have been shown to be better alternatives.

Despite that, according to a recent study lead by Dr. Larry Charleston IV and published in the journal, Cephalgia, doctors are prescribing dangerous opioids just as much as other, more-effective drugs.

A Number of Alternatives

Before getting into the details of this study, let’s take a quick look at what non-opioid pharmaceutical alternatives there are for those with migraine. For the most part, these focus on preventing onset of headache and can be split into five groups: [3]

  • Beta-blockers: This class works by relaxing blood vessels and include drugs like Tenormin, Lopressor, Toprol, and Inderal.  
  • Anticonvulsants: This kind of drug is designed to prevent seizures; however, they can work well in reducing incidence of migraine. Typical examples are Topomax and Depakene.
  • Antidepressants: There are many kinds of antidepressants, but the tricycline type helps with migraine because it improves other factors like quality of sleep and intensity of pain.
  • Calcium Channel Blockers: Drugs of this sort work by constricting blood flow in the brain.
  • Botox: While there’s much more work to be done, some evidence suggests that Botox—typically used in cosmetic procedures—can help with migraine.

On top of that, two technologies have been known to help with more chronic cases: The Omega Procedure and the Cephaly devices. As we’ve covered in the past, these work by sending mild electronic shocks to specific areas of the brain, with the former known to be more efficient than the latter.

Poor Prescription Practices

Dr. Charleston IV and his team initially wanted to look at racial disparities in the type of care delivered for migraine. While they did find that African Americans and Hispanics were less likely to receive better quality pharmaceutical drugs—what they called “Level A abortives”—the effect was too small to be considered statistically significant. Still, in assessing 2,860 migraine medical visits conducted between 2006 and 2013, they did find that opioids were far too often prescribed. [2]

Within every demographic group, “Level A abortives” were prescribed at very similar levels as opioid medications, despite what the authors see as close to definitive evidence of the former’s superiority. According to Dr. Charleston IV, “[t]his shows an underuse of medications with high-quality evidence” of efficacy. [2] Just under 40% of patients weren’t prescribed these more effective drugs at all, and, in many cases, lesser quality ones were chosen over those shown to be more effective.

What this points to is an endemic problem with the prescribing practices surrounding migraine. Given that better alternatives exist—as well as the well-known individual and social dangers associated with opioids—this is a significant issue.

The Path Towards Better Care

Migraine is notoriously difficult to pin down and can require a great deal of care to treat effectively. Treatment often involves attempting different approaches to see what works. This is why standards of care continue to evolve; where opioids may once have been more readily prescribed, increasing evidence shows that their drawbacks outweigh the advantages. [2]

Luckily, procedures and medications are already there to help, and more are being developed to improve prognosis. Effective management of migraine is possible for the many people who suffer with this condition. Though it may take significant effort, a brighter future is possible.

If you’d like to learn more about non-opioid-based approaches to migraine, talk to a Patient Care Manager at Migraine Treatment Centers of America. They’ll be able to tell you about innovative and highly-effective treatments employed at these clinics. Learn more by calling (855) 300-6822 today!


  1. Katz, Josh. 2017. “Drug Deaths In America Are Rising Faster Than Ever”. Com. Accessed August 16 2017.
  2. Otman, Haley. 2017. “Study: Opioids Overused In Migraine Treatment, Regardless Of Race”. Umhslab.Manifestdigital.Com.
  3. “Pharmaceutical Approaches To Migraine Care – Pain Doctor”. 2014. Pain Doctor. Accessed August 16 2017.

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