Medical Research: What is the background for this study? What are the main findings?
Dr. Minen: We conducted a survey on opioid and barbiturate use among patients visiting a headache center to find out which medications they were receiving for treatment. There’s limited evidence that long-term use of these medications can help treat headaches or migraines, and even short-term use in small quantities can cause medication overuse headache. It is important to determine which providers start these medications so that educational interventions can be tailored to these physician specialties to try to prevent situations such as incorrect prescribing practices and medication overuse.
In this sample of patients from a specialty headache center, approximately 20 percent of patients — or 1 in 5 — were using opioids or barbiturates, and about half had been prescribed these medications at some point in the past for their headaches. These findings show that opioids and barbiturates are commonly prescribed to patients with headaches. While two-thirds of patients found opioids or barbiturates helpful, many did not like them, were limited by side effects or did not find them to be helpful. Emergency department physicians were reported to be the most frequent first prescribers of opioids and general neurologists were the most frequent prescribers of barbiturate-containing medications. Primary care physicians were also identified as frequent first prescribers of these medications.
Medical Research: What should clinicians and patients take away from your report?
Dr. Minen: These data provide a snapshot of the wide variety of physician specialties that might benefit from additional education about the appropriate use of opioids and barbiturate-containing medications in patients with headache. Physicians are often put in a tough position when patients come in with headaches and ask for these medications. These physicians may benefit from learning more about the evidence-based treatment guidelines from the American Academy of Neurology and American Headache Society. Patients can address with their doctors their medication regimen and the frequency at which they use these medications.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Minen: More research is needed to develop educational interventions targeted to physician specialties with higher opioid and barbiturate prescribing rates for headache, and determine these initiatives’ effectiveness.
Dr. Mia T. Minen, MD, MPH Director, Headache Services, NYU Langone Medical Center, & Assistant professor, Department of Neurology (2015). Opioids and Barbituates Commonly Prescribed For Headaches MedicalResearch.com