Inappropriate Opioid, Barbiturate Prescribing Common for Migraine

Opioids and barbiturates are commonly prescribed as first-line migraine treatments, even though clinical guidelines recommend them only as a last resort.

A recent study presented at the American Headache Society’s 2015 annual scientific meeting found about 1 in 5 patients presenting to a headache center reported taking opioids or barbiturates at the time, and a quarter of them had been receiving the drugs for more than 2 years.

“Although many patients find these [drugs] effective, they are known to contribute to headaches related to medication overuse," stated lead study author Mia T. Minen, MD, MPH, in a press release.

That is one reason why “Choosing Wisely” standards from the American Academy of Neurology (AAN) advise against using either opioids or barbiturates for migraine. Instead, the AAN recommends nonprescription pain medications or triptans, a prescription drug class that is specifically indicated for migraines.

As medication experts, health-system pharmacists can play a more active role in educating both patients and other health care professionals about the short- and long-term risks of using opioids or barbiturates to treat migraines.

“To have someone who is highly trained in understanding the ins and outs and interactions of those medications is critical for patients,” Reid Blackwelder, MD, FAAFP, chairman of the American Academy of Family Physicians, previously told Pharmacy Times.

Rolee Pathak Das, PharmD, BCPS, clinical associate professor at the Rutgers University Ernesto Mario School of Pharmacy, told Pharmacy Times that pharmacists should be more patient-focused when they are dispensing drugs, especially prescription pain medications.

“Pharmacists should not just say, ‘Let’s get the medication prescribed to the patient,’ but [rather], ‘Let’s get the right medication, for the right reason, at the right time, and in the best form to improve overall care,’” Dr. Das said.