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Migraine Sufferers Often Don't Get Best Meds

Posted on: Thursday, 10 April 2003, 06:00 CDT

By Gary Gately, HealthScoutNews Reporter

Doctors tend to prescribe addictive drugs instead of newer, more effective treatments

HealthScoutNews -- Many migraine sufferers take too many addictive medications that only give short-term relief instead of using newer, more effective drugs.

That's the conclusion of researchers from Wake Forest University School of Medicine in a study in the April issue of Headache.

Migraine patients, the study says, often don't get the best treatments for the debilitating ailment because they see primary-care physicians, not specialists who are much more likely to prescribe the newer medications.

"The most striking finding was the most habit-forming drugs were used in large degrees," says Dr. Cormac O'Donovan, the senior author of the study.

O'Donovan, an assistant professor of neurology at Wake Forest, has a warning for migraine sufferers relying on addictive drugs: "They should reevaluate their own medications if they're on habit-forming medications for headaches. That should be addressed urgently."

These drugs, O'Donovan adds, only provide temporary relief, while increasing the risks of addiction and severe "rebound" headaches when a patient stops taking them.

The Wake Forest researchers based their conclusions on 1990-to-1998 data from the National Ambulatory Medical Care Survey, an ongoing survey of physicians. But O'Donovan says he believes the findings still mirror the current landscape in migraine treatment.

More than 70 percent of migraine sufferers who sought treatment saw primary-care physicians, while only about 17 percent saw neurologists, according to the data.

The number of doctor visits for migraines almost doubled, from 9.4 people per 1,000 in 1990 to 18 per 1,000 in 1998, the study found.

And the doctors prescribed addictive medications more than three times as often as triptans, which first hit the market in 1993 as a major breakthrough in migraine treatment. Triptans mimic the neurotransmitter serotonin, whose supply drops off during migraines, and soothe the inflammation of nerve endings in the brain.

The doctors also prescribed addictive drugs about twice as often as such preventive medications such as propranol, which is a beta blocker, the study says.

The research did not include over-the-counter medications, but O'Donovan says they're probably used by many who have undiagnosed migraines.

About 30 million Americans, three-fourths of them women, suffer migraines, and up to half of all migraines are never diagnosed, experts say. Migraines produce intense, throbbing pain, typically on one side of the head, in addition to nausea and sensitivity to light and sound.

Specialists can't come close to treating all those migraines, so better treatment will depend largely on more awareness of options among primary-care doctors, O'Donovan says.

"We need to get the primary-care physicians on board," he says. "There's not enough familiarity with [triptans and prophylactics]."

Dr. Seymour Diamond, executive chairman of the National Headache Foundation, agrees.

"There's a great majority of migraine sufferers still taking pain medicine" instead of more effective alternatives, Diamond says.

Too often, that's because of rushed appointments with a primary-care doctor, Diamond says.

"Typically, a patient comes in and says, 'I have a headache,' and the doctor will write a prescription for a pain killer, sedative or tranquilizer. Headache is probably one of the most common disorders -- and probably one of the most mistreated," he adds.

Doctors should do a complete physical exam on headache patients and ask about the pain, its frequency and location, other symptoms and possible contributing factors, Diamond says.

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On the Net:

Migraine Awareness Group

National Institute of Neurological Disorders and Stroke

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