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…

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.

But you should know that triptans temporarily narrow blood vessels, so they should not be taken by people with certain conditions, including coronary artery disease or angina (chest pain), and peripheral vascular disease. People who have had a heart attack or stroke, have uncontrolled high blood pressure, or have migraines that are accompanied by weakness or paralysis in an arm or leg, vertigo, ringing in the ears, or speech difficulties, should also avoid triptans.

In addition, triptans should be prescribed with caution for those with risk factors for vascular disease, such as men over 40, women over 55, and anyone who smokes, has high cholesterol, diabetes, a family history of early heart disease or stroke, or is significantly overweight.

The seven available triptans (plus one combination pill) differ in their effectiveness and the side effects they cause. They are fairly expensive (three—naratriptan, rizatriptan, and sumatriptan—are now available as generics), ranging from $12 to $46 per pill. The nasal spray and injectable forms cost more…

Triptans are a family of tryptamine-based drugs used as abortive medication in the treatment of migraines and cluster headaches. They were first introduced in the 1990s. While effective at treating individual headaches, they do not provide preventative treatment and are not considered a cure…

Triptans have few side effects if used in correct dosage and frequency. The most common adverse effect is recurrence of migraine. A systematic review found that “rizatriptan 10 mg was the only triptan with a recurrence rate greater than that of placebo”…

There is the potential for life-threatening serotonin syndrome (a syndrome of changes in mental status, autonomic instability, neuromuscular abnormalities, and gastrointestinal symptoms) in patients taking triptans and selective serotonin reuptake inhibitors (SSRIs) or selective serotonin/norepinephrine reuptake inhibitors (SNRIs) at the same time…

3 thoughts on “Inappropriate Opioid, Barbiturate Prescribing Common for Migraine

  1. As a teenager I was prescribed Fiorinal (butalbital, aspirin, caffeine) for my migraines. I first got plain Fiorinal and when that stopped controlling my migraine pain I was prescribed Fiorinal with Codeine. My family doctor finally cut off my prescription when I reached a level of taking the highest combined dose of Fiorinal with Codeine (butalbital, aspirin, caffeine, and codeine phosphate). I think the amount of codeine was comparable to a Tylenol #3. I was taken off them because they stopped helping with the pain and I couldn’t function when I took them. My doctor also expressed concerns about addiction because of the barbiturate content.

    Liked by 1 person

    • Codeine is one of the weakest opioids, so if you weren’t able to function with that drug, perhaps it was a good idea to stop taking them. Usually though, people adjust to the side effects of pain medications over a short period of time. If your doctor was only concerned about addiction, that would be a different story. Millions and millions of people take pain medications without any signs of addiction, just dependence, which is like a diabetic being dependent on insulin.


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