Treating Migraines with Codeine, Oxycodone or Barbiturates Increases Risk of Chronic Migraine

Treating migraine episodes with opioids or barbituates as few as eight times a month doubles the risk of developing chronic migraine. I’m in a Phenergan fog, so I’ll let the American Academy of Neurology‘s press release tell the story:

Overuse of Codeine, Oxycodone and Barbiturates Increases Risk of Chronic Migraine

People who overuse barbiturates and opioids, such as codeine, butalbital, and oxycodone, to treat migraine are at an increased risk of developing chronic migraine, according to research that will be presented at the American Academy of Neurology 60th Anniversary Annual Meeting in Chicago, April 12–19, 2008. People with chronic migraine have headaches on 15 or more days a month.

For the study, 24,000 people with headaches in the United States were surveyed about the types of medications they use to treat their headaches. From this sample of people with headache, the researchers selected those who had been diagnosed in 2005 with episodic migraine (fewer than 15 days of headache per month). Their risk of chronic migraine was then calculated based on the types of medications they used in 2005. Among those with episodic migraine in 2005, 209 people had developed chronic migraine in 2006.

The study found people who took drugs containing barbiturates or opioids for only eight days a month were twice as likely to develop chronic migraine a year later as those who didn’t take such drugs. [emphasis mine]

“People who use drugs that contain barbiturates and opioids, if only for a total of seven to eight days a month, appear to significantly increase their risk of migraine progression,” said study author Marcelo Bigal, MD, PhD, with Albert Einstein College of Medicine in Bronx, New York. “Strict limits for these types of drugs should be enforced among people with migraine as a way of preventing their migraines from becoming more frequent and more painful.”

The study found no evidence that the risk of developing chronic migraine increased among people who frequently used triptans, which are commonly prescribed drugs to treat migraine, or non-steroidal antiinflammatory drugs (NSAIDs), such as aspirin, ibuprofen and naproxen.

The study was supported by the National Headache Foundation.

Another interesting conundrum of treating pain with opioids: Opioids appear to change the brain so that the patient actually becomes more sensitive to pain. Building tolerance is not only your body getting use to the drug (called desensitization), but you actually become more sensitive to pain overall (referred to as sensitization), not just the pain that you are specifically treating. Treating Pain With Opioids has information on this research.

8 Responses to “Treating Migraines with Codeine, Oxycodone or Barbiturates Increases Risk of Chronic Migraine”

  1. Daniel Newby Says:

    POW! Holy confusion of correlation with causation, Batman!

    The data also support the hypothesis that people who have progressive migraine have a different underlying disease, with different pain control needs and drug sensitivities, than those with stable episodic migraine.

    “Opioids appear to change the brain so that the patient actually becomes more sensitive to pain.”

    There is research that suggests that analgesia (pain relief) is independent of sensitization. There’s at least one ongoing study that is trying to block the sensitization process using very low doses of naltrexone.

  2. Sue Says:

    I read this earlier today and felt that it really didn’t tell me anything I didn’t know already on an intuitive and entirely non-scientific level.

    But it leaves chronic pain sufferers in a real bind. Until there is something more effective for relieving the pain, what are we to do? When migraine abortives and anti-convulsants aren’t the answer, then it’s pain management which usually involves the drugs listed in the study.

    I had some high hopes for pregabalin (Lyrica) as it has been found effective in fibromyalgia treatment, however, my doc tells me it is not indicated for chronic daily headache. That doesn’t seem to leave a lot of pharmaceutical rescue options.

    Still, the study is a good heads-up for anyone with chronic pain. Thanks for posting it.

  3. Rain Gem Says:

    I did that piece with a different twist to it – for some of us, it could be a bad news, if doctors start restricting strong painkillers to migraine patients. “Triptans work only so well for aborting migraine headaches and for many, opioids are the last line of defense,” to quote meself 😛

    Check it out:

  4. katecollier Says:

    For the few of us out there diagnosed with chronic migraine without medication overuse, this kind of study is very disruptive to our treatment. Over the years, I didn’t use pills to treat my head pain as the very few times I tried OTC drugs they never even touched it. Now that I’ve seen a neurologist, they refuse to give me anything but a triptan (which doesn’t work very well and I can’t take more than twice per week) because other pain relievers can cause daily headache which I already have. Talk about a catch-22. Don’t we deserve some actual relief?

  5. Suzie of Carmelite's Habit Says:

    Yay! Thanks for the link to the whole story.

    Problem will always be balancing the cardiovascular risks of triptan use with the risk of developing chronic migraine. Triptan use, IMHO, should be the bellwether: if a person is using them more than a few days a month, prevention needs should be more aggressive.

    If preventatives will stop the development of chronic migraine, then that may resolve part of the problem. That was another glaring error I saw in the study–no comparison with people on aggressive prevention programs.

    But y’all know me: I’m HUGE into prevention by hook, crook, meds, and psychic love. XD

  6. NoMoreMigraines Says:

    I tried it on my doc’s advice because nothing else would work and it didn’t work either. Now he’s sending me to a neurosurgeon doc to see if there is anything else they can do.

  7. Healed Head Says:

    Hasn’t anyone here thought to enter the search terms ‘cannabis’ and ‘migraine’ on the same line, in for example GOOGLE or better yet scroogle search engines?

    As you read some of the resulting cites and articles, including Russo MD’s say in 1998 ‘Pain’, ask yourself why the single most potent and hands-down effective ‘migraine’ treatment from the 6th Century to the 1800s (and up to the magic year of 1938, in the USA, for that matter) has been quietly removed from all mention in the so-called ‘headache specialist’s armamentarium.

    There’s also the cite that comes up when you enter ‘migraine’ and ‘nitrous oxide’. A study done in an actual ED (Emergency Department) that found 80% of migraine walk-ins treated with N.O. needed no further rescue meds. As the infamous Bill O’Lielly frequently says, “look it up!”

    But let’s not mention safe-for-the-lungs vaporized marijuana, or nitrous….it’s so much more profitable to give the patient that $800/pop botox needle, and big pharma loves to sell their sometimes lethal Zomig.

    What’s wrong with Marinol, if the sufferer lives in a state without a viable medical cannbis law? Use with caution and very sparingly at first, but Marinol’s unwanted effects don’t include Zomig’s possible deadly aspects.

    In Canada, there’s a standardised extract of cannabis….Sativex…available by GP’s prescription. I’ve yet to hear of a migraineur who was not rescued after onset by applications of Sativex.

    One other thing that stuck in my head: why did the purported ‘researchers’, funded by the National Headache Foundation, inelegantly lump barbiturate use with opioids, and why didn’t they differentiate between opiATES and -OIDS? Seems to me that someone wanted to paint the issue with an over-broad brush.

    Funny…I was taught that the science in the details. Besides, ONE ‘study’ depending on the unobserved anecdotal pronouncements of patients rather than objective conclusions observed and recorded by scientists under controlled conditions…..doth not the truth make.

    The medical man most often accepts the patient’s word when the patient is telling him things that appear to confirm the doctor’s own cherished opinions, hypotheses or rank unfounded beliefs. Hence the vaunted ‘headache specialists’ become testy and skeptical when the patient complains that their crap triptans aren’t worth a fig.

    Simple fact that’s hard for our dear, dear doctors to ignore if they want to stay in business: a patient cured is a customer lost.

    A patient cured is a customer lost.

  8. Steve Says:

    Unfortunately this article is very limited. Yes, rebound headaches occur, however, if a long-acting opiad is used, you can avoid this situation. Check out this study from the Robbins Headache Clinic:

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