Prescription pain medications should not be the first treatment for migraines. And doctors shouldn’t routinely order brain scans for patients with these debilitating headaches, according to new guidelines.
Taking a stand on common but often unnecessary or potentially risky tests and treatments for migraine, the American Headache Society published new recommendations in the November-December issue of the journal Headache.
“Our aim is to encourage doctors and patients to think carefully about medical care that can be harmful or unnecessary,” said Dr. Elizabeth Loder, president of the American Headache Society. “We didn’t approach this with cost uppermost in mind. The goal is to help address the problems of low-value care.”
Opioid painkillers, such as OxyContin and Vicodin, and the barbiturate butalbital pose serious long-term risks, the society said.
“The effectiveness of opioids is not the question,” explained Loder, chief of the division of headache and pain in the neurology department at Brigham and Women’s Hospital in Boston. “The problem is that even if they are effective in a single attack, for many people migraine is a chronic disorder that they will have for many decades.”
Using too much of these pain medications can also lead to a condition called medication overuse headache, said another expert.