Migraines, Opioids & Butalbital
A recent article in Neurology Today discussed treatment and tests that are over utilized and minimally effective. The US is the only country in which butalbital is approved for headache treatment. The medication is minimally helpful and can worsen headache. Bultalbital slows thinking and can be addictive. Abrupt discontinuation can result in seizures. Therefore, this drug has only a limited role to play in headache therapy.
Likewise, opioids are seldom appropriate for migraine. When use frequently, opioids can block the effects of migraine-specific medications such as triptans (Imitrex, Relpax, etc.) In addition, opioids are potentially addictive. Effective treatment is available for migraines and patients can be helped. At my Northshore clinic, I completely analyse the patients headache issues and order testing and treatment that is in the patients best interest.
From February 2013 Neurology Today:
Don’t use opioid or butalbital treatment for migraine except as a last resort.
Opioid and butalbital treatment for migraine should be avoided because more effective, migraine-specific treatments are available. Frequent use of opioids and butalbital can worsen headaches. Opioids should be reserved for those with medical conditions precluding use of migraine-specific treatments or for those who fail these treatments.
(Sources: US Headache Consortium Guidelines, European Federation of Neurological Societies Guidelines on Drug Treatment of Migraine, Institute for Clinical Systems Improvement.)