As anyone who has ever suffered from migraines can tell you, the pain in unbearable and they will do almost anything to make it go away. But some medications designed to alleviate the suffering may be doing more harm than good.
Speaking at the Congress of the European Pain Federation in Florence, Italy, Professor Paolo Martelletti – one of the world’s foremost experts on headaches — said the high frequency of medication overuse is a common problem associated with migraine treatment.
“Between 50 and 80% of chronic migraine patients seen in headache clinics overuse acute medications. Although these drugs provide relief from the pain and other symptoms associated with migraine, overuse can actually make headaches worse,” said Martelletti, who is President of the Italian League of Headache Sufferers and a Professor of Internal Medicine at the School of Medicine, Sapienza University of Rome.
There are two types of medication treatment options that can help patients manage their headaches and migraines. Preventive medications, which help stop headaches or migraines from occurring, and acute medications that help stop the pain once the headache or migraine has begun.
While migraine patients are all too familiar with the intense pain caused by the neurological condition, those who have not experienced a severe headache or migraine may not be able to appreciate the wider, unseen impact that the problem can have, Martelletti explained.
“The disruptive nature of regular attacks can affect those around them and can prove detrimental to many aspects of everyday life, bringing about high levels of stress and depression,” he said.
Medication overuse can also influence the onset of comorbidities such as psychiatric and cardiovascular disorders or gastrointestinal complications.
Medication overuse is defined as the regular use of analgesics, ergotamines, triptans or opioids on ten or more days per month for more than three months; or regular use of simple analgesics or any combination of these drugs on more than 15 days per month for more than three months.
“An attempt should be made to limit the use of acute medication to treatment of no more than two or three headaches per week, and with no more than two doses per headache,” said Martelletti.
“Medication overuse should be treated by withdrawing acute medications, and with the use of preventives,” he added.
Martelletti says one promising new treatment for migraines is Botox injections in the muscles of the head, face and neck.
“Botox injections provide a valuable, evidence-based approach to the treatment of chronic migraine. Regular treatments with Botox provide an effective approach to the long-term management of chronic migraine and may have a disease-modifying effect in some cases where the chronic condition, though not entirely cured, may revert to its episodic form,” he said.
According to the World Health Organization, migraines are the third most common condition in the world and more prevalent than other common disorders such as diabetes and asthma.
Worldwide, headaches affect nearly 50% of adults each year. Approximately 11% of cases meet the criteria for migraines. Women are twice as likely to get migraines as men.
Like obesity, high blood pressure and anxiety disorders, migraines have high prevalence rates in the general population, so it’s possible that patients with chronic migraine may be visiting their doctor to discuss these disorders and not their migraines, said Martelletti.
That is why an accurate diagnosis of chronic migraine is crucial.
“Understanding the current medical and emotional state of the patient – as well as having a thorough understanding of patient’s current medication use – is of paramount importance to designing effective therapy.”