New data indicates rise in opioid use for migraine treatment

Summary: Almost 1 in 5 people now use opioids to treat migraines. Researchers say a growing number of patients are using opioids to replace medications approved and specially designed to treat migraines, despite knowing the risks of opioid use.

Source: BIDMC

An increasing number of Americans are using opioids to treat their migraine headaches, despite the fact that opioids are not the recommended first-line therapy for migraine in most cases. That’s according to the ObserVational Survey of the Epidemiology, tReatment and Care Of MigrainE (OVERCOME) study, a web-based patient survey of people living with migraine. Migraine care specialist Sait Ashina, MD, a neurologist and Director of the Comprehensive Headache Center at the Arnold-Warfield Pain Center at Beth Israel Deaconess Medical Center (BIDMC), presented the survey findings at the 61st annual meeting of the American Headache Society.

“These data show that, despite the known potential risks of using opioids for migraine, far too many continue to do so,” said Ashina, who is an Assistant Professor in the Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine BIDMC and Harvard Medical School. “Against the backdrop of the U.S. opioid epidemic, it’s concerning that people may be using these drugs in place of conventional therapies proven to be safer and more effective for migraine.”

A prospective, web-based patient survey designed to follow two U.S. population samples of 20,000 people with migraine for two years, the OVERCOME study began enrollment in 2018, with a second population sample slated to begin enrollment in 2020. Analysis of data from the first group showed that 19 percent of people with migraine were currently using opioids specifically to treat migraine — up from the 16 percent reported in 2009 in the American Migraine Prevalence and Prevention Study. Moreover, nearly a quarter of people who reported having four or more migraine headaches per month were currently using opioids to treat their pain, and more than half of these respondents reported taking opioids at least once to treat a migraine headache.

“OVERCOME showed that, overall, opioids are being used in place of medicines that are approved and indicated to treat migraine – particularly among those who experience migraine headaches more frequently,” said Ashina. “Patients and doctors should work together to develop a personalized treatment plan tailored to address patients’ particular health concerns and needs.”

Migraine is a disabling neurological disease afflicting more than 37 million Americans, a burden disproportionately carried by women. In addition to severe headache pain, migraine symptoms vary from person to person – and from migraine episode to episode – but may include nausea and vomiting, extreme sensitivity to light, sound, smells and sensations, fatigue, and changes in mood. Migraine attacks can be brought on by specific triggers such as foods, stressors, hormones, or nothing at all, and can last for hours or days at a time.

This is a cartoon of a woman holding her head, surrounded by pills
From left to right: Brad Mahon, an associate professor of psychology at BIDMC and scientific director of the Program for Translational Brain Mapping at the University of Rochester, and Adnan Hirad, an M.D./Ph.D. candidate at the University of Rochester’s Medical Scientist Training Program, led a study of college football players that found typical hits sustained from playing just one season cause structural changes to the brain. The image is in the public domain.

Clinical guidelines from the American Headache Society encourage the use of triptans, a class of drugs introduced in the 1990s that stop about 75 percent of headaches within an hour and half, and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen as first-line treatment for migraine headaches in most cases. The use of opioids as treatment for migraine headaches is typically reserved for patients in whom the use of triptans or NSAIDS is contraindicated.

Funding: The OVERCOME study is being conducted by Kantar, a private research firm, on behalf of Eli Lilly and Company, with expert guidance provided by a scientific advisory board. In addition to Ashina, the OVERCOME Scientific Advisory Board includes; study chair Richard B. Lipton, M.D., and Dawn C. Buse, Ph.D., of the Albert Einstein College of Medicine; Michael L. Reed, Ph.D., of Vedanta Research; Robert E. Shapiro, M.D., Ph.D., of Larner College of Medicine at the University of Vermont; and Susan Hutchinson, M.D., of Orange County Migraine and Headache Center.

As a member of the scientific advisory board, Ashina is a paid consultant for this study for Eli Lily and Company.

About this neuroscience research article

Media Contacts:
Jacqueline Mitchell – BIDMC
Image Source:
The image is credited to BIDMC.

Original Research: The findings will be presened at 61st annual meeting of the American Headache Society in Philadelphia, Pennsylvania.

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  1. I want to know why the hit on opioid when smoking kills MORE people every year than drug overdoses, vehicle accident, AIDS, and murder COMBINED. How about removing nicotine products from the market???

  2. That’s funny because no doctor has prescribed me opiates despite having a permanent migraine, and failing over a dozen migraine medications. Most of these “migraine” meds aren’t for migraines at all. They are for something else, and used off label for migraines. Some of these non opioid migraine meds come with their own set of debilitating side effects. Gabapentin literally made me feel like I had early dementia. I could not remember anything, or retain any information whatsoever. Also it did nothing for my pain.Excedrin has destroyed my stomach lining, and I now have precancerous cells in my esophagus from constant acid reflux. These non-opiod meds come with just as many detrimental effects as opioids, even the otc stuff.

  3. I have tried multiple ” more conventional” treatments over years and most of them are medications taken daily to prevent the headaches. None of them have worked as the side effects either make me too tired to function or throw up for hours. Sumitriptan works on onset but SIX nasal sprays are 900$ . luckily I have decent insurance. It’s outrageous. Norco works for me on the two or three times a week that I’d need to take it but my Dr. refuses to to prescribe it anymore. One prescription lasted me almost three months. I’ve never had addiction issues. This is ridiculously blown out of proportion and needs to be addressed per patient. Not make doctors afraid to treat patients needs.

  4. The American Headache Association must not have ANYBODY on staff suffering from migraines. Use aspirin or ibuprofen as a first line of defense. Sadly, for me neither of these work at all. Also, both aspirin and ibuprofen cause serious stomach problems for many of us. I love all these organizations that still support taking things that don’t work. I would like for some of these people to suffer for one day with migraine pain like me. They might sing a different tune.

  5. For some people, the “approved” migraine medications don’t work, or people are allergic to them, especially triptans which can cause heart failure, so they are left with no other option but to take opioids in order to have some form of a life.

  6. I sympathize with the nurse, as I also suffer with migraines, about 3 a week. I also do not take opioids due to the reactions they give me. I was lucky enough to get a shot of aimovig but then insurance would not cover and I cant afford $690.00 an injection. That month I only had 4 migraines. Bring the price of these new meds down!!!!!!!
    Its immoral! No wonder people turn to opioids. Migraines are debilitating. I am also in healthcare, and work at a surgery center.

  7. I am a registered nurse with chronic migraines. Currently I don’t use pain pills for them. The pain can be so debilitating that I can understand why others do. You have to jump through hoops before you are offered Botox and some of the newer treatments. I have had 28 days of migraines out of 30 on several months myself and ended up at Urgent Care and ER to get a Torodol shot/IV. It got pretty desperate before I found help by using Botox, preventative and abortive medications, an OSKA electromagnetic pulse unit, and Cephaly unit. I can’t take OTC pain meds because of rebound migraines. So, until you walk a mile in our shoes, consider these things. My job keeps me from using cannabis products. Not sure I would want to. Will have to be really bad before that.

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