Approximately 20% of patients who visited a headache center reported current use of opioids and/or barbiturates, despite the fact that these drugs can worsen headaches, be ineffective, or carry dependency or withdrawal risks, according to a new study presented this week at the 57th Annual Scientific Meeting of the American Headache Society.

Reviewing surveys completed by 218 headache patients, most of whom had a migraine diagnosis, researchers at NYU Langone Medical Center and Brigham and Women's Hospital found that more than half of the patients reported having been prescribed an opioid or a barbiturate and about one-fifth were on opioids and barbiturates at the time of completing the survey, according to Mia T. Minen, MD, MPH, Director of Headache Services at NYU Langone, and lead author of the study.

"Headache specialists are often in a difficult position when patients request opioids or increasing quantities of barbiturates," she said. "And although many patients find these effective, they are known to contribute to headaches related to medication overuse."

Her team sought to identify which physicians in which settings are prescribing these drugs and found the most frequent first prescribers of opioids are emergency room physicians while general neurologists were most frequent first prescribers of barbiturates. Primary care physicians were also identified as first prescribers.

Such medications have been designated as inappropriate as first line treatment for migraine patients by the American Board of Internal Medicine's "Choosing Wisely" campaign. The campaign recommends that first medications for migraine be either non-prescription pain medications or a class of prescription drugs called triptans that are specifically for migraine.

"Taken as a whole, these data provide a useful snapshot of the wide variety of physician specialties that might benefit from additional education on the appropriate use of opioids and barbiturate-containing medications in patients with headaches," Dr. Minen said.

The American Headache Society Annual Scientific Meeting draws about 1,000 headache and migraine researchers and treatment specialists from around the world to hear the latest scientific and clinical information on headache and migraine. This year's program, "Drawing upon Headache Research," is four days of teaching and scientific presentations.