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| 50th Annual Meeting of the American Headache Society |
Boston, Massachusetts June 26-29, 2008 |
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Harold G. Wolff Lecture Award Recipient Warns
Against Medication Overuse |
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BY MAURY M. BREECHER
Contributing Writer |
BOSTON — The use of opiates and barbiturates
should be well monitored in migraineurs and caution
should be advised to individuals with high frequency of
headaches who use any medications, said Dr. Marcelo
Bigal during his Harold G. Wolff Lecture at the 50th
Annual Scientific Meeting of the American Headache
Society on June 27.
Dr. Bigal, the Global Director for Scientific
Affairs-Neuroscience for Merck Research Laboratories,
was the recipient of the Harold G. Wolff Award and
presented results from the American Migraine Prevalence
and Prevention (AMPP) Study. The research was funded by
a National Headache Foundation grant from Ortho-McNeil
Neurologics, Inc.
The question posed was whether patients with frequent
headaches overuse medication?
“Of course they do,” stated Dr. Bigal. “No one wants to
endure pain. However patients with infrequent headaches
who start to use too much acute care medications begin
to have more frequent headaches. If they continue to do
so, they develop frequent and often daily headaches or
chronification of headache.”
Three clinic-based studies suggested that in individuals
with migraine, analgesic use for other reasons were
associated with transformed migraine. The studies were
of opiates to control bowel movements, opiate use in a
pain clinic, and triptans in cluster headache (Headache
2001;41:303-309; Headache 2003; 43:179-190; Neurology.
2006;67:109-113).
As part of the AMPP study, Dr. Bigal and fellow
researchers, including Dr. Richard B. Lipton, modeled
the probability of transition from episodic migraine in
2005 to transformed migraine in 2006 in relation to
medication use status at baseline, with adjustment for
gender, headache frequency, and severity and
preventative medication use.
Dr. Bigal said that among individuals with episodic
migraine, the average annual incidence of transformed
migraine is 2.5%.
Both frequency of headaches and use of specific classes
of acute medication are independently associated with
the development of transformed migraine, he explained.
Furthermore, within a class of acute treatments, the
influence of drug is modified by frequency of use as
well as headache frequency. The influence of drug use
remains after adjusting for baseline headache
characteristics.
The relationships of medication type and frequency of
use to gender and headache frequency are complex but the
influenced of medication on headache frequency is class
specific: Barbiturates and opiates increase the risk.
Triptans, for the most part do not, although an effect
was seen in males with high frequency. NSAIDs do not
increase risk and are protective unless the frequency of
headache is high.
“The conclusions from this frequent headache
epidemiology study is that the incidence of chronic
daily headache is 3 per 100 person-years, meaning three
percent of the general population will develop chronic
daily headache over the next year,” stated Dr. Bigal in
the notes to his talk.
Case control and cohort analyses have identified risk
factors for chronic daily headache. There are risk
factors that are not readily modifiable and there are
risk factors that are readily modifiable, he pointed
out.
“We cannot modify inherited genetic predisposition for
migraine, or being female, or education or social
economic status, or a history of head injury,” said Dr.
Bigal. “But what we may be able to intervene on and
modify is attack frequency, obesity, and medication
overuse. We hope to find a way to modify response to
stressful life events. Snoring is also an interesting
factor that needs further exploration.”
Dr. Bigal’s data came from an analysis of 120,000
households surveyed between June and August of 2004. The
sample was of 257,339 Americans ages 12 and older. The
response to the survey was from 162,576 Americans ages
12 and older. |
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