Reporting on Narcotics & Headache: What a Mess
ABC World News Tonight’s three-part series on migraine is raising awareness, but now all I can think is, be careful what you ask for. Really, what’s worse, a lack of understanding of the seriousness of headache or a feature story on the bad patients who take narcotics, thus worsening their pain?
The story, entitled Warning About Using Narcotics to Treat Migraines, looks more like a warning about treating undiagnosed headache with narcotics or using them as an early line of defense. According to the article, people who go to their doctors and complain about headache get prescriptions for narcotics about 70% of the time.
Triptans are offered up as the better alternative. But triptans, although they can be used to treat other episodic headaches, are primarily thought of as migraine drugs. I don’t have quantifiable evidence of this, but I doubt most GPs would consider treating non-migraine headache with triptans. Since half of migraineurs are undiagnosed or misdiagnosed, it’s clear why so many people with migraine aren’t treated with triptans.
There are probably a lot of people with headache who are given narcotics too early in their treatment. That doesn’t mean that no one with headache should use opioids to treat pain. Even though the story sets up a pain specialist and a headache specialist as representing opposing opinions on this, they both say basically the same thing: If no other treatment works, narcotics can make life bearable.
I think that ABC’s story was based on an analysis from the March issue of The Journal of Headache and Pain that highlights all these important issues without making us all look like drug addicts. Medical News Today summarizes:
“. . . of the patients diagnosed with migraines, only 50 percent received a prescription medication commonly used to treat headaches; of those, 59 percent received narcotics/opioids while only 41 percent received triptans. . . .”
“The analysis also suggests a high incidence of under-diagnosis and/or misdiagnosis of migraine. Nationally, approximately 12 percent of people suffer from migraines; however, in this data set, only 3 percent of subjects had a diagnosis of migraine, much lower than the national prevalence level. Therefore, the analysis confirms that there is a need for greater education and awareness of migraine.”