New Survey Shows Medication Overuse is a Real Issue

Nearly 60% of people with migraine are currently overusing their, their pain relief medication

1 in 5 people with migraine have been diagnosed with Medication Overuse Syndrome

  

The true extent of medication overuse in migraine treatment and prevention has been revealed in a new survey of over 1,300 people with migraine (1).

The survey, carried out by Migraine Action in partnership with Cefaly®, the non-pharmaceutical anti migraine device, found that 58% per cent of migraine sufferers are overusing pain relief medication. This is putting them at risk of Medication Overuse Syndrome, (rebound headache) and medication addiction. Nearly one in five (18%) of those surveyed have already been formally diagnosed with the Syndrome.

These figures are worrying,’ says Simon Evans, CEO of Migraine Action. ‘Medication Overuse is a significant issue which exacerbates migraine and this survey spells out just how widespread the problem is.’


According to the International Headache Society, Medication overuse is defined as taking pain relief for a headache more than twice a week
(8 days a month). for more than three months (2). Medication overusers are at high risk of developing Medication Overuse Syndrome, a condition where their headaches are actually caused or made worse by the medication rather than the original condition for which they were originally taken. (2)

Pain killers implicated in medication overuse and Medication Overuse Syndrome can be over the counter or prescribed pain relief and include codeine-based drugs, those containing caffeine, and a group of anti-migraine drugs known as triptans. However other drugs, including paracetamol and ibuprofen, can also cause the syndrome. In addition, overuse of codeine-based drugs can also lead to physical addiction.

‘This survey presents a highly significant finding on the extent of medication overuse within the migraine community,’ explains Dr Andrew Dowson, a migraine specialist and medical advisor to Migraine Action.

‘Migraines can be an extremely unpleasant and dehabilitating occurrence and it is completely understandable that people might reach for medication to either prevent or relieve migraine.

‘However, if you are overusing your pain relief medication and either not aware of it or not dealing with it then you are at real risk that, over time, the threshold level of your pain and sensitivity tolerance will drop and you will get more migraine headaches. Some people too, may become physically dependent to the painkillers themselves, particularly if they are codeine or caffeine based.

‘Effectively it creates a whole new condition for the patient to deal with on top of their migraine.’

‘It is essential to remember that these people are doing nothing wrong, explains Simon Evans. ‘Usually they are following the prescription written by their clinician or, if they buy over the counter, they are taking the drug within the daily prescribed limit.

‘All they know is that their migraines became worse and more frequent over time and so they take, or are prescribed, more and more pain relief to combat the worsening headaches. People can end up with continuous headaches, leaving them unable to work or enjoy a social life, all the while completely unaware that this is happening in part because of the medication that they are taking to help them in the first place.’


Jayne Thorne, 29, from Hampshire, was diagnosed with Medication Overuse Syndrome in April 2016 after 12 years of continuous and increasing drug treatment for worsening migraine which culminated in anti-epilepsy medication, anti-depressants and emergency hospital admissions. She is now drug free and experiences one or two migraines a month.

‘When I was finally diagnosed with MOS in a private consultation, my first reaction was one of relief that I could be helped,’ says Jayne. ‘The second was anger.  In 12 years no one ever mentioned the danger of medication overuse. Much of my medication was just given to me on a repeat prescription and my GP never once queried why I was taking or needed more and more.

‘I was weaned off all my drugs over a six-week process during which I was given naproxen as my only pain relief. Predictably the first two weeks were horrendous, I was told that it was similar to addiction withdrawal. The whole process took around 4-5 months but by September 2016 I had stopped taking all pain relief. Amazingly my migraines, which had been pretty much a constant part of my life, now occur just once or twice a month and are perfectly manageable with paracetamol and other therapies such as chiropractic.

‘Medication overuse pretty much stole the last five years of my life which greatly upsets me. I did go tell my GP about my diagnosis but there was very little interest. I changed my GP soon afterwards.’

Jayne is not alone in receiving little or no information about MOS from her doctor. The survey found that only 15% of patients were told about the risk of medication overuse at the time of their migraine diagnosis and although 88% of those surveyed were now aware of the condition only 16% had heard about it from their GP and 19% from their hospital specialist. The remainder had to make do with gleaning information from the media, charities and other sources.


‘Medication Overuse was first mentioned in medical circles in the late 1990s and whilst it seems that some progress has been made, there is clearly a great deal of work still be done in terms of understanding and awareness of the condition especially within primary care which is where the majority of migraine patients will be treated,’ added Dr Andrew Dowson.

‘This may be due to a variety of factors including lack of education and advice for healthcare professionals (HCPs), a lack of awareness of the definition of Medication Overuse or even a fear of labelling people as drug addicts, although this is absolutely not what we are talking about here.

‘Whatever the reason, the end result is that people with migraine are being left in the dark about a really significant side effect of their migraine treatment.’

‘There is definitely need to raise awareness and provide support around Medication Overuse Syndrome both within the medical profession and the migraine community,’ agrees Simon Evans. ‘Currently we don’t even have NICE Guidelines on the condition.

We are calling for all migraine patients to be given clear information on Medication Overuse, together with a system of checking back with them on the amount of medication that they are taking - and support if they need it to rein back on their medication.

‘Around nine million people in the UK are living with migraine. If our figures are borne out that translates to around five million people living with medication overuse right now, and most of them are completely unaware how this condition is affecting their lives. This survey highlights the overwhelming need for a serious awareness and prevention strategy and for all HCPs involved with migraine to begin take medication overuse seriously.


Cefaly is non-pharmaceutical, non-invasive an anti-migraine device with similar efficacy to pharmaceutical treatment with none of the side effects (3) Cefaly was granted NICE Guidance in 2016. Bharat Vadukul, Business Director of BHR comments: ‘The worrying extent of this dependency on pharmaceutical pain relief shows that there is a growing and real need for a first line non-pharmaceutical effective migraine treatment.’

 

  

NOTES

 The Medication Overuse Survey was run by Migraine Action and supported by BHR Ltd, the sole UK distributors of Cefaly.

1301 respondents between 23/02/2017 and 19/04/2017

  • Age range:    17 and younger – 60 or older  (81% over 40+)

  • 86% Female  14%Male

  • 90% UK residents

  • 97% White

  • 94% have formal Headache/Migraine Diagnosis

    References

    1. See Media Pack for full survey summary

    2. http://www.ihs-klassifikation.de/en/02_klassifikation/03_teil2/08.02.00_substance.html

    3. Migraine prevention with a supraorbital transcutaneous stimulator:A randomised controlled trial. Jean Schoenen, Bart Vandersmissen, Sandrine Jeangette, et al. Neurology Feb 6,2013.

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