Don’t use opioid or butalbital treatment for migraine except as a last resort.
Opioid and butalbital treatment for migraine should be avoided because more effective, migraine-specific treatments are available. Frequent use of opioid and butalbital treatment can worsen headaches. Opioids should be reserved for those with medical conditions precluding the use of migraine-specific treatments or for those who fail these treatments.
These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.
The American Academy of Neurology (AAN) established aChoosing Wisely® Working Group to develop its list of recommendations. Members of this group were selected to broadly represent varying practice settings and neurological subspecialties. Neurologists with methodological expertise in evidence-based medicine and practice guideline development were also included. The working group solicited recommendations from AAN members, which were then rated based upon their judgments of harm and benefit that would result based upon compliance with the recommendation. Based on committee voting and a literature review, candidate recommendations were sent to relevant AAN sections, committees, specialty societies and patient advocacy groups for review and comment. The working group reviewed this feedback and voted on the final Top Five recommendations, which were approved by the AAN Practice Committee and Board of Directors.
AAN’s disclosure and conflict of interest policy can be found at www.aan.com.
Silberstein SD; US Headache Consortium. Practice parameter: Evidence-based guidelines for migraine headache (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology [Internet]. 2000;55(6):754-762.
Evers S, Afra J, Frese A, Goadsby PJ, Linde M, May A, Sandor PS, European Federation of Neurological Societies. EFNS guideline on the drug treatment of migraine – revised report of an EFNS task force. Eur J Neurol [Internet]. 2009 Sep;16(9):968-81.
Institute for Clinical Systems Improvement. Headache, Diagnosis and Treatment of (Guideline) [Internet]. Bloomington, MN: Institute for Clinical Systems Improvement; 2011 [cited 2012 Oct 25]. Available from: www.icsi.org/headache/headache__diagnosis_and_treatment_of_2609.html.