Transformed (Chronic) Migraine - Risk Increased by Some Medications

by Teri Robert, Lead Health Guide

In learning about Migraines and headaches, we've learned that taking some medications more than two or three days a week can lead to medication overuse headache, aka rebound. We've also learned that medication overuse is a factor in 80% of cases of transformed Migraine.

Note: Since the time this article was first published, changes in the International Headache Society's International Classification of Headache Disorders have resulted in what was called "transformed Migraine" now being classified as chronic Migraine.

Now, there's additional evidence that any use of barbiturates such as Fioricet or opioids are associated with increased risk of transformed Migraine.

Dr. Marcelo Bigal and his team, knowing that medication overuse was believed to play a major role in Migraine progressing from episodic to chronic or transformed Migraine but limited solid limited data, undertook a study to assess the role of specific classes of acute medications (medications taken when a Migraine occurs) in episodic Migraine (EM) sufferers developing transformed Migraine (TM).

Study Methods

For the American Migraine Prevalence and Prevention study (AMPP), 120,000 people were surveyed to identify a group of Migraineurs to be followed annually for five years. They calculated the probability of transition from EM in 2006 to TM in 2006 as related to medication use at the beginning of the period.

Study Results

  • Out of 8,219 Migraineurs with EM in 2005, 209 Migraineurs (2.5%) developed TM by 2006.
  • Baseline headache frequency was a risk factor for TM.
  • Study participants who used medications containing barbiturates (such as Fiorinal or Fioricet) were at increased risk of TM. A dose–response relationship was found for use of barbiturates.
  • Use of triptans at baseline was not associated with prospective risk of TM.
  • Overall, NSAIDs were not associated with TM.
  • NSAIDs were protective against transition to TM at low to moderate monthly headache days, but were associated with increased risk of transition to TM at high levels of monthly headache days.

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