Transformed Migraine - Risk Increased by Some Medications

The authors write that their study "supports and expands" findings of previous studies and summarize those points:

1. Among individuals with episodic Migraine, the average annual incidence of TM is 2.5%. This estimate is in close agreement with a prior population based longitudinal study.
2. Both frequency of headaches [Migraines] and use of specific classes of acute medication are independently associated with the development of TM (see Table 5).
3. Within a class of acute treatments, the influence of drug is modified by frequency of use as well as headache [Migraine] frequency.
4. The influence of drug remains after adjusting for baseline headache [Migraine] characteristics.
5. Relationships of medication type and frequency of use to gender and headache frequency are complex. Use of opiates and barbiturates is associated with an overall increased risk of TM, at any frequency of use. Although triptan use days did not significantly predict transition to TM, controlling for monthly triptan use days, monthly headache days and gender were both significant predictors of transition to TM. NSAID use was associated with a decreased risk of TM, but only in those with low or intermediate frequency of headaches.
6. Gender seems to influence the transition to TM.

The final paragraph of the journal article is quite clear:

"These findings have potential implications for clinical practice. We suggest that use of opiates and barbiturates should be limited and well monitored in Migraineurs. We also suggest particular caution in using opiates to treat Migraine in men. Caution is also advised in individuals with high frequency of headaches [Migraines] using any medication."
 

Summary and comments

Any use of opiates / opioids and barbiturates has been shown to be associated with an overall increased risk of transformed Migraine, no matter how frequently or infrequently they are used.

Triptans (Imitrex, Maxalt, Zomig, etc.) do not increase risk of TM when the days of use per month are kept low.

NSAIDs were actually associated with a decreased risk of TM ONLY for Migraineurs with fewer than 10 - 14 Migraine days per month. This would serve to confirm that NSAID use should be restricted to no more than two or three days per week and should NOT be used for Migraine prevention.