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The study tracked 8,200 episodic migraine sufferers for a year, and found 2.5 percent worsened to a state of chronic migraine. Those who took two classes of prescription medications -- drugs containing narcotics, such as Percocet, or drugs containing barbiturates, such as Fiorinal -- were most likely to worsen, Lipton and colleagues reported in the journal Headache. Risk increased with higher doses.
Over-the-counter standbys, from plain acetaminophen to the anti-inflammatories called NSAIDS -- ibuprofen, naproxen and their cousins -- weren't linked to chronic migraine. The NSAIDS even showed a hint of protection. Migraine-specific painkillers called triptans likewise showed no risk at low to moderate use, becoming a risk factor only after 10 pain days a month.
Some patients will need the stronger narcotics or barbiturates, especially for severe attacks, Lipton acknowledges. But, "the reality is they're overused" in migraines, he says, advising that patients who truly need them limit weekly doses.
Chronic migraine aside, getting out of the medication-overuse rut is hard. In New Jersey, it took Cerbone several tries before she found a migraine specialist who cut her prescription painkiller cold turkey and found a daily prevention medication that has worked since August.
Headache specialists advise:
Ask about migraine-prevention drugs. Choices range from blood pressure-lowering drugs called beta-blockers to epilepsy drugs and certain antidepressants, all of which have side effects to be considered. Some patients even try Botox injections, to quiet overactive nerve endings.
Quit the overused medication, but brace for painful withdrawal. A doctor may advise different short-term medications to help.
Use a headache diary to pinpoint migraine triggers and learn to minimize them.
Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
Copyright 2008 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
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