Jessica Ailani, MD: Lowering the Opioid Use Rates in Migraine


The director of the MedStar Georgetown Headache Center spoke about the higher-than-desired rates of opioid prescriptions for patients with migraine, and how new treatment options and provider education can help lower those numbers.

“We know that in this country we’re facing this huge opioid epidemic. Minus that, we know that opioids and butalbital are not good treatments for migraine and that we can actually worsen the underlying disease by using these types of medication. There’s an area where you have the patients and the clinicians feeling like ‘We have something, but we don’t like it’ because of an adverse effect or it’s not as effective as the patient was hoping for…this is where that gap is.”

In a presentation of CaMEO study data by Richard Lipton, MD, at the 2019 American Headache Society (AHS) Annual Meeting, July 11-14, in Philadelphia, Pennsylvania, it was revealed that a high rate of patients with migraine are still being prescribed opioids for acute relief, despite contradicting recommendations from the AHS and other organizations.1

For headache specialists, this is troubling from a number of aspects, and the solution to the problem appears to be at least 2-fold: better education of primary care providers (with whom 70% of migraine will meet regarding their condition) about the use of opioids in migraine, and the introduction of additional, safe acute medications.

To find out more about what this could mean in the midst of a period when a number of agents from the gepant class are taking steps closer to regulatory approval, NeurologyLive spoke with Jessica Ailani, MD, director, MedStar Georgetown Headache Center, and associate professor, neurology, MedStar Georgetown University Hospital. Ailani, who was involved in the clinical development of urbogepant, saw firsthand the efficacy of these new acute medications as well as their lack of adverse events common with other medications, such as triptans.2

Ailani discussed the possibility of introducing new treatment options to patients with migraine and improving provider education, and how these steps could, in turn, improve the care situation for the millions of Americans with the disease.

For more coverage of AHS 2019, click here.


1. Litpon R. Depression and Anxiety Are Associated with Increased Headache-Related Disability in Episodic and Chronic Migraine: Results from the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study. Presented at: 2019 American Headache Society Annual Meeting. July 11-14, 2019; Philadelphia, PA. Poster P160.

2. Ailani J. Long-term Safety Evaluation of Ubrogepant for the Acute Treatment of Migraine Attacks. Presented at: 2019 American Headache Society Annual Meeting. July 11-14, 2019; Philadelphia, PA. Poster P109.

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