Choosing Wisely:

Don’t use opioids or butalbital for migraine except as a last resort.

Rationale and Comments: Opioid and butalbital treatment for migraine should be avoided because more effective, migraine-specific treatments are available. Frequent use of opioids and butalbital can worsen headaches. Opioids should be reserved for those with medical conditions precluding use of migraine-specific treatments or for those who fail these treatments.
Sponsoring Organizations:
  • American Academy of Neurology
  • Sources:
  • U.S. Headache Consortium guidelines
  • Institute for Clinical Systems Improvement
  • Disciplines:
  • Neurologic
  • References: • U.S. Headache Consortium guidelines. http://www.american
    • European Federation of Neurological Societies guideline on drug treatment of migraine. upload/guidline_papers/EFNS_guideline_2009_drug_treatment_of_migraine.pdf.
    • Institute for Clinical Systems Improvement. Headache, diagnosis and treatment of. more/catalog_guidelines_and_more/catalog_guidelines/catalog_neurological_guidelines/headache/.

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