Treating Migraine Headaches: Some drugs should rarely be used
Choosing Wisely Mailing List
To treat migraines, you may get a prescription for an opioid (narcotic) or a barbiturate (sedative) called butalbital. These are pain medicines. But you should think twice about using these drugs. Here's why:
Using too much pain medicine can lead to a condition called MOH, or medication overuse headache.
- Drugs containing opioids-such as hydrocodone (Norco, Vicodin, and generics) or oxycodone (Percocet and generics).
- Drugs containing butalbital (Fioricet, Fiorinal, and generics).
They are not as effective as other migraine drugs.
There are other drugs that can reduce the number of migraines you have and how severe they are- better than opioids and butalbital. Even in the emergency room-where people with severe migraines often ask for opioids-better drugs are available.
They have risks.
Opioids and butalbital can cause serious withdrawal symptoms if you stop taking them suddenly. People who use high doses for a long time may need to be in the hospital in order to stop using them.
Opioids, even at low doses, can make you feel sleepy or dizzy. Other side effects include constipation and nausea. Using them for a long time can lower your sex drive and cause depression and sleep problems.
What drugs are good for migraines?
If you have migraine attacks, try one of the drugs listed below. They all work best if you use them when the migraine is just beginning.
- Start with a non-prescription pain drug that combines aspirin, acetaminophen, and caffeine (Excedrin Migraine, Excedrin Extra Strength, and generics). Or try non-steroidal anti-inflammatory drugs such as ibuprofen (Advil and generic) or naproxen (Aleve and generic).
- If these drugs do not help, or your headaches are more severe, try one of the prescription migraine drugs called triptans, such as sumatriptan (Imitrex and generic).
- Start If triptans do not work, try dihydroergotamine nasal spray (Migranal). This drug works even better as an injection (DHE-45 and generic). You or your doctor can do the injection.
If you have migraines often, or if they are very severe, ask your doctor about drugs to prevent headaches.
When are opioids or butalbital useful for migraines?
Your doctor may suggest an opioid if none of the treatments listed above help, or if you have bad side effects.
It is not clear if butalbital should be used at all for treating migraines. If your doctor prescribes butalbital for your migraines, ask why. And ask if there are any other drugs that would work.
Limit the use of all pain medicines.
- Do not use prescription pain medicine for headaches for more than nine days in a month.
- Do not use non-prescription pain medicine for more than 14 days in a month.
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Employers are a Part of the Solution to Ending Rhode Island's Overdose Crisis
The nation's opioid overdose epidemic is the single greatest public health crisis of our time. In the past five years, we have lost more than 1,400 Rhode Islanders to opioid-related overdose. Governor Gina M. Raimondo established the Overdose Prevention and Intervention Task Force in 2015 to reduce the number of overdose deaths and save lives.
As a part of this statewide initiative, the Rhode Island Department of Health (RIDOH) Drug Overdose Prevention Program is partnering with local businesses and corporations to conduct workplace outreach and education.
Save the Date
RIBGH Golf Tournament
August 27, 2018
Shotgun start @ 1:15 PM
Wannamoisett Country Club
96 Hoyt Ave
RIBGH Healthcare Summit
Friday, October 5, 2018
7:30 AM - 11:00 AM
Providence Marriott Downtown
1 Orms Street
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Thanks to a grant from the Rhode Island Foundation, RIBGH has begun working on a new campaign to continue the promotion of Choosing Wisely throughout the state. In this newsletter, we will introduce you the program's coordinator and share information on how you can adopt this valuable initiative at your workplace, if you haven't already.
If you were unable to attend RIBGH's recent Wellbeing Summit, we have included highlights from this informative and well-attended event. Registration is already open for our next two events, our Annual Healthcare Summit on October 5th and our 5th annual golf tournament. We hope you find the newsletter content useful and would love to hear your feedback at
RIBGH's Wellbeing Summit: Well Attended and Highly Informative
The RIBGH June 8th Wellbeing Summit, in partnership with RISHRM, BHDDH, and RIDOH, was well attended and attendees commented that the program was highly informative. Tom Coderre, senior advisor to RI Governor Gina Raimondo, started the morning off with a heartfelt story of his own personal battle with opioid addiction. His story took attendees through the ups and downs of the loss of his previous job, his home, his family, and his desire to live, coming full circle to the start of his recovery process in 2003 and the reclaim of his career. Today, Coderre is
Co-chair of the governor's Overdose Prevention and Intervention Taskforce.
His story highlighted the importance of employment and peer support as resources for recovery, urging employers to stray from the discrimination of substance use disorders. Coderre also highlighted the importance of adhering to the clinical standard of care for substance use disorder: medication assisted-treatment, or MAT. Three particular medications, methadone, buprenorphine, and naltrexone, have been FDA approved to treat substance use disorder. In combination with psychological behavioral therapy, MAT is the most effective means of treatment. In a recent RI prison study of MAT, followed by outpatient treatment upon individual release, overdoses in the state have plunged. Not only does MAT save lives, but it saves government and employer dollars by avoiding acute health conditions or disability.
Linda Mahoney, State Administrator for the Department of Behavioral Health Care, Developmental Disabilities, and Hospitals (BHDDH) took the stage following Coderre. Mahoney implored employers to recognize the brain changes that are observed in people with substance use disorder, acknowledging that some people also have a physiological pre-disposition to addiction. The BHDDH Administrator proposed that interventions such as peer recovery coaches be implemented in businesses. Due to the breadth of the opioid epidemic, Rhode Islanders "have to treat this like the HIV crisis."
Dr. Robert 'Neal' Mills, specializing in family medicine and serving as the Medical Director of the Health and Benefits Practice at Aon, echoed the themes of Coderre and Mahoney. Although Mills commended Rhode Island for being ahead of the game in terms of making script manipulation harder to accomplish through our Electronic Medical Record system (EMR), he emphasized employers' roles in the opioid epidemic. 81% of employers lack a comprehensive drug-free workplace policy, and Mills also proposed that 76% of employers are not offering training on how to identify signs of opioid misuse. He recommended that each company's goal be to have 95% compliance with the CDC guidelines for opioid prescribing by 2020, which can be accomplished by working with the Pharmacy Benefit Managers (PBMs) affiliated with company health plans to assure that both the dosage and longevity of opioid prescriptions are being monitored.
Following a networking break, the Summit's Employer Panel Discussion featured insight from Dr. Susan Andrews of Electric Boat and Ronnie King, Senior Director of Human Resources for Blount Fine Foods. Andrews, who previously served as a physician in corrections, recommended the hair drug testing method that is employed at Electric Boat. Because this method detects drug use over a long period of time, it makes it easier for the employer to intervene against potential substance use disorder and assist in employee rehabilitation. King, who revealed that her knowledge of the opioid epidemic stemmed from seeing a pattern in employee termination, noted that "if it's in America, it's in our businesses."
The Summit concluded with a training by Erin McDonough, the Director of Naloxone and Overdose Prevention Program of the RI Medical Reserve Corps. Since opioid deaths have surpassed driving accident deaths, McDonough believes that broadening the knowledge and access of naloxone (brand name Narcan) in businesses can save lives.
Healthcare Costs Increasing at
Medical costs are poised to continue their relatively flat growth in 2019, but researchers say the steady trend is unsustainable for consumers.
The expected 6% growth in 2019 aligns with the 5.5% to 7% trend over the past five years-a welcome change from the double-digit spikes in the 2000s-but higher costs haven't translated to similar gains in consumers' health and productivity, said PricewaterhouseCoopers researchers who
studied employer-sponsored healthcare spending
Expensive new medical services and drugs
are driving higher costs, said Barbara Gniewek, a health services principal at PwC.
"It looks like costs are stabilizing, but they are still going up at a rate above inflation," she said. "They are still increasing at an uncontrolled level and are ultimately unsustainable."
New Campaign Manager to Continue Promotion of Choosing Wisely - RI
Joanne Bilotta has signed on as the RIBGH's new Choosing Wisely - RI Campaign Manager. Over the course of a year, she will be overseeing the continuation of the RIBGH's Choosing Wisely-RI campaign, promoting the benefits of the initiative statewide. Joanne was instrumental in the acquisition of grant funding and the launch of the Choosing Wisely campaign.
Joanne Bilotta is the founder and principal of Joanne Bilotta Strategic Solutions a consulting firm whose services include strategic planning, program development and execution, and event planning for businesses and non-profit organizations. Joanne has worked with leaders of large and small businesses across all industries and non-profit agencies to develop and implement programs and strategies that have amplified their brand recognition in the market, improved operations on average over 50%, broadened their networks and increased revenue.
Joanne has over 25 years of experience in the healthcare industry. In her role as Vice President of Account Management for Telcare, Inc., Joanne worked with hospital executives, physician groups, and health plan leaders to develop strategies for incorporating remote Diabetes monitoring technology into their practices to improve patient care. As an Assistant Vice President at Blue Cross & Blue Shield of Rhode Island, Joanne developed and launched innovative product lines that increased market share and improved customer satisfaction. Joanne led the operations and health education/account management teams as the Assistant Vice President for The Health & Wellness Institute.
Tune In To Learn More About Choosing Wisely!
In case you missed the 6/23 broadcast of the
Patricia Raskin Radio Show with featured guests RIBGH Executive Director Al Charbonneau & RIBGH Choosing Wisely Campaign Manager, Joanne Bilotta, the show is now available on RIBGH.org!
Choosing Wisely-Transforming Low-Value Care
into High-Value Care for a Better Bottom Line
- Listen in as the RIBGH Executive Director, Al Charbonneau and Board Member and Choosing Wisely Campaign Manager, Joanne Bilotta discuss how low-value care is impacting our health and bottom line, how participation by all in the Choosing Wisely campaign will help reduce wasteful spending and drive higher-value care, and how you and your company can participate in the Choosing Wisely statewide initiative!
- In 2012 the Institute of Medicine (IOM) of the National Academies issued a report stating that 30% of US health spending annually is wasted on unnecessary care!
- The RIBGH was recently awarded a generous grant from the RI Foundation to continue to promote implementation of the Choosing Wisely program throughout the state. The nationally recognized initiative of the American Board of Internal Medicine Foundation (ABIM) encourages effective communications between doctors and their patients with the goal of eliminating unnecessary tests and procedures.
Want to learn more about Choosing Wisely?
Contact Joanne Bilotta
Campaign Manager, Choosing Wisely-RI
RIBGH Board Member
T: (800) 606-1384
C: (508) 404-6560
To learn about your perspectives and current actions on the waste in healthcare, we ask you to complete this brief survey from the National Alliance and Benfield-Gallagher through
The survey should take no more than 5-7 minutes to complete. If we have at least 20 employers complete this survey we will have access to an aggregate summary of all responses for our state.
Your response no later than Tuesday, July 10th is appreciated.
Please contact Laura Huff at firstname.lastname@example.org or 314-656-2391 with questions on the survey or technical issues.