Migraine patients who take opioids or barbiturates to control their pain may be making their condition worse, a new study suggests. Patients who used them just six to eight days a month were twice as likely to develop chronic migraine within a year as those who relied on acetaminophen.

“Strict limits for these types of drugs should be enforced among people with migraine as a way of preventing their migraines from becoming more frequent and more painful,” advises study author Marcelo Bigal, MD, PhD, of Albert Einstein College of Medicine in Bronx, N.Y.

Dr. Bigal presented his findings to the American Academy of Neurology in April. He and his colleagues surveyed 24,000 migraine patients in 2005. Those who had <15 headaches per month were classified as “episodic” patients. Those who had >15 episodes per month were classified with chronic disease.

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One year later, 209 (2.5%) episodic patients had developed chronic disease. Using acetaminophen as a reference, the researchers found that those who took barbiturates doubled their chances of progressing to ≥15 headaches per month.

Opioids produced a similar pattern. However, other pain relievers, including triptans and nonsteroidal anti-inflammatory drugs (NSAIDs), appeared to have no effect on transforming from episodic to chronic disease.