THURSDAY, June 23 (HealthDay News) -- Delivered intravenously in an emergency-care setting, nonsteroidal anti-inflammatory drugs (NSAIDs) may be at least as effective as narcotics in treating late-stage migraines, a new study suggests.

Even better, the researchers add, they are much safer and non-habit forming.

Thus, NSAIDs should be considered first-line therapy for migraine sufferers showing up in emergency rooms, say the researchers, who are to present their findings Thursday at the American Headache Society annual meeting in Philadelphia.

"Patients who go to the emergency room because they cannot get rid of a migraine any other way should request that they be treated with intravenous NSAIDs rather than intravenous opioids," said study author Rami Burstein, an associate professor at Harvard Medical School and vice chairman of research of the department of anesthesia and critical care at Beth Israel Deaconess Medical Center.

"Intravenous NSAIDs are as effective, if not more, and they are not habit-forming drugs," he explained.

Migraines are particularly debilitating headaches plaguing about 28 million Americans. Some 800,000 of these sufferers end up in the emergency room each year seeking relief from hard-to-treat symptoms.

Burstein said that, according to one 1998 survey, about 51 percent of migraine sufferers showing up at ERs are given opioid narcotics, "basically without even being offered any other possibility."

What happens next, Burstein added, is that patients all too often return to their doctors and ask for a prescription for this "miracle drug" that banished their migraine. "This is the beginning of them going on opioid therapy, and once a patient gets on opioids, they basically stop responding to any other drugs for pain," Burstein said.

For this study, Burstein treated 32 people who had developed allodynia, a hypersensitivity of the skin that affects about two-thirds of people with advanced migraine.

Previous studies had indicated that once allodynia occurs, triptans, which are drugs commonly used to treat migraines, no longer work. This is when people typically end up in the emergency room hooked up to an IV drip filled with opioids.

But in this case, NSAIDs were chosen because previous research had shown that inflammatory molecules play a role in chronic pain, including frequent migraines.

"These inflammatory molecules are found in the periphery [of the body] but also in the central nervous system," Burstein explained.

While NSAIDs in pill form can block inflammation in the periphery, they "don't make it to high enough concentrations to block production in the central nervous system," he said. Delivered intravenously, however, NSAIDs can reach that highly effective concentration.

In the study, half of the participants received the NSAID ketorolac (brand name Toradol) delivered intravenously beginning four hours after the start of a migraine attack. The other 16 participants received an injection of one of the triptans (in this case, sumatriptan) four hours after the migraine began, followed by ketorolac two hours later if their pain refused to subside.

After receiving ketorolac, 64 percent of patients were pain-free one hour after infusion, with skin sensitivity returning to normal.

On the other hand, 32 percent received no benefit at all from ketorolac, the researchers said. All of these individuals had a previous history of using opioids.

"This immediately raised a red flag regarding treating migraine patients with opioids, which we believe is wrong practice," Burstein said.

"Patients don't go every day to the emergency room," he added, but the finding "really is a proof of concept of a new direction that we should develop to address migraines in late stages after onset."

More information

For more on migraines and their treatments, visit the Migraine Awareness Group.