Zopiclone and prazepam abuse in a chronic migraine patient

Painful conditions are frequently accompanied by sleep disorders. Here we present the case, never previously reported, of high doses of zopiclone and prazepam abuse in a patient suffering from migraine and insomnia. A 37-year-old female Caucasian patient, nursing degree, with two 7-year-old twin daughters, began to suffer from migraines in her childhood. Migraine worsened and was associated with insomnia after the daughters’ birth. Eight months ago, migraine and insomnia further worsened in conjunction with the prescription of fluoxetine and prazepam as migraine prophylaxis and of zopiclone for insomnia. From that moment, the patient increased the dose of zopiclone up to 20 tablets (150 mg) nightly and prazepam up to 20 tablets (400 mg) daily. As acute migraine treatment she also used ketorolac 1-2 f every day intramuscularly. The patient was hospitalised for withdrawal of medications and to treat migraine. Hair analysis documented the history of this patient and the good progress of the treatment. Zopiclone and prazepam are considered drugs with low abuse potential. However, the final outcome of a drug treatment may be influenced by non-drug factors, such as the patient’s characteristics and the treatment milieu. In fact, in a stressful context, the prescription of zopiclone in a patient vulnerable for migraine triggered abuse of this drug and of prazepam, which was associated with chronification of migraine and analgesics overuse, without relieving insomnia. In prescribing hypnotics and anxiolytics to patients with chronic pain there must therefore be great caution.