Although consensus statements and guidelines do not recommend the use of opioids for the management of acute migraine, more than one-third of patients report current opioid use or keep opioids on hand to manage their migraines, according to results from a study published in Neurology.
Researchers analyzed data from the Chronic Migraine Epidemiology an Outcomes (CaMEO) study to explore demographic and clinical characteristics associated with opioid use for migraine. Respondents who completed the screen were assessed every 3 months on a broad set of medical conditions. From September to October 2012, screening and recruitment of study respondents occurred; cross-sectional and longitudinal CaMEO study modules were administered from September 2012 to November 2013, as well as longitudinal assessments occurring at 3-month intervals up to 12 months following baseline assessment.
Eligible respondents were at least 18 years of age, lived in the United States, agreed to participate, completed the survey in adequate time, provided data on headache frequency, reported consistent age and sex throughout the survey, and met modified International Classification of Headache Disorders, 3rd edition (ICHD-3) symptom criteria for migraine. Participants were further classified into chronic (headache frequency of ≥15 days) or episodic migraine (headaches <15 days).
Headache characteristics included monthly headache days, Migraine Disability Assessment, and Migraine Symptom Severity Score. Health care variables included physician diagnosis of migraine or chronic migraine and use of an emergency department or urgent care facility in the preceding 6 months for headache. Participants also completed the Migraine-Specific Quality of Life Questionnaire (MSQ), scored on a scale ranging from 0 to 100. Respondents who reported current use of medications for the acute treatment of migraine attacks indicated which medications they were taking or had available to use by referring to a precoded list that included both generic and brand names of drugs.
Opioid users were defined as individuals who self-reported current use of an opioid or had opioid medicine on hand to treat headache. Opioid use considered a risk for developing medication overuse headache (MOH) was defined as opioid use for at least 10 days each month.
Of the 2388 respondents who met inclusion criteria, 36.3% reported that they currently used or kept on hand opioid medications to treat headaches. Participants who used opioids had more comorbidities, greater headache-related burden, and lower quality of life compared with nonusers. Factors associated with opioid use included male sex, higher body mass index, allodynia, increasing monthly headache frequency, a higher Total Pain Index score, anxiety, depression, ≥1 cardiovascular comorbidity, and emergency department/urgent care use for headache in the past 6 months.
Full- or part-time employment status and income >$75,000/year were associated with higher odds of opioid use, but these results were not considered significant after adjustment for respondents’ headache characteristics.
“The current analysis confirmed that opioid use among individuals with migraine is not uncommon,” the study authors concluded. “Results of this study are important for a global audience, especially in countries where prescriptions for opioids are increasing.”
Lipton RB, Buse DC, Friedman BW, et al. Characterizing opioid use in a US population with migraine. Neurology. 2020;94:e1-e12.