Understanding Why Opioid Use is High Among People With Migraine

According to recent research presented at the AMCP Annual Meeting 2019, opioid use is common among migraine patients using prescription medication. Further, increased opioid use among this patient population leads to worsened health, including elevated body mass index, cardiovascular comorbidities, emergency facility use, and more.

“Opioid use for acute treatment of migraine is not recommended by scientific organizations and is of concern because it may be associated with dependence, suboptimal outcomes, and increased risk of new-onset chronic migraine (CM),” said lead author Richard Lipton, MD, and colleagues.

In order to identify variables associated with opioid use among patients using acute prescription medications for migraine, Dr Lipton and his colleagues identified patients with ICHD-3 migraine from a Web panel demographically matched to the US population. The team compared the features of self-reported opioid users with those of non-opioid users.

The research team identified 2388 patients with migraine that are using prescription medications for migraine. Of the 2388 identified patients, 867 were opioid users. According to the findings, the researchers identified the following to be significant factors associated with opioid use:

• male sex;
• increasing BMI;
• allodynia;
• increasing monthly headache day frequency;
• increasing Total Pain Index;
• anxiety;
• depression; and,
• emergency facility use for headache.

Of note, the researchers said there was a decreased likelihood of opioid for physician-diagnosed migraine or CM.  

“Despite recommendations to the contrary, opioid use is common among migraine patients using prescription medication and is generally associated with markers of worse health, including elevated BMI, CV and psychiatric comorbidities, elevated TPI, and emergency facility use,” Dr Lipton and colleagues concluded. “Modifiable variables associated with opioid use include presence/absence of physician diagnosis and greater monthly headache days.”

—Julie Gould

Reference:

Lipton R, Schwedt T, Friedman B, et al. Demographics, Headache Characteristics, and Other Factors Associated with Opioid Use in People with Migraine: Results from the Chronic Migraine Epidemiology and Outcomes Study [G47]. J Manag Care Spec Pharm. 2019;25(3-a). https://www.jmcp.org/doi/pdf/10.18553/jmcp.2019.25.3-a.s1