Three observational studies will be presented this week at the American Headache Society (AHS) 61st Annual Scientific Meeting in Philadelphia. The studies provide insight into how opioids are being used to treat migraine in a range of acute care settings.
Migraine Treatment in Emergency Setting
An analysis of a de-identified, longitudinal electronic health records database from 2010-2016 looked at 14,494 unique emergency department (ED) visits by adolescents and young adults with diagnosed migraine. In 23 percent of those visits, healthcare providers ordered an opioid within 12 hours of emergency department admission, and in more than half of these cases (58 percent), an opioid was ordered as first-line therapy. Titled “Rates and Predictors of Using Opioids in the Emergency Department to Treat Migraine in Adolescents and Young Adults,” the study also revealed that the likelihood of opioid administration was significantly higher if a patient was older and seen by a surgical specialist versus an emergency medicine physician. However, rates of administering opioids to treat migraine in the emergency department significantly decreased during the observation period.
Impact of Formal Migraine Diagnosis on Treatment Plan
An analysis from the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study looked at 2,388 respondents who reported currently using or having on hand acute prescription pain medication to treat migraine. Surprisingly, 36.3% of this sample used opioids. Compared to non-opioid users, patients taking opioids reported elevated monthly headache days, use of emergency care for headache treatment, allodynia, depression and anxiety, and CV comorbidity. However, the study recognized a trend in decreased opioid use when a formal migraine diagnosis is made by a physician. Making a specific migraine diagnosis increases the use of treatments specific for migraine rather than general pain killers such as opioids.
Opioid Use and Mental Health Factors in Migraine Care
A separate analysis looking at data collected through an observational study of 21,143 people living with migraine found that patients reporting current or former opioid use for pain were more likely to experience depression or anxiety in addition to pain when compared to those with migraine who never used opioids. This analysis was based on data collected from the Observational survey of the Epidemiology, treatment and Care of Migraine (OVERCOME) study. From this cross-sectional study it is difficult to know if taking opioids contributes to the development of depression and anxiety or if depression and anxiety are associated with the prescribing of opioids.
Research reinforces a connection between opioid use in migraine treatment and negative impacts like depression, anxiety and CV comorbidity. Patients have been shown to benefit greatly from alternative and targeted treatment options when they are able to work closely with a migraine specialist to develop a personalized treatment plan.
“Opioids are generally not recommended for the treatment of migraine due to limited evidence for efficacy, the risk of dependence and the evidence that opioid treatment is a risk factor for headache exacerbation. The very medication that relieves pain short term may lead to the onset of chronic migraine,” said Richard Lipton, MD, FAHS and American Headache Society Past President and lead investigator on two of the three studies being presented. “Given the chronic nature of migraine, it is critical to find solutions that go beyond acute management, yet we also must be compassionate when patients are experiencing the pain of a migraine attack.”