Acute Migraine Care to be Presented at the American Headache Society 61st Annual Scientific Meeting

Acute Migraine Care to be Presented at the American Headache Society 61st Annual Scientific Meeting

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.”

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Gemma N.

“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.”

People who take opioids are generally in a great deal of pain, some suffering for months or years. This never-ending pain is a much more likely cause of depression and anxiety than opioids. Saying that “taking opioids causes depression and anxiety” is a ridiculous statement, especially when that conclusion is being drawn from historical data, not a new/current clinical study specifically designed to explore the validity of the statement.

There’s also a difference between “taking opioids” and “the prescribing of opioids.” They’re not even comparing apples to apples. I call shenanigans on the interpretation of the data.

You know what’s really causing an epidemic of depression and anxiety? The continued vilification of a useful, time-tested medication - and the corresponding vilification of anyone who takes that medication.

Thank you Danny for your response it’s so true. I am a chronic migraine person . I have them more than 15 days a month. Migraines came first & then The Chronic body pain came on through overuse overworked injuries . I have been given so many different diagnosis by different doctors that I don’t think they know what they’re talkin about just like this study. I suffered as a child but they were not chronic but when I hit age 25 became chronic. My Siblings have migraines inherited from my mother’s. I was told it was due to a hormone imbalance. But no test was done to find out if I even had a hormone imbalance. There are tests for this. I was first given birth control that made me even have the worst migraine, then a different hormone yaz, I threw up for two weeks straight only taking it 3 days in a row. Cannot get out of bed. Then came antidepressants which most of them I had horrible side effects & did not help at all. Then I was told it was occipital neuralgia, also told cervicogenic then I was diagnosed with over usage of medication which was a total lie. I’ve only been to the hospital four times in 30 years BC I don’t like all that waiting & I know in 3 days it will finally go away then come back later. But they would only treat me either with steroids or injection of Imitrex. I’ve had an occipital blocks higher up in the neck which only made my head felt like it was going to explode, I couldn’t even speak it hurt so bad. I’ve had Botox which is a joke works great for wrinkles. My list can go on but this study again is berating opiate use. In the past for the first time I found some relieved had a neurologist who was also a pain management doctor & he upped my opiates & it got my migraines down to twice a week instead of 4 × a wk but that blessing is now over. With all the chronic pain I deal with daily I feel so much hate/ resentment. Chronic pain people suffering affects the economy BC we can’t keep our jobs now or buy groceries.


My God, the data-mining without our consent is astounding. I don’t care if they “de-identify” the patient. They didn’t tell you about the ongoing, longitudinal study they were conducting; why would they tell you the truth as to how our information is being used?

Every comment we make, on every forum, YouTube video, blog, Facebook, or Twitter, is linked to US…and they have access.



I’ve suffered from savage, intractable migraines for over 40 years, getting 12-25 migraine days a month. I have a 4+ page list of the non-opioid medications, triptans, prophylactics, herbs, therapies, procedures, diets, journals, etc etc etc. Nothing helped decrease them at all except lots & lots of exercise, which got eliminated as an option in 2001 when I was undertreated for pain after thoracic surgery & got a permanent crps-like condition. The usual dogma is, “opioids make migraines worse.” Maybe they do in many cases…but like all dogmatic statements that ignore huge variations in patients, conditions, & physiologies, sometimes they DO work*, as rescue/interventional meds. Especially on the few occasions I’ve been able to get strong meds at the ER for the worst of the worst; Nubain, which is almost impossible to get anywhere, stops mine dead in its tracks, even when it’s been going on for days.

But; “. . .yet we also must be compassionate when patients are experiencing the pain of a migraine attack.”” This strikes me as grimly hilarious. I’ve gone to the ER for migraine maybe 20 times in the last 40+ years. I’ve gotten some sort of treatment maybe 6-7 of those times, truly effective treatment 3 of the 6-7. The rest, I was booted from the ER with attitude ranging from dismissive (occasionally, when I was lucky) to strongly abusive (most common). I got cussed out for being a drug seeker before anyone was talking about rampant abuse of opioids & there was no such concept as the farcical & false “epidemic.” I quit going to the ER years ago because I was mortally sick of having abuse heaped on top of blinding agony. Compassion is not a part of any ER I’ve been at in the last 10-15 years; vicious, prejudiced sadism, yes: compassion…not a frigging chance.

*or they did, when I could get them.

Molly K Canfield

Frustrating, yes. Definitive, no. As a migraine sufferer since the age of 21, I have experienced the complete range of preventive and treatment options for chronic migraine: calcium channel blockers, blood pressure medication , ergotamine treatment, Botox, opioid pain medicine, imitrex and all of its cousins. Very much like the chronic pain patient ( me) included migraines (me as well) also take a significant chunk out of the sufferer’s life. We are so desperate to get back to our families, raise our children, exercise, our jobs and have some semblance of a life that, yes, we breakdown and use opioid pain medicine when the preventive fails, the abortive fails and the third line opioid medicine is the option left aside from having ourselves admitted inpatient for IV treatment. I would like to see people who suffer from chronic pain and migraine not be beat up on so much for trying to find some solution to their struggle.

erik w bjornson

a doctor in kalispell mt did a fusion surgery on my neck and ruined everything for me then lied on my medical records , i’ve got level 10 pain 24/7 365 days a year and noone cares i’ve spent my entire life savings on terrible doctors since the surgery it’s so horrible i’ve been cut off cold turkey from anti dpssants and pain meds that was over a year ago and they ” followed protocol ” for my case ??? as a citizen you are nothing you have no rights all u are is a tax payer and your life is meaningless


Danny, your post was excellent. Unfortunately, TBI, Tramatc Brain Injuries, are occurring more than people know.
Like my condition , the type of which is rare, your condition also takes many forms, as you are well aware.
I also noted they did not say how long the migraines lasted, which is very important to those of us who suffer excruciating pain.
As in any condion many factors play a part in TBI.
I wish you the best of luck and hope you are able to get the help you need, including medication.
As of three yrs ago, there was extensive research into it and how to help.

Thomas Wayne Kidd

Sadly millions and millions will ignore and continue on. Because; Iniquity, (lawlessness) has become a way of life for most people in the 21St. Century and not much will be done to slow down evil’s progress let also stop it. Mankind has had a Book for several centuries now, which warns us and teaches us how to live but only a few will actually take hold of
that Book, ie, the Bible and gain Salvation so lovingly provided by the Creator. Jesus Christ is the only hope of mankind. By the way Jesus Christ is the Creator sent into this world by the Heavenly Father to bring Salvation to whosoever will.

Thomas Wayne Kidd

Just another jab at opioid pain meds. How can we believe or trust any of these after what they have done to us. These uncaring people will continue finding more and more terrible side affects in their getting rid of a pain Medicine which has been used for many thousands of years with success. Only the rich people who have money will eventually be the only ones that will have access to this much needed pain medication. This is a concerted effort of evil wicked men to take control of the masses. Sale millions and millions will fall right into line and perish. I understand that most people who read this will just ignore and continue on.

Deborah M Babcock

No,I disagree. I took low doses of percocet for my migraines for many years,never any kind of complication whatsoever I went from emergency room visits alot to maybe one a year no other medication worked for me ,nothing. The pain medicine saved me ! Now I can’t get any pain medicine. I’m in a dark house most of my days and nights ! I never had to up my dosage or ask for more either ! Migraines are an excruciating type of pain worse than having a baby natural !! I completely disagree with their supposed findings and I bet none of them have ever experienced a single migraine let alone a lifetime of them….!!

Mary W.

Cervicogenic headache does not respond to triptans because it is not migraine. Has a unique ICD10 code for diagnosis and treatment than migraine.


I hate it when my pain is reduced by opioids. It makes me feel so dirty. I think that is because the Church of Medicine says opioid use is a sin.


I have written before. I have a rare case of Occpital Nuralgia and Trigeminal nuralgia, made worse by surgery.
I also get eye migraines.
I have said dozens of times my pain is not a headache. I was told anything to do with head pain is referred thus.
Opioids not only did not help , but, made my head explode.
Those who know ON realize there are so many ways , different for the pain to come.
I know studies are being done on what I have, but, being able to take noting is unbearable. Even an antibiotic will make my head explode.


Uh, or maybe the people taking opioids have other health issues (like chronic pain that can contribute to depression or anxiety). These studies are frustrating.


While I don’t suffer with migraines, I do have severe, intractable head pain due to TBI. One specific area of this study that I have serious questions about is that there’s no mention of how long the patients have been suffering from the pain of migraines. When the article says the patients who are treated with opioids “… are more likely to experience elevated monthly headache days, use of emergency care for headache treatment, allodynia, depression and anxiety, and CV comorbidity…”, my first thought was much of this sounds like the effects of chronic pain. And if there’s a history of migraines and the patients have previously been treated with medications specifically designed for migraines but still have pain, of course they would be treated initially with opioids.

I get so frustrated with the results of “studies” that have such gaping, obvious holes as this one does. It’s as if the researchers are looking for a certain outcome and they dismiss or ignore what doesn’t fit into the results they want.