A retrospective analysis of electronic health records from 2010 through 2016 evaluated 14,494 emergency department visits for migraine. In 23%, opioids were given within 12 hours of presentation. When opioids were given, they were the first therapy given more than half the time (58%). Likelihood of opioid correlated with higher age and care from a surgical specialist vs an emergency medicine physician. It is notable that rates of administering opioids to treat migraine in the emergency department significantly decreased during the observation period.
In the CaMEO study (NCT01648530) only 20% of people with migraine surveyed (2,366/~12,000) were using or had available acute prescription medicines for treatment of their migraines. Of those who did, a large percentage (36.3%) used opioids. Use of opioids was higher in men, people who were obese, people of relatively lower income or education, and those who received care in the emergency department. Having received opioids for headache in the emergency department vs after diagnosis of migraine from an in-office physician, correlated with higher use of opioids overall. Compared with individuals who did not treat their headaches with opioids, these individuals had higher frequency of attacks, more use of emergency care, allodynia, depression and anxiety, and CV comorbidity.
In addition, the OVERCOME study--an observational study of 21,143 people living with migraine--found that those who reported former or current opioid use were also more likely than individuals who did not use opioids to have depression and anxiety in addition to pain. Although it is unclear whether taking opioids leads to depression and anxiety or the reverse, as well as if these are comorbid rather than causative, research reinforces a connection between opioid use for migraine and other negative states including depression, anxiety, and higher cardiovascular risk. Nonopioid alternatives and targeted treatments could reduce these negative conditions in people with migraine.
“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 2 of the 3 studies described. “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.”
These data were presented at the American Headache Society’s 61st Annual Meeting July 11-14 in Philadelphia, PA.
Diana Castro, MD
Neha M. Kramer, MD; Jessica Besbris, MD; and Rima M. Dafer, MD, MPH