Burden of increasing opioid use in the treatment of migraine: Results from the Migraine in America Symptoms and Treatment Study

Abstract

Objective: We sought to assess factors associated with the frequency of self-reported prescription opioid use in persons with migraine, including demographic variables, comorbidities, headache characteristics, and patterns of consultation. Background: Despite the dose-dependent effect of opioids on migraine progression and the association with negative outcomes, migraine treatment often includes opioids. The Migraine in America Symptoms and Treatment Study focuses on individuals with migraine who receive prescription acute medications, including those receiving and those not receiving opioids. Methods: This web-based panel survey identified people in the United States with migraine using a validated screener. This analysis stratified people with migraine into 4 groups based on days of monthly opioid use: non-opioid users, ≤3 days, 4-9 days, and ≥10 days per month. Results: Of 15,133 respondents with migraine, 4701 (31%) reported acute prescription medication use for headache/migraine in the previous 3 months (mean age 45 years, 71.6% [3367/4701] female), of whom 32.5% (1528/4701) reported opioid use. About one-third of respondents with primary care or neurology consults in the prior 6 months reported receiving an opioid, and more than half of respondents (209/391, 53.5%) with a pain clinic consultation did so. Models compared those using opioids ≤3 days/month (879/4701, 18.7%), 4-9 days/month (304/4701, 6.5%), ≥10 days/month (345/4701, 7.3%) to non-opioid users (3173/4701, 67.5%). Compared to non-opioid users, infrequent users (≤3 days/month) were more likely to be male and less likely to have chronic migraine or to screen positive for anxiety and depression; and frequent opioid users (the 4-9 days/month and the ≥10 days/month groups) were more likely to be male, to smoke, to be obese, to report greater pain interference, to have moderate to severe disability, to have symptoms of anxiety and depression, to

Treatment pattern and health care resource utilization for Taiwanese patients with migraine: a population-based study

“…This proportion is low compared with a study from Germany, which reported that opioids were one of the most commonly prescribed acute medications (19.1% of acute medication prescriptions), although opioids were generally not recommended in German guidelines ( 18 ). A survey of migraine patients in the US found that 32.5% of respondents with acute prescription medication for headache/migraine in the previous 3 months reported the use of opioids ( 36 ). Besides, in the American Migraine Prevalence and Prevention (AMPP) study, nearly 30% people with migraine included in the study were either previous users of opioids, or were current opioid users.…”

Special issue on cholinergic signalling

“…Migraines are a common neurologic condition that can be associated with periods of intense pain, though treatment options are limited. Although opioids are not currently recommended for the management of migraine‐associated pain, a recent study noted that 31% of patients affected with chronic migraine report either using or maintaining a supply of opioids (Lipton et al, 2021). Such off‐label use of opioids could set the stage for future abuse in vulnerable individuals and highlights the need for more effective strategies for managing the symptoms of this disorder.…”

Prevalence and burden of migraine in the United States: A systematic review

“…Data on file. 24,53 modified ICHD criteria, as assessed by the AMS/AMPP diagnostic questionnaire; however, its validity in assessing migraine is wellestablished. 14,15 Additionally, by excluding probable migraine, a sizable portion of those with potentially burdensome disease were excluded.…”