Multicenter prevalence of opioid medication use as abortive therapy in the ED treatment of migraine headaches

Young, Neil; Silverman, Dan; Bradford, Heather; Finkelstein, J.

doi:10.1016/j.ajem.2017.06.015

Cited by 25 publications

(57 citation statements)

References 12 publications

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“…An evaluation of 3 emergency departments, published in 2017, found that opioids were ordered in 35.8% of visits for migraines, either as first-line or rescue treatment. 9 An analysis of data from the 2009 American Migraine Prevalence and Prevention (AMPP) study found that 15.9% of persons with migraine were current users of opioids, and 13.8% were previous users of opioids. 10 …”

Section: Introductionmentioning

confidence: 99%

Concomitant use of opioid medications with triptans or serotonergic antidepressants in US office-based physician visits

Molina

Fairman

Sclar

2018

DHPS

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BackgroundOpioids are not recommended for routine treatment of migraine because their benefits are outweighed by risks of medication overuse headache and abuse/dependence. A March 2016 US Food and Drug Administration (FDA) safety communication warned of the risk of serotonin syndrome from using opioids concomitantly with 5-hydroxytryptamine receptor agonists (triptans) or serotonergic antidepressants: selective serotonin reuptake inhibitors (SSRIs) or serotonin–norepinephrine reuptake inhibitors (SNRIs). Epidemiological information about co-prescribing of these medications is limited. The objective of this study was to estimate the nationwide prevalence of co-prescribing of an opioid with a serotonergic antidepressant and/or triptan in US office-based physician visits made by 1) all patients and 2) patients diagnosed with migraine.MethodsNational Ambulatory Medical Care Survey (NAMCS) data were obtained for 2013 and 2014. Physician office visits that included the new or continued prescribing of ≥1 opioid medication with a triptan or an SSRI/SNRI were identified. Co-prescribed opioids were stratified by agent to determine the proportion of co-prescriptions with opioids posing a higher risk of serotonergic agonism (meperidine, tapentadol, and tramadol).ResultsOf an annualized mean 903.6 million office-based physician visits in 2013–2014, 17.7 million (2.0% of all US visits) resulted in the prescribing of ≥1 opioid medication with a triptan or an SSRI/SNRI. Opioid–SSRI/SNRI was co-prescribed in 16,044,721 visits, while opioid–triptan was co-prescribed in 1,622,827 visits. One-fifth of opioid co-prescribing was attributable to higher-risk opioids, predominantly tramadol (18.6% of opioid–SSRI/SNRI, 21.8% of opioid–triptan). Of 7,672,193 visits for patients diagnosed with migraine, 16.3% included opioid prescribing and 2.0% included co-prescribed opioid–triptan.ConclusionDuring a period approximately 2 years prior to an FDA warning about the risk of serotonin syndrome from opioid–SSRI/SNRI or opioid–triptan co-prescribing, use of these combinations was common in the USA. Studies on prescribing patterns following the March 2016 warning, and on the risk of serotonin syndrome associated with these co-prescriptions, are needed.

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Section: Introductionmentioning

confidence: 99%

Concomitant use of opioid medications with triptans or serotonergic antidepressants in US office-based physician visits

Molina

Fairman

Sclar

2018

DHPS

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“…In another study comparing the efficacy of opioids versus non-opioid medications for the treatment of migraine headaches, Young et al found opioids to be inferior in the treatment of acute migraine in the ED [ 19 ]. This cross-sectional study looked at three different ED settings in Connecticut, an academic medical center, a non-academic urban ED, and a community ED between January 1, 2014 and February 27, 2015 to determine the prevalence of opioid orders, rescue medications required, and length of stay [ 19 ].…”

Section: Reviewmentioning

confidence: 99%

“…Patients with stroke or intracranial hemorrhage were excluded along with those who received nitrates. In total, 1222 visits were included in the analysis [ 19 ].…”

Section: Reviewmentioning

confidence: 99%

Migraine Treatment in the Emergency Department: Alternatives to Opioids and their Effectiveness in Relieving Migraines and Reducing Treatment Times

Dodson

Bhula

Eriksson

et al. 2018

Cureus

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The objective of this literature review is to evaluate the efficacy of opioids for the treatment of headaches, particularly migraines, in the emergency department (ED). Despite safer alternatives, opiates are routinely used as an abortive treatment for migraine headaches. The studies reviewed demonstrate that opiates are less effective in terminating acute headaches and result in prolonged ED visits. Dopamine receptor antagonists, such as metoclopramide and prochlorperazine, were the most efficacious in terminating migraines in the studies examined.

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“…Another goal of an abortive plan may be to reduce the management of nonemergent headache attacks in the emergency department (ED) . One multicenter study has shown that opioids are ordered for acute migraine treatment in 12.3% of academic medical center visits, 40.9% of urban ED visits, and 68.6% of community ED visits . ED management often includes nonmigraine specific medications and opioids.…”

Section: Introductionmentioning

confidence: 99%

“…8 One multicenter study has shown that opioids are ordered for acute migraine treatment in 12.3% of academic medical center visits, 40.9% of urban ED visits, and 68.6% of community ED visits. 9 ED management often includes nonmigraine specific medications and opioids. The 2000 AAN practice parameter for migraine recommends meeting the goal of acute management using migraine specific agents (triptans and DHE) for patients with moderate to severe migraine or poor non steroidal anti-inflammatory drug (NSAID) responders.…”

Section: Introductionmentioning

confidence: 99%

Migraine Care Challenges and Strategies in US Uninsured and Underinsured Adults: A Narrative Review, Part 2

et al. 2018

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Multicenter prevalence of opioid medication use as abortive therapy in the ED treatment of migraine headaches

Cited by 25 publications

References 12 publications

Concomitant use of opioid medications with triptans or serotonergic antidepressants in US office-based physician visits

Concomitant use of opioid medications with triptans or serotonergic antidepressants in US office-based physician visits

Migraine Treatment in the Emergency Department: Alternatives to Opioids and their Effectiveness in Relieving Migraines and Reducing Treatment Times

Migraine Care Challenges and Strategies in US Uninsured and Underinsured Adults: A Narrative Review, Part 2

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