The Opioid Epidemic and Primary Headache Disorders: A Nationwide Population-Based Study

Abstract

The opioid epidemic has been linked to several other health problems, but its impact on headache disorders has not been well studied. We performed a population-based study looking at the prevalence of opioid use in headache disorders and its impact on outcomes compared to non-abusers with headaches. Methodology We performed a cross-sectional analysis of the Nationwide Inpatient Sample (years 2008-2014) in adults hospitalized for primary headache disorders (migraine, tension-type headache [TTH], and cluster headache [CH]) using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. We performed weighted analyses using the chi-square test, Student's t-test, and Cochran-Armitage trend test. Multivariate survey logistic regression analysis with weighted algorithm modelling was performed to evaluate morbidity, disability, and discharge disposition. Among US hospitalizations during 2013-2014, regression analysis was performed to evaluate the odds of having opioid abuse among headache disorders. Results A total of 5,627,936 headache hospitalizations were present between 2008 and 2014 of which 3,098,542 (55.06%), 113,332 (2.01%), 26,572 (0.47%) were related to migraine, TTH, and CH, respectively. Of these headache hospitalizations, 128,383 (2.28%) patients had abused opioids. There was a significant increase in the prevalence trend of opioid abuse among patients with headache disorders from 2008 to 2014. The prevalence of migraine (63.54% vs. 54.86%), TTH (2.29% vs. 2.01%), and CH (0.59% vs. 0.47%) was also higher among opioid abusers than nonabusers (p<0.0001). Opioid abusers with headaches were more likely to be younger (43 years old vs. 50 years old), men (30.17% vs. 24.78%), white (80.83% vs. 73.29%), Medicaid recipients (30.15% vs. 17.03%), and emergency admissions (85.4% vs. 78.51%) as compared to opioid nonabusers with headaches (p<0.0001). Opioid abusers with headaches had higher prevalence and odds of morbidity (4.06% vs. 3.70%; adjusted odds ratio [aOR]: 1.48; 95% CI:

Headache Attributed to Refractive Error: Improvement after Topography-Guided Photorefractive Keratectomy with Corneal Cross-Linking in Patients with Keratoconus

“…This not only carries cost-saving outcomes but results in a decrease in morbidity and reduction in opioid use. Opioid use and comorbid depression or anxiety can also add to morbidity [31].…”

Knowledge of the medical resident about diagnosis and treatment of patients with headache

“…This justifies the little knowledge many residents have about the use of morphine derivatives in the treatment of patients with headache, which is contraindicated. [16][17][18] This is a wrong practice that is still done in many countries. 18 Concepts such as defining chronic daily headache and analgesic overuse headache were not known by all residents.…”

Acute Pain and Development of Opioid Use Disorder: Patient Risk Factors

“…Opioid use as a regimen for acute migraine attacks led to an increased rate of returns to the emergency department due a lacking benefit during the acute phase [ 63 ]. Furthermore, using opioids as the initial treatment for acute headaches was associated with a longer length of hospital stay and led to a high risk of medication overuse headache [ 67 ]. Depending on the specific type of headaches, opioids should be avoided and primarily treatment should include non-steroidal anti-inflammatory drugs (NSAIDs), neuroleptic antinauseants, triptans, or corticosteroids [ 63 ].…”

“…Depending on the specific type of headaches, opioids should be avoided and primarily treatment should include non-steroidal anti-inflammatory drugs (NSAIDs), neuroleptic antinauseants, triptans, or corticosteroids [ 63 ]. Second, headache patients should be monitored carefully and followed up systematically in order to reduce the effect on their quality of life and the related burden on society and health care [ 63 , 67 ].…”