Characterizing opioid use in a US population with migraine

Abstract

Objective To determine the prevalence of and risk factors associated with opioid use in the treatment of migraine, we examined demographics and clinical characteristics of 867 individuals who reported using opioids for the treatment of migraine. Methods We analyzed data from the CaMEO study (Chronic Migraine Epidemiology and Outcomes), a cross-sectional, longitudinal, Internet study, to compare sociodemographics, clinical characteristics, and migraine burden/disability of opioid users vs nonusers. Covariates were entered as categorical or continuous variables. Factors associated with opioid use were identified using nested, multivariable binary logistic regression models. Results Of 2,388 respondents with migraine using prescription medications for acute treatment, 36.3% reported that they currently used or kept on hand opioid medications to treat headaches. Current opioid users had significantly more comorbidities, greater headache-related burden, and poorer quality of life than nonusers. Regression models revealed factors significantly associated with opioid use, including male sex, body mass index, allodynia, increasing monthly headache frequency, Total Pain Index score (excluding head, face, neck/shoulder), anxiety, depression, ≥1 cardiovascular comorbidity, and emergency department/urgent care use for headache in the past 6 months. Self-reported physician-diagnosed migraine/chronic migraine was associated with significantly decreased likelihood of opioid use. Conclusions Of respondents who were using acute prescription medications for migraine, more than one-third used or kept opioids on hand, contrary to guidance. This analysis could not distinguish risk factors from consequences of opioid use; thus further research is needed to guide the development of strategies for reducing the inappropriate use of opioids in migraine. AMPP= : American Migraine Prevalence and Prevention; BMI= : body mass index; CaMEO= : Chronic Migraine Epidemiology and Outcomes; CI= : confidence interval; CV= : cardiovascular; ED= : emergency department; GAD-7= : 7-item Generalized Anxiety Disorder scale; HCP= : health care professional; ICHD-3= : International Classification of Headache Disorders, 3rd edition; MIDAS= : Migraine Disability Assessment; MOH= : medication overuse headache; MSQ= : Migraine-Specific Quality of Life Questionnaire; MSSS= : Migraine Symptom Severity Score; NSAID= : nonsteroidal anti-inflammatory drug; OR= : odds ratio; PHQ-9= : 9-item depression module of the Patient Health Questionnaire scale; TPI= : Total Pain Index; UC= : urgent care