Characterizing opioid use in a US population with migraine: Results from the CaMEO study

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.

Figure 1. Analysis population

CaMEO = Chronic Migraine Epidemiology and Outcomes; CV = cardiovascular; Rx = prescription; TPI = Total Pain Index.

Figure 2. Opioid use and nonuse by specialist type and medication overuse by medication class

(A) Opioid use and nonuse distribution across specialties differed significantly (χ² = 29.18; p < 0.001); more opioid users than nonusers reported having their headaches managed by pain specialists. Neurologists and headache specialists managed more opioid nonusers. (B) Medication use among opioid users vs nonusers. This analysis presents medication use meeting criteria of ≥15 days/month for respondents using nonsteroidal anti-inflammatory drugs and ≥10 days/month for all other classes/agents. *p < 0.001; other differences not statistically significant. NSAID = nonsteroidal anti-inflammatory drug.

Figure 3. Migraine-related disability and quality of life among opioid users and nonusers

(A) For migraine-related disability among opioid users and nonusers, current opioid users had a greater headache-related burden overall than did opioid nonusers (χ² = 47.55; p < 0.001). (B) Migraine-related quality of life scores among opioid users and nonusers. *p < 0.001 for all between-group comparisons. MIDAS = Migraine Disability Assessment; MSQ = Migraine-Specific Quality of Life Questionnaire.