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. 2022 Oct 31;99(18):e1968-e1978.
doi: 10.1212/WNL.0000000000201064.

Headache, Opiate Use, and Prescribing Trends in Women With Idiopathic Intracranial Hypertension: A Population-Based Matched Cohort Study

Nicola Jaime Adderley  1 , Anuradhaa Subramanian  1 , Mary Perrins  1 , Krishnarajah Nirantharakumar  1 , Susan P Mollan  1 , Alexandra Jean Sinclair  2
Affiliations

Headache, Opiate Use, and Prescribing Trends in Women With Idiopathic Intracranial Hypertension: A Population-Based Matched Cohort Study

Nicola Jaime Adderley et al. Neurology. .

Abstract

Background and objectives: Physician prescribing habits for opiates and headache therapies have not been previously evaluated in a large, matched cohort study in idiopathic intracranial hypertension (IIH). Our objective was to evaluate opiate and headache medication prescribing habits in women with IIH compared with matched women with migraine and population controls. We also investigated the occurrence of new onset headache in IIH compared with population controls.

Methods: We performed a population-based matched, retrospective cohort study to explore headache outcomes. Cross-sectional analyses were used to describe medication prescribing patterns. We used data from IQVIA Medical Research Data, an anonymized, nationally representative primary care electronic medical record database in the United Kingdom, from January 1, 1995, to September 25, 2019. Women aged 16 years and older were eligible for inclusion. Women with IIH (exposure) were matched by age and body mass index with up to 10 control women without IIH but with migraine (migraine controls), and without IIH or migraine (population controls).

Results: A total of 3,411 women with IIH, 13,966 migraine controls, and 33,495 population controls were included. The adjusted hazard ratio for new onset headache in IIH compared with population controls was 3.09 (95% CI 2.78-3.43). In the first year after diagnosis, 58% of women with IIH were prescribed acetazolamide and 20% topiramate. In total, 20% of women with IIH were prescribed opiates within the first year of their diagnosis, reducing to 17% after 6 years, compared with 8% and 11% among those with migraine, respectively. Twice as many women with IIH were prescribed opiates compared with migraine controls, and 3 times as many women with IIH were prescribed opiates compared with population controls. Women with IIH were also prescribed more headache preventative medications compared with migraine controls.

Discussion: Women with IIH were more likely to be prescribed opiate and simple analgesics compared with both migraine and population controls. Women with IIH trialed more preventative medications over their disease course suggesting that headaches in IIH may be more refractory to treatment.

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Figures

Figure 1
Figure 1. Analgesic Prescriptions in Women With IIH and Matched Migraine and Population Controls
IIH = idiopathic intracranial hypertension.
Figure 2
Figure 2. Preventative Prescriptions in Women With IIH and Matched Migraine and Population Controls
IIH = idiopathic intracranial hypertension; TCA = tricyclic antidepressants.
Figure 3
Figure 3. Number of Preventative Medications Initiated at Baseline and Within 3 Years in Women With IIH and Matched Migraine and Population Controls
IIH = idiopathic intracranial hypertension.
See this image and copyright information in PMC

References

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