Emergency Room Opioid Use for Migraine Linked to Future Health Costs

Author(s):

Factors such as previous emergency department visits, hypertension, and tobacco use disorder were related to future migraine-related emergency department visits.

Qiujun Shao, MS

Results from a retrospective cohort study found that patients with migraine who received opioid medications at their emergency department (ED) visits were associated with increased future health resource utilization (HRU), highlighting the need for optimizing migraine management in emergency settings.¹

A total of 788 patient cases pulled from the Baylor Scott & White Health record between December 2013 and April 2017 were included in the study. During the 6-month follow-up period, compared to patients with migraine who were non-recipients at their index ED visits, opioid recipients had significantly more all-cause (3.6 [standard deviation (SD), 6.3] vs 1.9 [SD, 4.8]; P <.0001) and migraine-related (1.6 [SD, 4.2] vs 0.6 [SD, 2.1]; P <.0001) opioid prescriptions.

Led by Qiujun Shao, MS, graduate student, University of Texas, the study also found those who received opioids to have more all-cause (2.6 [SD, 4.3] vs 1.6 [SD, 2.6]; P = .002) and migraine-related (0.6 [SD, 1.4] vs 0.3 [SD, 0.8]; P = .001) ED visits. Furthermore, opioid recipients had a higher risk of future migraine-related ED visits after controlling for covariates (hazard ratio [HR], 1.49 [95% CI, 1.09-2.03]; P = .013).

Shao and colleagues aimed to evaluate the HRU differences between patients with migraine who received opioid medications compared with those who did not in an ED setting. They noted that previous studies have found opioid use to be common in this setting, but that there was limited evidence on how the medication prescriptions impacted future HRU among people with migraine.

Those included in the study had at least 6 months of continuous enrollment before (baseline or pre-index) and after (follow-up) the first date they had an ED visit with a diagnosis of migraine (defined as index date).

Previous opioid use (HR, 2.12 [95% CI, 1.24-3.65]; P = .007), previous ED visits (HR, 2.38 [95% CI, 1.23-4.58]; P = .010), and hypertension (HR, 1.46 [95% CI, 1.07-2.00]; P = .017) were all noted as factors that were significantly (P <.05) related to future migraine-related ED visits.

Other such significant factors included age between 45 and 64 years (HR, 0.68 [95% CI, 0.48-0.97]; P = .033), female sex (HR, 1.82 [95% CI, 1.12-2.86]; P = .015) and tobacco use disorder (HR, 1.45 [95% CI, 1.07-1.97]; P = .017).

A subgroup analysis restricted to patients who were baseline opioid naïve but received opioids during their index ED visits were more likely to have future migraine-related ED visits compared to patients who were baseline opioid negative and did not receive any opioids during their index ED visits, controlling for covariates (HR, 2.30 [95% CI, 1.54-5.46]; P = .001).

Results from a study published in July 2019 found that opioid use is common among patients with migraine, despite previous recommendations erring on the side of caution. The researchers also found that they are associated with markers of worsened health such as elevated body mass index, total pain index scores, cardiovascular and psychiatric comorbidities, and frequency of emergency facility use for headache.²

At the time, study investigator Richard Lipton, MD, director, Montefiore Headache Center, said in a statement, “opioids are generally not recommended for the treatment of migraine due to limited evidence for efficacy, the risk of dependence and the evidence that opioid treatment is a risk factor for headache exacerbation. The very medication that relieves pain short term may lead to the onset of chronic migraine.” He added, “given the chronic nature of migraine, it is critical to find solutions that go beyond acute management, yet we also must be compassionate when patients are experiencing the pain of a migraine attack.”

REFERENCES

1. Shao Q, Rascati KL, Lawson K, Wilson JP, Shah S, Garrett JS. Impact of emergency department opioid use on future health resource utilization among patients with migraine. Headache. Published online February 18, 2021. doi: 10.1111/head.14071

2. New Research on Opioid Use in Migraine Reveals Challenges of Acute Migraine Care as Revealed in Studies to be Presented at AHS 61st Annual Scientific Meeting. News release. American Headache Society. Published July 10, 2019. Accessed February 22, 2021. americanheadachesociety.org/news/new-research-opioid-use-in-migraine-reveals-challenges-of-acute-migraine-care.