Studies Evaluate Opioid and Preventive Treatment for Migraine

Two study abstracts presented at the International Society for Pharmacoeconomics and Outcomes Research 23rd Annual International Meeting, in Baltimore, Maryland, examined the prevalence of preventive and opioid treatment for migraine. One study found that approximately one-third of people with migraine (PWM) were prescribed a preventive treatment, while another found that opioids were administered in nearly half of the emergency department (ED) visits for migraine.

The first study¹ aimed to estimate the size of the migraine population being treated with preventive therapy in the United States. Researchers used the Truven Health MarketScan Research Databases to identify patients age 18 and older between 2012 and 2014 and described their prophylactic treatment for migraine in 2014.

Additionally, the study classified the patients based on the number of distinct prescription preventive treatments they received for migraine from 2012 until the most recent fill date.

The results revealed that 34% of PWM were using a preventative migraine therapy. Of those, 55% were on their initial therapy, 27% were on their second therapy, 11% were on their third therapy, and 7% were on their fourth or higher preventive therapy.

“Many individuals who receive preventive medications for migraine cycle through multiple therapies,” the authors concluded. “These estimates are higher than previous studies because of restriction to persons with medically diagnosed migraine.”

In the second study,² researchers assessed the use of opioids and other acute medication in patients with migraine in the ED. The study included a retrospective analysis of electronic medical records from Ochsner Health System in Louisiana from 2011 to 2016. Data from patients who were at least 18 years old and visited an ED for migraine with at least 6 months baseline data were included.

According to the results, 47.5% of ED visits for migraine where prescription medication was administered included at least 1 opioid. Furthermore, IV hydromorphone was administered in more than half (56.6%) of these ED visits, and in 26.2% of ED encounters in which an opioid was administered, patients were administered more than one dose of an opioid.

“Despite best practice guidelines discouraging the use of opioids for migraine, opioids were administered in nearly half of the ED visits, pointing to potentially suboptimal care,” wrote the authors of the study.

They concluded by calling for more research to focus on the factors related to clinical decision making for migraine management, specifically in the ED.

References

1. Burrell ER, Mues KE, Xue F, Buse DC, Lipton RB, Chia VM. Sizing of the migraine population treated with preventive medications for migeaine. Presented at the International Society for Pharmacoeconomics and Outcomes Research 23rd Annual International Meeting. May 21, 2018; Baltimore, Maryland. Abstract PND15.

2. Shah S, Rascati KL, Brown CM, Khan F, Thach A, Desai P. Opioid use among patients presenting with migraine in the emergency department. Presented at the International Society for Pharmacoeconomics and Outcomes Research 23rd Annual International Meeting. May 21, 2018; Baltimore, Maryland. Abstract PND51.