We sought to assess factors associated with the frequency of self-reported prescription
opioid use in persons with
migraine, including demographic variables, comorbidities,
headache characteristics, and patterns of consultation.
BACKGROUND: Despite the dose-dependent effect of
opioids on
migraine progression and the association with negative outcomes,
migraine treatment often includes
opioids. The
Migraine in America Symptoms and Treatment Study focuses on individuals with
migraine who receive prescription acute medications, including those receiving and those not receiving
opioids.
METHODS: This web-based panel survey identified people in the United States with
migraine using a validated screener. This analysis stratified people with
migraine into 4 groups based on days of monthly
opioid use: non-
opioid users, ≤3 days, 4-9 days, and ≥10 days per month.
RESULTS: Of 15,133 respondents with
migraine, 4701 (31%) reported acute prescription medication use for
headache/migraine in the previous 3 months (mean age 45 years, 71.6% [3367/4701] female), of whom 32.5% (1528/4701) reported
opioid use. About one-third of respondents with primary care or neurology consults in the prior 6 months reported receiving an
opioid, and more than half of respondents (209/391, 53.5%) with a pain clinic consultation did so. Models compared those using
opioids ≤3 days/month (879/4701, 18.7%), 4-9 days/month (304/4701, 6.5%), ≥10 days/month (345/4701, 7.3%) to non-
opioid users (3173/4701, 67.5%). Compared to non-
opioid users, infrequent users (≤3 days/month) were more likely to be male and less likely to have chronic
migraine or to screen positive for anxiety and depression; and frequent
opioid users (the 4-9 days/month and the ≥10 days/month groups) were more likely to be male, to
smoke, to be obese, to report greater
pain interference, to have moderate to severe disability, to have symptoms of anxiety and depression, to use fewer
triptans and nonsteroidal anti-inflammatory drugs, and to have poor acute treatment optimization.
CONCLUSION: Among prescription medication users, this cross-sectional analysis shows that increasing use of prescription
opioids is associated with male gender, chronic
migraine, more severe disability, anxiety and depression, poor acute treatment optimization, and treatment in a pain clinic.