CaMEO study highlights factors influencing opioid use in migraine
Increasing body mass index (BMI), male sex, and certain comorbidities are factors associated with an elevated risk of opioid use in patients with migraine, according to results from the CaMEO* study presented at the recent American Headache Society conference (AHS 2019).
“The American Academy of Neurology and AHS recommend against using opioids for treatment of migraine,” said the researchers, noting key exceptions such as “last resort” or contraindication to other agents.
“These results may help clinicians identify individuals who may use opioids to treat their migraine and offer alternative treatments,” they said.
The CaMEO study population comprised members of an Internet research panel (Research Now) who completed a longitudinal, cross-sectional, web-based survey, of whom 16,789 self-reported migraine. The present analysis consisted of 2,388 individuals (mean age 46.3 years, 80.3 percent female, 86.6 percent Caucasian) who reported using acute prescription pain medications** to treat the symptoms of their migraines. Of these, 36.3 percent (n=867) reported using opioids.
Compared with patients not using opioids, those who did had more headache days per month (mean 8.3 vs 6.5 days) and more commonly required emergency or urgent care for headache in the previous 6 months (16.5 percent vs 8.2 percent; p<0.001 for both comparisons). Opioid users were also less likely to have migraine or chronic migraine diagnosed by a healthcare professional (67.4 percent vs 86.2 percent) and had lower symptom severity as determined using the Migraine Symptom Severity Score (MSSS; mean 16.6 vs 17.3; p<0.001 for both comparisons) compared with nonusers. [AHS 2019, abstract OR05]
They also were more likely to have moderate or severe depression (49.9 percent vs 29.2 percent) or anxiety (42.3 percent vs 25.6 percent), allodynia (65.6 percent vs 57.1 percent), diabetes (14.9 percent vs 8.1 percent), and cardiovascular (CV) comorbidities (46.5 percent vs 32.9 percent) than those not using opioids (p<0.001 for all comparisons).
Men were significantly more likely to use opioids than women (odds ratio [OR], 1.743, 95 percent confidence interval [CI], 1.385–2.195), as were patients with depression (OR, 1.495, 95 percent CI, 1.184–1.887), anxiety (OR, 1.371, 95 percent CI, 1.085–1.733), allodynia (OR, 1.39, 95 percent CI, 1.14–1.70), and with ≥1 CV comorbidity (OR, 1.560, 95 percent CI, 1.280–1.901).
Other factors significantly associated with opioid use were increasing BMI (OR, 1.016, 95 percent CI, 1.004–1.028), 10–14 or ≥15 headache days/month (OR, 1.367, 95 percent CI, 1.024–1.824 and OR, 1.622, 95 percent CI, 1.235–2.130, respectively), increasing Total Pain Index (TPI***; OR, 1.319, 95 percent CI, 1.148–1.516), and seeking emergency or urgent care for headache in the previous 6 months (OR, 1.734, 95 percent CI, 1.304–2.307).
Conversely, being diagnosed with migraine or chronic migraine was associated with a significantly lower likelihood of opioid use (OR, 0.384, 95 percent CI, 0.304–0.484), as was an increasing MSSS (OR, 0.941, 95 percent CI, 0.910–0.972).
Migraine-related disability was more commonly associated with opioid use than non-use (46.5 percent vs 33.1 percent; p<0.001 for MIDAS# Grade IV migraine).
“This analysis extends knowledge about associations among demographic variables, headache characteristics, and other factors associated with opioid use by people with migraine,” said the researchers.
They acknowledged the potential bias that could have resulted from self-reported data, as well as the inability to derive causality due to the cross-sectional design. “Future research may help elucidate the nature of associations between identified variables and opioid use, including their directionality,” they said.