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Opioid Treatment of Migraine Is Associated with Multiple Risks

The use of opioid medications for treating acute migraine is controversial. Drugs in this class are not considered first-line treatment for migraine but are prescribed for many migraineurs to eliminate the pain of an acute attack.

Well-known risks associated with opioids include medication overuse headaches, drug dependence and abuse.

According to a new study that examined the use of these medications among migraineurs, the use of opioids for migraine is related to more headache days per month; higher headache-related disability; increased rates of depression, anxiety and cardiovascular disease and more frequent use of healthcare resources.

In this study, which appeared in January in the journal Headache, lead author Dawn C. Buse, PhD, of the Montefiore Headache Center in Bronx, New York, and her colleagues studied the data from 5,796 migraineurs who were part of the 2009 American Migraine Prevalence and Prevention study, sponsored by NHF. They divided participants into four categories: non-users of opioids (70%); previous users of opioids (13.8%); current non-dependent users (13.2%) and current probable dependent users (2.6%). In all, results showed that 30% of study participants reported using opioids for migraine within the past four years.

Of the four groups, the average number of headache days per month was highest for probable dependent users of opioids at 8.6 days per month compared to 3.2 days per month for non-users; 4.3 days per month for previous users and 5.6 days per month for current non-dependent users. Additionally, those who currently or previously used opioids had higher scores on the Migraine Disability Assessment (MIDAS). The average MIDAS score for probable dependence users was 44.4 compared to just 7.8 for non-opioid users.

All opioid user groups also reported higher rates of other illness than the non-user counterparts. For depression, 51% of the probable dependent group met the criteria for depression compared to 14.3% of non-users. The same pattern held true for anxiety, with 25.5% of probable-dependent patients meeting the criteria for an anxiety diagnosis, compared to just 7.3% of nonusers.

Those in the opioid user groups also had higher rates of seeking healthcare than their non-user counterparts, whether the visits were to primary care providers, neurologists, alternative care providers or mental health specialists.

As a whole, those who used opioids were older than non-users, were more likely not married or employed and had lower household incomes.

While opioid use is associated in migraineurs with multiple negative outcomes, the authors note that the cause of this association is not known.

“We recognize that a carefully designed, longitudinal study is required to unravel the complexities of causality in the case of opioid use and dependence in migraine,” they wrote.

Despite the need for further research, these findings are clinically important. Opioids may sometimes be necessary, the authors stated, but they should be prescribed with discretion, and patients who use them should be monitored carefully.

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