Factors associated with acute medication overuse in people with migraine: results from the 2017 migraine in America symptoms and treatment (MAST) study

Todd J. Schwedt, Aftab Alam, Michael L. Reed, Kristina M. Fanning, Sagar Munjal, Dawn C. Buse, David W. Dodick, Richard B. Lipton

Research output: Contribution to journalArticle

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Abstract

Background: The MAST Study is a longitudinal, cross-sectional survey study of US adults with migraine. These analyses were conducted to estimate rates of acute medication overuse (AMO) and determine associations of AMO with individual and headache characteristics. Methods: Eligible respondents had ICHD-3-beta migraine, reported ≥3 monthly headache days (MHDs) in the past 3 months, ≥1 MHD in the past 30 days, and currently took acute headache medication. AMO was defined according to ICHD-3-beta thresholds for monthly days of medication taking when diagnosing medication overuse headache. Results: Eligible respondents (N = 13,649) had a mean age of 43.4 ± 13.6 years; most were female (72.9%) and Caucasian (81.9%). Altogether, 15.4% of respondents met criteria for AMO. Compared with those not overusing medications, respondents with AMO were significantly more likely to be taking triptans (31.3% vs 14.2%), opioids (23.8% vs 8.0%), barbiturates (7.8% vs 2.7%), and ergot alkaloids (3.1% vs 0.6%) and significantly less likely to be taking NSAIDs (63.3% vs 69.8%) (p < 0.001 for all comparisons). Respondents with AMO had significantly more MHDs (12.9 ± 8.6 vs 4.3 ± 4.3, p < 0.001); higher migraine symptom severity (17.8 ± 2.7 vs 16.4 ± 3.0, p < 0.001), higher pain intensity scores (7.4 vs 6.5, p < 0.001); and higher rates of cutaneous allodynia (53.7% vs 37.5%, p < 0.001). Adjusted for MHDs, the odds of AMO were increased by each additional year of age (OR 1.02, 95% CI 1.02, 1.03); being married (OR 1.19, 95% CI 1.06, 1.34); smoking (OR 1.54, 95% CI 1.31, 1.81); having psychological symptoms (OR 1.62, 95% CI 1.43, 1.83) or cutaneous allodynia (OR 1.22, 95% CI 1.08, 1.37); and greater migraine symptom severity (OR 1.06, 95% CI 1.04, 1.09) and pain intensity (OR 1.27, 95% CI 1.22, 1.32). Cutaneous allodynia increased the risk of AMO by 61% in males (OR 1.61, 95% CI 1.28, 2.03) but did not increase risk in females (OR 1.08, 95% CI 0.94, 1.25). Conclusions: AMO was present in 15% of respondents with migraine. AMO was associated with higher symptom severity scores, pain intensity, and rates of cutaneous allodynia. AMO was more likely in triptan, opioid, and barbiturate users but less likely in NSAID users. Cutaneous allodynia was associated with AMO in men but not women. This gender difference merits additional exploration.

Original languageEnglish (US)
Article number38
JournalJournal of Headache and Pain
Volume19
Issue number1
DOIs
StatePublished - Dec 1 2018

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Migraine Disorders
Hyperalgesia
Headache
Skin
Therapeutics
Tryptamines
Non-Steroidal Anti-Inflammatory Agents
Pain
Opioid Analgesics
Secondary Headache Disorders
Prescription Drug Overuse
Cross-Sectional Studies
Ergot Alkaloids
Barbiturates
Surveys and Questionnaires
Smoking
Psychology

Keywords

  • Adults
  • Allodynia
  • Epidemiology
  • Medication overuse headache
  • Migraine

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Factors associated with acute medication overuse in people with migraine : results from the 2017 migraine in America symptoms and treatment (MAST) study. / Schwedt, Todd J.; Alam, Aftab; Reed, Michael L.; Fanning, Kristina M.; Munjal, Sagar; Buse, Dawn C.; Dodick, David W.; Lipton, Richard B.

In: Journal of Headache and Pain, Vol. 19, No. 1, 38, 01.12.2018.

Research output: Contribution to journalArticle

Schwedt, Todd J. ; Alam, Aftab ; Reed, Michael L. ; Fanning, Kristina M. ; Munjal, Sagar ; Buse, Dawn C. ; Dodick, David W. ; Lipton, Richard B. / Factors associated with acute medication overuse in people with migraine : results from the 2017 migraine in America symptoms and treatment (MAST) study. In: Journal of Headache and Pain. 2018 ; Vol. 19, No. 1.
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abstract = "Background: The MAST Study is a longitudinal, cross-sectional survey study of US adults with migraine. These analyses were conducted to estimate rates of acute medication overuse (AMO) and determine associations of AMO with individual and headache characteristics. Methods: Eligible respondents had ICHD-3-beta migraine, reported ≥3 monthly headache days (MHDs) in the past 3 months, ≥1 MHD in the past 30 days, and currently took acute headache medication. AMO was defined according to ICHD-3-beta thresholds for monthly days of medication taking when diagnosing medication overuse headache. Results: Eligible respondents (N = 13,649) had a mean age of 43.4 ± 13.6 years; most were female (72.9{\%}) and Caucasian (81.9{\%}). Altogether, 15.4{\%} of respondents met criteria for AMO. Compared with those not overusing medications, respondents with AMO were significantly more likely to be taking triptans (31.3{\%} vs 14.2{\%}), opioids (23.8{\%} vs 8.0{\%}), barbiturates (7.8{\%} vs 2.7{\%}), and ergot alkaloids (3.1{\%} vs 0.6{\%}) and significantly less likely to be taking NSAIDs (63.3{\%} vs 69.8{\%}) (p < 0.001 for all comparisons). Respondents with AMO had significantly more MHDs (12.9 ± 8.6 vs 4.3 ± 4.3, p < 0.001); higher migraine symptom severity (17.8 ± 2.7 vs 16.4 ± 3.0, p < 0.001), higher pain intensity scores (7.4 vs 6.5, p < 0.001); and higher rates of cutaneous allodynia (53.7{\%} vs 37.5{\%}, p < 0.001). Adjusted for MHDs, the odds of AMO were increased by each additional year of age (OR 1.02, 95{\%} CI 1.02, 1.03); being married (OR 1.19, 95{\%} CI 1.06, 1.34); smoking (OR 1.54, 95{\%} CI 1.31, 1.81); having psychological symptoms (OR 1.62, 95{\%} CI 1.43, 1.83) or cutaneous allodynia (OR 1.22, 95{\%} CI 1.08, 1.37); and greater migraine symptom severity (OR 1.06, 95{\%} CI 1.04, 1.09) and pain intensity (OR 1.27, 95{\%} CI 1.22, 1.32). Cutaneous allodynia increased the risk of AMO by 61{\%} in males (OR 1.61, 95{\%} CI 1.28, 2.03) but did not increase risk in females (OR 1.08, 95{\%} CI 0.94, 1.25). Conclusions: AMO was present in 15{\%} of respondents with migraine. AMO was associated with higher symptom severity scores, pain intensity, and rates of cutaneous allodynia. AMO was more likely in triptan, opioid, and barbiturate users but less likely in NSAID users. Cutaneous allodynia was associated with AMO in men but not women. This gender difference merits additional exploration.",
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TY - JOUR

T1 - Factors associated with acute medication overuse in people with migraine

T2 - results from the 2017 migraine in America symptoms and treatment (MAST) study

AU - Schwedt, Todd J.

AU - Alam, Aftab

AU - Reed, Michael L.

AU - Fanning, Kristina M.

AU - Munjal, Sagar

AU - Buse, Dawn C.

AU - Dodick, David W.

AU - Lipton, Richard B.

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Background: The MAST Study is a longitudinal, cross-sectional survey study of US adults with migraine. These analyses were conducted to estimate rates of acute medication overuse (AMO) and determine associations of AMO with individual and headache characteristics. Methods: Eligible respondents had ICHD-3-beta migraine, reported ≥3 monthly headache days (MHDs) in the past 3 months, ≥1 MHD in the past 30 days, and currently took acute headache medication. AMO was defined according to ICHD-3-beta thresholds for monthly days of medication taking when diagnosing medication overuse headache. Results: Eligible respondents (N = 13,649) had a mean age of 43.4 ± 13.6 years; most were female (72.9%) and Caucasian (81.9%). Altogether, 15.4% of respondents met criteria for AMO. Compared with those not overusing medications, respondents with AMO were significantly more likely to be taking triptans (31.3% vs 14.2%), opioids (23.8% vs 8.0%), barbiturates (7.8% vs 2.7%), and ergot alkaloids (3.1% vs 0.6%) and significantly less likely to be taking NSAIDs (63.3% vs 69.8%) (p < 0.001 for all comparisons). Respondents with AMO had significantly more MHDs (12.9 ± 8.6 vs 4.3 ± 4.3, p < 0.001); higher migraine symptom severity (17.8 ± 2.7 vs 16.4 ± 3.0, p < 0.001), higher pain intensity scores (7.4 vs 6.5, p < 0.001); and higher rates of cutaneous allodynia (53.7% vs 37.5%, p < 0.001). Adjusted for MHDs, the odds of AMO were increased by each additional year of age (OR 1.02, 95% CI 1.02, 1.03); being married (OR 1.19, 95% CI 1.06, 1.34); smoking (OR 1.54, 95% CI 1.31, 1.81); having psychological symptoms (OR 1.62, 95% CI 1.43, 1.83) or cutaneous allodynia (OR 1.22, 95% CI 1.08, 1.37); and greater migraine symptom severity (OR 1.06, 95% CI 1.04, 1.09) and pain intensity (OR 1.27, 95% CI 1.22, 1.32). Cutaneous allodynia increased the risk of AMO by 61% in males (OR 1.61, 95% CI 1.28, 2.03) but did not increase risk in females (OR 1.08, 95% CI 0.94, 1.25). Conclusions: AMO was present in 15% of respondents with migraine. AMO was associated with higher symptom severity scores, pain intensity, and rates of cutaneous allodynia. AMO was more likely in triptan, opioid, and barbiturate users but less likely in NSAID users. Cutaneous allodynia was associated with AMO in men but not women. This gender difference merits additional exploration.

AB - Background: The MAST Study is a longitudinal, cross-sectional survey study of US adults with migraine. These analyses were conducted to estimate rates of acute medication overuse (AMO) and determine associations of AMO with individual and headache characteristics. Methods: Eligible respondents had ICHD-3-beta migraine, reported ≥3 monthly headache days (MHDs) in the past 3 months, ≥1 MHD in the past 30 days, and currently took acute headache medication. AMO was defined according to ICHD-3-beta thresholds for monthly days of medication taking when diagnosing medication overuse headache. Results: Eligible respondents (N = 13,649) had a mean age of 43.4 ± 13.6 years; most were female (72.9%) and Caucasian (81.9%). Altogether, 15.4% of respondents met criteria for AMO. Compared with those not overusing medications, respondents with AMO were significantly more likely to be taking triptans (31.3% vs 14.2%), opioids (23.8% vs 8.0%), barbiturates (7.8% vs 2.7%), and ergot alkaloids (3.1% vs 0.6%) and significantly less likely to be taking NSAIDs (63.3% vs 69.8%) (p < 0.001 for all comparisons). Respondents with AMO had significantly more MHDs (12.9 ± 8.6 vs 4.3 ± 4.3, p < 0.001); higher migraine symptom severity (17.8 ± 2.7 vs 16.4 ± 3.0, p < 0.001), higher pain intensity scores (7.4 vs 6.5, p < 0.001); and higher rates of cutaneous allodynia (53.7% vs 37.5%, p < 0.001). Adjusted for MHDs, the odds of AMO were increased by each additional year of age (OR 1.02, 95% CI 1.02, 1.03); being married (OR 1.19, 95% CI 1.06, 1.34); smoking (OR 1.54, 95% CI 1.31, 1.81); having psychological symptoms (OR 1.62, 95% CI 1.43, 1.83) or cutaneous allodynia (OR 1.22, 95% CI 1.08, 1.37); and greater migraine symptom severity (OR 1.06, 95% CI 1.04, 1.09) and pain intensity (OR 1.27, 95% CI 1.22, 1.32). Cutaneous allodynia increased the risk of AMO by 61% in males (OR 1.61, 95% CI 1.28, 2.03) but did not increase risk in females (OR 1.08, 95% CI 0.94, 1.25). Conclusions: AMO was present in 15% of respondents with migraine. AMO was associated with higher symptom severity scores, pain intensity, and rates of cutaneous allodynia. AMO was more likely in triptan, opioid, and barbiturate users but less likely in NSAID users. Cutaneous allodynia was associated with AMO in men but not women. This gender difference merits additional exploration.

KW - Adults

KW - Allodynia

KW - Epidemiology

KW - Medication overuse headache

KW - Migraine

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