Opioid use and dependence among persons with migraine

Results of the ampp study

Dawn C. Buse, Starr H. Pearlman, Michael L. Reed, Daniel Serrano, Daisy S. Ng-Mak, Richard B. Lipton

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Objective.To assess the frequency of opioid use for acute migraine treatment and characterize use groups by sociodemographics, health-care resource utilization (HRU), comorbidities and probable dependence within a large, US population-based sample of persons with migraine. Background.Opioids are used in the acute treatment of migraine. However, their use is controversial. Methods.Data from the 2009 American Migraine Prevalence and Prevention (AMPP) study were used to categorize persons with migraine into 4 groups based on reported opioid use: nonusers (between 2005 and 2009), previous users (history of use between 2005 and 2008 but no-use in 2009), and current opioid users (those reporting use of opioids in the 3 months preceding the 2009 American Migraine Prevalence and Prevention survey). Current opioid users were divided into nondependent and probable dependence users according to criteria for dependence adapted for inclusion in the survey from the Diagnostic and Statistical Manual of Mental Disorders-4th edition. All opioid-use groups were contrasted by sociodemographics, headache characteristics, medical and psychiatric comorbidities (depression [measured by the Patient Health Questionnaire-9], anxiety [measured by the Primary Care Evaluation of Mental Health Disorders, PRIME-MD], and cardiovascular events and risk factors), and headache-related HRU. Results.In a sample of 5796 migraineurs, 4076 (70.3%) were opioid nonusers, 798 (13.8%) were previous users, and 922 (15.9%) were current opioid users. Among current opioid users, 153 (16.6%) met criteria for probable dependence and 769 (83.4%) did not. Headache-related disability (Migraine Disability Assessment sum scores) increased across groups as follows: nonusers: 7.8, previous users: 13.3, current nondependent users: 19.1, and current probable dependence users: 44.4, as did monthly headache frequency: nonusers: 3.2 days/month, previous users: 4.3 days/month, current nondependent users: 5.6 days/month, and current probable dependence users: 8.6 days/month. The prevalence of depression and anxiety was highest among current users with probable dependence. Rates of headache-related HRU were higher for all opioid-use groups for emergency department/urgent care, primary care, and specialty care visits compared to nonusers. Conclusions.Opioid use for migraine is associated with more severe headache-related disability, symptomology, comorbidities (depression, anxiety, and cardiovascular disease and events), and greater HRU for headache. Longitudinal studies are needed to further assess the directionality and causality between opioid use and the outcomes we examined.

Original languageEnglish (US)
Pages (from-to)18-36
Number of pages19
JournalHeadache
Volume52
Issue number1
DOIs
StatePublished - Jan 2012

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Migraine Disorders
Opioid Analgesics
Headache
Patient Acceptance of Health Care
Health Resources
Comorbidity
Anxiety
Depression
Primary Health Care
Ambulatory Care
Mental Disorders
Diagnostic and Statistical Manual of Mental Disorders
Causality
Psychiatry
Longitudinal Studies
Hospital Emergency Service
Mental Health
Cardiovascular Diseases
Cross-Sectional Studies

Keywords

  • acute treatment
  • anxiety
  • depression
  • health-care resource utilization
  • migraine
  • opioid use

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Opioid use and dependence among persons with migraine : Results of the ampp study. / Buse, Dawn C.; Pearlman, Starr H.; Reed, Michael L.; Serrano, Daniel; Ng-Mak, Daisy S.; Lipton, Richard B.

In: Headache, Vol. 52, No. 1, 01.2012, p. 18-36.

Research output: Contribution to journalArticle

Buse, Dawn C. ; Pearlman, Starr H. ; Reed, Michael L. ; Serrano, Daniel ; Ng-Mak, Daisy S. ; Lipton, Richard B. / Opioid use and dependence among persons with migraine : Results of the ampp study. In: Headache. 2012 ; Vol. 52, No. 1. pp. 18-36.
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N2 - Objective.To assess the frequency of opioid use for acute migraine treatment and characterize use groups by sociodemographics, health-care resource utilization (HRU), comorbidities and probable dependence within a large, US population-based sample of persons with migraine. Background.Opioids are used in the acute treatment of migraine. However, their use is controversial. Methods.Data from the 2009 American Migraine Prevalence and Prevention (AMPP) study were used to categorize persons with migraine into 4 groups based on reported opioid use: nonusers (between 2005 and 2009), previous users (history of use between 2005 and 2008 but no-use in 2009), and current opioid users (those reporting use of opioids in the 3 months preceding the 2009 American Migraine Prevalence and Prevention survey). Current opioid users were divided into nondependent and probable dependence users according to criteria for dependence adapted for inclusion in the survey from the Diagnostic and Statistical Manual of Mental Disorders-4th edition. All opioid-use groups were contrasted by sociodemographics, headache characteristics, medical and psychiatric comorbidities (depression [measured by the Patient Health Questionnaire-9], anxiety [measured by the Primary Care Evaluation of Mental Health Disorders, PRIME-MD], and cardiovascular events and risk factors), and headache-related HRU. Results.In a sample of 5796 migraineurs, 4076 (70.3%) were opioid nonusers, 798 (13.8%) were previous users, and 922 (15.9%) were current opioid users. Among current opioid users, 153 (16.6%) met criteria for probable dependence and 769 (83.4%) did not. Headache-related disability (Migraine Disability Assessment sum scores) increased across groups as follows: nonusers: 7.8, previous users: 13.3, current nondependent users: 19.1, and current probable dependence users: 44.4, as did monthly headache frequency: nonusers: 3.2 days/month, previous users: 4.3 days/month, current nondependent users: 5.6 days/month, and current probable dependence users: 8.6 days/month. The prevalence of depression and anxiety was highest among current users with probable dependence. Rates of headache-related HRU were higher for all opioid-use groups for emergency department/urgent care, primary care, and specialty care visits compared to nonusers. Conclusions.Opioid use for migraine is associated with more severe headache-related disability, symptomology, comorbidities (depression, anxiety, and cardiovascular disease and events), and greater HRU for headache. Longitudinal studies are needed to further assess the directionality and causality between opioid use and the outcomes we examined.

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