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Opioid Use and Dependence Among Persons With Migraine: Results of the AMPP Study

Authors

  • Dawn C. Buse PhD,

    Corresponding author
    1. From the Albert Einstein College of Medicine, Bronx, NY, USA (D.C. Buse, R.B. Lipton); Montefiore Headache Center, Bronx, NY, USA (D.C. Buse, R.B. Lipton); Armstrong Atlantic State University, Savannah, GA, USA (S.H. Pearlman); Vedanta Research, Chapel Hill, NC, USA (M.L. Reed, D. Serrano); Merck Sharp & Dohme Corp., West Point, PA, USA (D.S. Ng-Mak); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA (R.B. Lipton).
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  • Starr H. Pearlman PhD,

    1. From the Albert Einstein College of Medicine, Bronx, NY, USA (D.C. Buse, R.B. Lipton); Montefiore Headache Center, Bronx, NY, USA (D.C. Buse, R.B. Lipton); Armstrong Atlantic State University, Savannah, GA, USA (S.H. Pearlman); Vedanta Research, Chapel Hill, NC, USA (M.L. Reed, D. Serrano); Merck Sharp & Dohme Corp., West Point, PA, USA (D.S. Ng-Mak); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA (R.B. Lipton).
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  • Michael L. Reed PhD,

    1. From the Albert Einstein College of Medicine, Bronx, NY, USA (D.C. Buse, R.B. Lipton); Montefiore Headache Center, Bronx, NY, USA (D.C. Buse, R.B. Lipton); Armstrong Atlantic State University, Savannah, GA, USA (S.H. Pearlman); Vedanta Research, Chapel Hill, NC, USA (M.L. Reed, D. Serrano); Merck Sharp & Dohme Corp., West Point, PA, USA (D.S. Ng-Mak); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA (R.B. Lipton).
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  • Daniel Serrano PhD,

    1. From the Albert Einstein College of Medicine, Bronx, NY, USA (D.C. Buse, R.B. Lipton); Montefiore Headache Center, Bronx, NY, USA (D.C. Buse, R.B. Lipton); Armstrong Atlantic State University, Savannah, GA, USA (S.H. Pearlman); Vedanta Research, Chapel Hill, NC, USA (M.L. Reed, D. Serrano); Merck Sharp & Dohme Corp., West Point, PA, USA (D.S. Ng-Mak); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA (R.B. Lipton).
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  • Daisy S. Ng-Mak PhD,

    1. From the Albert Einstein College of Medicine, Bronx, NY, USA (D.C. Buse, R.B. Lipton); Montefiore Headache Center, Bronx, NY, USA (D.C. Buse, R.B. Lipton); Armstrong Atlantic State University, Savannah, GA, USA (S.H. Pearlman); Vedanta Research, Chapel Hill, NC, USA (M.L. Reed, D. Serrano); Merck Sharp & Dohme Corp., West Point, PA, USA (D.S. Ng-Mak); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA (R.B. Lipton).
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  • Richard B. Lipton MD

    1. From the Albert Einstein College of Medicine, Bronx, NY, USA (D.C. Buse, R.B. Lipton); Montefiore Headache Center, Bronx, NY, USA (D.C. Buse, R.B. Lipton); Armstrong Atlantic State University, Savannah, GA, USA (S.H. Pearlman); Vedanta Research, Chapel Hill, NC, USA (M.L. Reed, D. Serrano); Merck Sharp & Dohme Corp., West Point, PA, USA (D.S. Ng-Mak); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA (R.B. Lipton).
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  • Conflict of Interest: None

  • Sponsorship

  • The American Migraine Prevalence and Prevention Study is funded through a research grant to the National Headache Foundation from Ortho-McNeil Neurologics, Inc., Titusville, NJ. Additional analyses and manuscript preparation were supported by a grant to the National Headache Foundation from Merck & Co., Inc., Whitehouse Station, NJ.

  • Disclosures

  • Dawn C. Buse, PhD, has received grant support and honoraria from Allergan Inc., Endo Pharmaceuticals, Iroko Pharmaceuticals, MAP Pharmaceuticals, and Merck, Inc.

  • Starr H. Pearlman, PhD, has received consulting honoraria from NuPathe, Merck & Co., Inc., Map Pharmaceuticals, and the American Headache Society.

  • Michael Reed, PhD, has received grant support and honoraria from Allergan Pharmaceuticals, Endo Pharmaceuticals, GlaxoSmithKline, MAP Pharmaceuticals, Merck & Co., Inc., NuPathe, Novartis, Ortho-McNeil, and the National Headache Foundation.

  • Daniel Serrano, PhD, has received grant support and honoraria from Allergan Pharmaceuticals, Endo Pharmaceuticals, GlaxoSmithKline, MAP Pharmaceuticals, Merck & Co., Inc., NuPathe, Novartis, Ortho-McNeil, and the National Headache Foundation.

  • Daisy S. Ng-Mak, PhD, is a full-time employee of Merck Sharp & Dohme Corp., West Point, PA.

  • Richard B. Lipton, MD, has received grants from Advanced Bionics, Allergan Pharmaceuticals, Endo Pharmaceuticals, GlaxoSmithKline, Minster, Merck & Co., Inc., Neuralieve, Novartis, OrthoMcNeil, Pfizer, ProEthics/KOWA, the National Headache Foundation, and the National Institutes of Health. He has received honoraria from Allergan Pharmaceuticals, AstraZeneca, Endo Pharmaceuticals, GlaxoSmithKline, Merck & Co., Inc., Novartis, OrthoMcNeil, and Pfizer.

D.C. Buse, Montefiore Headache Center, Montefiore Medical Center, 1575 Blondell Avenue, Suite #225, Bronx, NY 10461, USA, email: dbuse@montefiore.org

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.

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