Albert Einstein College of Medicine, Bronx, NY, USA.
Headache. 2012 Jan;52(1):18-36. doi: 10.1111/j.1526-4610.2011.02050.x.
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.
Opioids are used in the acute treatment of migraine. However, their use is controversial.
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.
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.
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.
在一项基于美国人群的偏头痛患者大型样本中，评估阿片类药物治疗急性偏头痛的使用频率，并根据社会人口统计学、医疗资源利用（HRU）、合并症和可能的依赖性对使用组进行特征描述。
阿片类药物用于急性偏头痛的治疗。然而，它们的使用存在争议。
使用 2009 年美国偏头痛患病率和预防（AMPP）研究的数据，根据报告的阿片类药物使用情况，将偏头痛患者分为 4 组：非使用者（2005 年至 2009 年期间）、既往使用者（2005 年至 2008 年期间有使用史，但 2009 年无使用史）和当前阿片类药物使用者（报告在 2009 年美国偏头痛患病率和预防调查前 3 个月内使用过阿片类药物）。根据纳入调查的《精神障碍诊断与统计手册-第 4 版》中对依赖性的改编标准，当前阿片类药物使用者被分为无依赖性和可能依赖性使用者。通过社会人口统计学、头痛特征、医疗和精神合并症（抑郁症[用患者健康问卷-9 测量]、焦虑症[用初级保健评估心理健康障碍，PRIME-MD 测量]、心血管事件和危险因素）以及与头痛相关的 HRU，对所有阿片类药物使用组进行对比。
在 5796 名偏头痛患者的样本中，4076 名（70.3%）为非阿片类药物使用者，798 名（13.8%）为既往使用者，922 名（15.9%）为当前阿片类药物使用者。在当前阿片类药物使用者中，153 名（16.6%）符合可能依赖性标准，769 名（83.4%）不符合。与头痛相关的残疾（偏头痛残疾评估总分）随组增加如下：非使用者：7.8，既往使用者：13.3，当前无依赖性使用者：19.1，当前可能依赖性使用者：44.4，每月头痛频率也增加：非使用者：3.2 天/月，既往使用者：4.3 天/月，当前无依赖性使用者：5.6 天/月，当前可能依赖性使用者：8.6 天/月。当前可能依赖性使用者的抑郁和焦虑患病率最高。与非使用者相比，所有阿片类药物使用者在急诊/紧急护理、初级保健和专科护理就诊方面的头痛相关 HRU 率更高。
偏头痛使用阿片类药物与更严重的与头痛相关的残疾、症状、合并症（抑郁、焦虑和心血管疾病及事件）以及更多的头痛相关 HRU 相关。需要进行纵向研究，以进一步评估阿片类药物使用与我们研究的结果之间的方向性和因果关系。
