Opioid Use among People with Migraine: Results of the OVERCOME (US) Study.

INTRODUCTION

Despite expert recommendations against using opioids for migraine treatment, their use remains common in the USA. We aimed to evaluate the use of opioids among people with active migraine using data from the Observational Survey of the Epidemiology, Treatment, and Care of Migraine (OVERCOME) (US) study.

METHODS

This observational, longitudinal, web-based survey study included a demographically representative sample of adults with migraine in the USA (2018-2020). Participants with migraine (International Classification of Headache Disorders, third edition [ICHD-3]) and ≥ 1 headache in the previous 12 months were identified via a questionnaire and/or self-reported diagnosis. Information on opioid use for acute migraine treatment was collected. Demographics, clinical, and migraine-related characteristics among those with current opioid use and those with non-use were evaluated in the cross-sectional analysis using standardized mean difference (SMD). Multivariable analysis was conducted using machine learning (least absolute shrinkage and selection operator regression, random forest) and logistic regression models to assess factors associated with current opioid use.

RESULTS

Of 61,932 respondents with active migraine, 13,331 (21.5%) reported currently using opioids to treat migraine. Among those using opioids, 68.0% were female, 64.3% identified as White, and 13.7% identified as Hispanic. Those currently using opioids differed from those not using opioids in various characteristics, including higher tobacco/marijuana use, more comorbidities, higher migraine-related disability, and higher interictal burden (all SMD > 0.2). The factors most associated with current opioid use were "currently taking recommended acute medications for migraine" (odds ratio [OR], 10.1; confidence interval [CI], 9.47, 10.78), "currently taking barbiturates for migraine" (OR, 2.2; CI, 2.03, 2.34), and "sought care at an Emergency Department/Urgent Care for migraine in the previous 12 months" (OR, 1.7; CI, 1.67, 1.85).

CONCLUSIONS

This study shows that opioid use for migraine is associated with using recommended acute medications, barbiturates, and emergency department care for migraine. Understanding how to limit these factors is key to developing interventions to reduce opioid use in migraine.