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Many patients find migraine medications ineffective, some turn to opioids

PHILADELPHIA — Results from a large study of patients with chronic migraine found that a significant number of patients discontinued medications due to perceived lack of efficacy, showing a substantial unmet need and high levels of disability, according to a presentation at the American Headache Society Annual Scientific Meeting. Patients also reported significant opioid use for migraine despite recommendations against this practice.

“Acute prescription medication for migraine are associated with low satisfaction, poor persistence and inadequate efficacy,” Susan Hutchinson, MD, of the Orange County Migraine and Headache Center in Irvine, California, said.

Hutchinson and colleagues conducted an analysis of respondents from the Chronic Migraine Epidemiology and Outcomes, or CaMEO, study to identify those with lapsed treatment and to evaluate relationships between treatment decisions, headache characteristics and headache disability.

Of 13,624 CaMEO respondents with migraine, 1,719 were lapsed users of acute prescription migraine medication. Among lapsed users, 11% reported at least 15 migraine days per month, one in five reported being able to work and function normally with a headache, and 41.8% were at moderate to severe disability on the Migraine Disability Assessment Scale.

 

Results from a large study of patients with chronic migraine found that a significant number of patients discontinued medications due to perceived lack of efficacy, showing a substantial unmet need and high levels of disability, according to a presentation at the American Headache Society Annual Scientific Meeting. Patients also reported significant opioid use for migraine despite recommendations against this practice.

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The most common reason for discontinuing prescription treatment was switching to nonprescription pain medication (33.7%), followed by concerns about prescription medication efficacy (28.2%) and safety (24.9%). Among former prescription medication users, 11% reported at least 15 migraine days per month, one in five reported being able to work and function normally with a headache, and 41.8% were at moderate to severe disability on the Migraine Disability Assessment Scale.

“These results further confirm a high level of disability and unmet treatment needs among those with migraine who discontinue acute prescription medication for migraine,” Hutchinson said.

Other results from the CaMEO trial presented at the meeting included:

• A cross-sectional analysis of 16,788 CaMEO respondents found that 39.5% of those with migraine reported depression and/or anxiety. Compared with those with episodic migraine (n = 15,312), patients with chronic migraine (n = 1,476) were more likely to have both depression and anxiety (42% vs. 20.8%; P < .001). Those with episodic or chronic migraine and both depression and anxiety were had the highest risk for disability (RR = 1.79; 95% CI, 1.71-1.87).

• 2,975 (17.7%) of 16,789 CaMEO respondents with migraine met the criteria for medication overuse. Medication overuse was reported in 55.2% of patients with 10 or more headache days and 64.6% of those with 15 or more headache days. Compared with those who did not have medication overuse, those who did had more headache-related disability, anxiety, depression, and both ED and urgent care use for migraine.

• Among 2,388 CaMEO respondents who used acute prescription medications to treat headaches, 867 (36.3%) were opioid users. Opioid users were more likely to experience more headache days, use emergency care for headache within the last 6 months, reported depression, anxiety, and cardiovascular comorbidities, and other markers of worse health.

“These analyses extend knowledge about associations between demographic variables, headache characteristic, and other factors associated with opioid use,” Richard B. Lipton, MD, FAHS, director of the Montefiore Headache Center at the Albert Einstein College of Medicine, said. “It might help devise educational and other interventions to reduce use of opioids in migraine therapy, and future work I hope will elucidate the directionality of these associations.” – by Erin Michael

Reference:

Lipton R, et al. Demographics, headache characteristics, and other factors associated with opioid use in people with migraine: results from the chronic migraine epidemiology and outcomes study.

Lipton R, et at. Depression and anxiety are associated with increased headache-related disability in episodic and chronic migraine; results from the chronic migraine epidemiology and outcomes (CaMEO) study.

Lipton R, et al. Results from the chronic migraine epidemiology and outcomes study demonstrate a high level of unmet need for migraine treatment in people who discontinue acute prescription migraine medication.

Schwedt T, et al. Greater headache burden and disability among those with medication overuse: results from the chronic migraine epidemiology and outcomes (CaMEO) study.

All presented at: American Headache Society Annual Scientific Meeting; July 11-14, 2019; Philadelphia.

Disclosures: Hutchinson is on the speaker’s bureau and serves on advisory boards for Allergan. Healio Primary Care was unable to determine other authors’ relevant financial disclosures prior to publication.