Recent migraine diagnosis linked to increased risk for car crashes among older drivers

Key takeaways:

• The increased risk may be because symptoms were not stabilized or properly treated, an expert said.
• Self-medication with possibly inappropriate therapies like opioids may also contribute to the increased risk.

Older adults recently diagnosed with migraine were more than three times likely to be involved in a motor vehicle crash within a year compared with those who never had a migraine diagnosis, according to researchers.

“We were surprised to see such a large increase in the odds of a crash associated with incident migraine,” Carolyn G. DiGuiseppi, MD, MPH, PhD, a professor in the department of epidemiology at the Colorado School of Public Health, told Healio. “Prior studies have shown small increases in the risk of motor vehicle crash injuries in people with prevalent migraine but did not examine recently diagnosed migraine. This suggests there is a high-risk period for people immediately following their diagnosis with migraine.”

For the study, published in the Journal of the American Geriatrics Society, DiGuiseppi and colleagues examined data from 2,589 drivers aged 65 to 79 years to determine how migraines impacted motor vehicle crash rates in a 2-year period.

At the start of enrollment, participants were asked whether they had ever been diagnosed with migraine. Those who answered “yes” were classified as having prevalent migraine. Meanwhile, those who answered “no” but then received a migraine diagnosis at a subsequent visit were classified as having incident migraine, DiGuiseppi said.

Of the drivers, 12.5% and 1.3% reported having prevalent migraine and incident migraine, respectively.

Diguiseppi and colleagues reported that prevalent migraine was not associated with an increased risk for a motor vehicle crash within the subsequent 2 years. However, incident migraine substantially increased the odds for a crash within 1 year (OR = 3.27; 95% CI, 1.21-8.82), according to the researchers.

Diguiseppi said it was surprising to find no association between prevalent migraine and crash risk, which conflicted with findings from prior studies. She suggested that this could be due to the studies having different factors like age and how the migraine question was framed.

Meanwhile, the high crash rate linked to new migraine diagnoses “could be because these patients’ symptoms are not yet stabilized or adequately treated with medication or managed with lifestyle changes,” Diguiseppi said.

“These individuals may also be self-medicating with potentially inappropriate medications like opioids, which could themselves increase crash risk,” she said. “Older adults with a new diagnosis of migraine may benefit from reducing or avoiding driving during initial stabilization and management of migraine, holistic clinical assessment of other driving risk factors, and intervention and counseling to reduce other risks for motor vehicle crashes, such as avoiding use of opioids, alcohol or cannabis before driving.”

Future research is warranted to better understand how migraine symptoms, severity and frequency impact driving safety and crash risk, Diguiseppi said.

"We also need studies that collect and examine more detailed information about the type, dose and duration of medications specifically prescribed for migraines, in relation to driving safety and crash risk,” she said.

References:

• DiGuiseppi C, et al. J Am Geriatr Soc. 2023;doi:doi.org/10.1111/jgs.18719.
• Older adults with newly diagnosed migraine disorder three times more likely to have motor vehicle crash. https://www.eurekalert.org/news-releases/1030209. Published Jan. 3, 2023. Accessed Jan. 9, 2023.