Use and Overuse of Acute Medications Common Among Migraineurs

A variety of pills on a table
Investigator analyzed the number of scripts and days of therapy in patients with migraine to determine use and frequency of overuse.

The following article is part of conference coverage from the PAINWeek 2018 conference in Las Vegas, Nevada. Clinical Pain Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in pain medicine. Check back for the latest news from PAINWeek 2018.

LAS VEGAS — Most individuals in a large cohort study of migraineurs made a claim for acute medication, with a subset of the cohort overusing opioids, triptans, or barbiturates during the study. This research was recently presented during the 2018 PAINWeek conference, held September 4-8.

This observational, retrospective, cross-sectional study included 216,674 individuals with significant migraine, 101,111 of whom were using preventatives and 115,536 of whom were not. In 2016, 83.5% of the individuals had made a claim for an acute migraine medication, with 49.7% having a claim for triptans, 44.3% for NSAIDS/acetaminophen, 46.9% for opioids, and 14.2% for barbiturates.

Those with claims used at least 1 medication for an average of 116 days of therapy in 2016. Triptans were used on average for 99 days out of the year, NSAIDS/acetaminophen for 60 days, opioids for 67 days, and barbiturates for 58 days. Of the whole cohort, overuse had occurred in 15.7% of those using triptans, 3.8% of those using barbiturates, and 9.7% of those using opioids. Among individuals with at least one day of therapy with triptans, the overuse rate was 31.5%. Among those with at least one day of opioid use, 20.7% had overused, while the rate was 27% with barbiturates.

Individuals included in this study were 85.9% women, had a mean age of 44.3 years (minimum age 18), and had at least one diagnosis of migraine in 2016. Their data were collected from the Truven Marketscan Commercial and Medicare Supplemental administrative claims database. Exclusion criteria included HIV, cluster headache, epilepsy, or cancer. To assess use of acute medication, the study researchers performed descriptive analyses, with acute medication overuse categorized as over 120 annual days of triptan use, over 96 days of opioids, or over 60 days of barbiturates.

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The study researchers conclude that “[the] majority of patients with migraine had at least one claim for an acute medication and a subset of patients appeared to have overused triptans, opioids, or barbiturates during the study period. Effective treatment options that can help to reduce acute medication use are needed in the management of patients with migraine. Understanding current utilization and overuse of acute medications among patients with migraine will better inform potential interventions to improve patient care and outcomes.”

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Foster S, Schroeder K, Choong CKC, Curtis S, Morrow P, Ford J. Acute medication use and overuse in patients with migraine. Poster presentation at: PAINWeek; September 4-8, 2018; Las Vegas, NV. Abstract 109.

For more coverage of PAINWeek 2018, click here.