Other opioid studies
In another recent study, nonpersistence with prophylactic treatment was observed in 90% of patients with migraine. Of those patients, 39% switched, 30% restarted, and 31% discontinued treatment. Opioid use was common—77.4% of patients received opioids over the follow-up. Among opioid users, the risk of gastrointestinal adverse events and abuse increased with long-term use, which suggests a need for more effective prophylactic migraine treatments.
A commentary that described risk factors and behavioral issues in opioid treatment for migraine suggested that opioids be used sparingly and exclusively in conjunction with comprehensive assessment and integration of psychological treatment. “Psychological comorbidities, cognitive constructs, and behavioral responses to pain greatly impact the perception of migraine pain, treatment efficacy and outcome, and overall quality of life and functioning,” it was noted. “Current considerations for migraine treatment emphasize the utility of the biopsychosocial model in understanding and treating migraine, noting both the importance of addressing psychological factors such as cognitive beliefs as well as psychiatric comorbidities.”
Review authors suggested another reason to avoid opioids in headache and migraine treatment—opioids are overused because physicians may be unfamiliar with drug interactions between opioids and other medications, especially the possibility of serotonin toxicity. The potential for serotonin syndrome is relatively high in patients who are using opioids for pain control, they noted.
1. Global Leaders in Migraine Research to Convene at The American Headache Society 61st Annual Scientific Meeting [press release]. Mount Royal, NJ: American Headache Society. July 8, 2019. Accessed July 9, 2019.
2. Schwedt TJ, Alam A, Reed ML, et al. Factors associated with acute medication overuse in people with migraine: results from the 2017 migraine in America symptoms and treatment (MAST) study. J Headache Pain. 2018;19:38. doi: 10.1186/s10194-018-0865-z.
3. Pringsheim T, Davenport WJ, Marmura M, et al. How to apply the AHS evidence assessment of the acute treatment of migraine in adults to your patient with migraine. Headache. 2016;56:1194-1200. doi: 10.1111/head.12870. Epub 2016 Jun 20.
4. Ashina S, Sackheim K, Gharibo C. Pain: what we have achieved in the past 25 years. Neurology Reviews. 2018;26:17-18.
5. Ashina S. Opioid analgesic use during pregnancy: commentary by Sait Ashina, MD. Neurology Reviews. 2011;19:34.
6. Connelly M, Glynn EF, Hoffman MA, Bickel J. Rates and predictors of using opioids in the emergency department to treat migraine in adolescents and young adults. Pediatr Emerg Care. 2019 Jun 22. doi: 10.1097/PEC.0000000000001851. [Epub ahead of print]
7. Bonafede M, Wilson K, Xue F. Long-term treatment patterns of prophylactic and acute migraine medications and incidence of opioid-related adverse events in patients with migraine. Cephalalgia. 2019 Feb 28:333102419835465. doi: 10.1177/0333102419835465. [Epub ahead of print]
8. Stone MT, Weed V, Kulich RJ. Opioid treatment of migraine: risk factors and behavioral issues. Curr Pain Headache Rep. 2016;20:51. doi: 10.1007/s11916-016-0581-9.
9. Ansari H, Kouti L. Drug interaction and serotonin toxicity with opioid use: another reason to avoid opioids in headache and migraine treatment. Curr Pain Headache Rep. 2016;20:50. doi: 10.1007/s11916-016-0579-3.