Rates and Predictors of Using Opioids in the Emergency Department to Treat Migraine in Adolescents and Young Adults

Abstract

Objectives: This study aimed to determine the rate and context in which opioids are used to treat migraine in adolescents and young adults seen in emergency care settings.Methods: Data from 2010 to 2016 in the Cerner Health Facts electronic health record data warehouse were analyzed using multilevel logistic regression to estimate the population likelihood of an opioid being used in the emergency department (ED) to treat a primary diagnosis of migraine in adolescents and young adults and to evaluate the extent to which this likelihood varies as a function of characteristics of the patient (age, sex, race, and insurance), encounter (referral source, provider specialty, and encounter duration and year), and ED (region, setting, size, payer mix, and academic status). Results:The study identified 14,494 eligible ED encounters with unique patients, of which 23% involved an opioid. Likelihood of being treated with opioids was significantly higher for patients who were older, female, white, and seen by a surgeon and who had longer encounters and encounters earlier in the time period sampled. Sites varied widely in percentage of encounters involving opioids (mean, 26.4% ± 20.1%; range, 0-100%), with higher rates associated with smaller sites with relatively higher proportions of commercially insured patients.Conclusions: Use of opioids in the ED to treat migraine in youth is fairly common, with rate variation reflecting broader trends in for whom opioids tend to be more likely to be prescribed. These findings may be helpful for benchmarking and informing quality improvement efforts aimed at reducing unwarranted opioid exposure in youth.

Sex-Specific Pharmacotherapy for Migraine: A Narrative Review

“…Activation of these receptors decreases neurotransmitter release (pre-synaptic inhibition) and neuronal excitability (post-synaptic inhibition). There is some evidence that morphine produces greater analgesia in women and is more likely to be prescribed for women with migraine (Niesters et al, 2010;Connelly et al, 2019).…”

Improving Acute Treatment of Pediatric Primary Headache Disorders With a Novel Headache Treatment Center: Retrospective Review of Preliminary Outcomes

“…1 In addition to variable efficacy of headache treatments received in the emergency department, 2,3 there are other limitations associated with this setting that can make it suboptimal for the acute management of migraine. Such limitations include a lack of headache-trained or informed providers, 4 -6 limited targeted interventions and comfort measures used for active headaches, 2,7,8 a higher rate of treatment with opioids, 9,10 and unnecessary imaging. 11,12 Developing alternative viable models for early therapeutic intervention of headaches may be advantageous to improve management and limit disability.…”

Once too many: Impact of emergency department opioid use on future health resource utilization among patients with migraine

“…6 Despite this, opioids are frequently prescribed for migraine across all ages and clinical settings. [7][8][9] One study found that opioids were administered in 35% of ED visits for headache, whereas triptans were administered in only 1.5% of visits. 10 Opioid use has also been shown to continue after the ED visit, with one study finding that approximately 20% of patients reported use of opioids at the time of presentation to a tertiary headache care center and ED physicians were among the most frequent first prescribers of the opioids.…”