Opioid use, disability, and patient-reported cognitive impairment in migraine: Multi-country results from the Chronic Migraine Epidemiology and Outcomes-International Study.

Abstract

Objective: To characterize the population who do and do not use opioids to treat migraine in the Chronic Migraine Epidemiology and Outcomes-International (CaMEO-I) Study.

Background: Opioids are not recommended for migraine treatment because of efficacy and safety limitations.

Methods: This was a post hoc analysis of CaMEO-I, an international, cross-sectional, observational, Web-based survey conducted in six countries from 2021 to 2022. Migraine status was determined by applying modified International Classification of Headache Disorders, 3rd edition, criteria, using a validated diagnostic questionnaire. Opioid users were defined as those who used opioids or kept them on hand to treat headache over the previous 30 days. Disability was assessed with the MIDAS, patient-reported cognitive impairment with the Migraine Cognitive Impairment Questionnaire (MCIQ), and acute treatment optimization with the Migraine Treatment Optimization Questionnaire (mTOQ). Multivariable binary logistic regression models evaluated the association between current opioid use and headache-related disability. Odds ratios (ORs) were adjusted for age, gender at birth, current consultation with a headache specialist, education, employment status, and treatment optimization.

Results: A total of 12,612 respondents with migraine who used prescription or over-the-counter medication for acute treatment of headaches (mean age, 41.8 years; 71.3% female) were included; 23.5% (2965/12,612) used opioids. Rates of opioid use for migraine ranged from 6.3% (127/2023) in Japan to 37.2% (814/2186) in France. The proportions of respondents with moderate to severe disability were higher among opioid users than nonusers at each level of treatment optimization on the mTOQ (very poor [64.7% {123/190} vs. 49.7% {373/750}], poor [62.6% {1110/1772} vs. 46.5% {2208/4747}], moderate [51.0% {338/663} vs. 35.6% {824/2314}], maximum [38.8% {132/340} vs. 19.9% {366/1836}]). Poorer treatment optimization was associated with significantly greater odds of moderate to severe disability (p < 0.001), and opioid use was associated with increased disability across all countries (p < 0.001). Opioid users had higher median (interquartile range [IQR]) patient-reported cognitive impairment scores on the MCIQ than nonusers (61.1 [44.4, 83.3] vs. 50.0 [33.3, 72.2], p < 0.001). Higher proportions of opioid users than nonusers had one or more doctor visits (49.3% [1462/2965] vs. 20.3% [1960/9647]), emergency department/urgent care visits (14.4% [426/2965] vs. 3.5% [336/9647]), and hospital stays (19.4% [571/2949] vs. 4.9% [472/9617]) for headache during the past 6 months (p < 0.001).

Conclusion: Among CaMEO-I respondents with migraine, opioid users were more likely to have moderate or severe disability and patient-reported cognitive impairment, although causality cannot be determined from cross-sectional analyses. These results support the need for better treatment optimization.