Patients reporting to the emergency room with migraines are more likely that those receiving opioid prescriptions have increased future health resource utilization, suggesting that emergency migraine management needs to be optimized. This emerges from the study results published in Headache.
Using data from the Baylor Scott & White Health electronic health record database, researchers conducted a retrospective cohort study of health resource utilization in people with migraines who received and did not receive opioids during visits to the emergency room between 2013 and 2017.
A total of 788 patients (mean age 44.5 ± 14.6 years; 85.9% women; 76.1% whites) met the admission criteria and were included in the study. Within this cohort, 35.9% (n = 283) received 1 or more opioid drugs during their index emergency visit, and 34.8% of the total cohort were opioid-naive at baseline. During the index visit, 22.6% of these opioid-naïve patients received an opioid drug.
Compared to non-recipients, patients receiving opioid drugs had significantly more opioid prescriptions for all causes and migraines during the follow-up period. This difference remained significant even when opioid use was rated as number of prescriptions or when these prescriptions were grouped into different levels.
People who received opioids had significantly more visits to the emergency room for migraines and all causes during the follow-up period. This remained consistent when use of the emergency room was rated as a number of visits or broken down into multiple tiers.
Investigators simultaneously tested time-dependent covariates for pre-index opioid use, emergency room visits, outpatient visits, hospital stays, preventive drug use, and index opioid use. No time-dependent covariate was significant (x2 = 10.17; df = 6; P = 0.118).
In an unmatched analysis, researchers found that people who received opioids had a significantly shorter time before their next visit to the emergency room-related migraine (x2 = 11.36; df = 1; P <0.001). At the end of the 6-month follow-up period, 25.5% of patients returned to the emergency room with a diagnosis of migraine. 25% of patients had a subsequent visit to the emergency room related to migraine within 136.5 days.
Using a Cox proportional hazard model, the overall fitted analyzes were significant (x2 = 131.52; df = 34; P <0.0001). The expected hazard ratio (HR) for the return visit to the emergency room was 1.49 times higher in people who received opioids than in people who did not, after adjusting all covariates (95% CI, 1.09-2 , 03; P = 0.013).
Women also returned to the emergency room more frequently (HR 1.82; 95% CI 1.12-2.86; P = 0.015) and people who had 10 or more non-migraine opioid prescriptions prior to the index period (HR 2.12; 95%) % CI 1.24-3.65; P = 0.007). Other factors included 4 or more emergency room visits for all causes prior to the index, a diagnosis of hypertension, a diagnosis of tobacco use disorder, and a diagnosis of long-term drug use (HR, 2.38, 1.46, 1.45, and 4.28) . respectively).
Compared to non-naive opioid recipients, patients who were opioid-naïve at baseline had significantly more visits to the emergency room related to migraine during the follow-up period (P <0.05 for all).
The results of a log-rank test showed that opioid-naive opioid recipients had a significantly shorter time before their next visit to the emergency room related to migraine (x2 = 8.87; df = 1; P = 0.003). Within this group, 16.8% of patients returned to the emergency room with a diagnosis of migraine at the end of the 6-month follow-up period. The risk of returning to the emergency room was higher in opioid-naïve opioid recipients than in non-recipients after control of the covariates (HR 2.90; 95% CI 1.54-5.46; P = 0.001).
Study restrictions include those inherent in observational studies; the inability to track care received outside of that specific health system, leading to a possible underestimation of resource consumption; and possible problems with the accuracy, completeness, and comparability of electronic health records due to missing variables. These results may not generalize to patients outside the study area of north and central Texas.
“This real-world database analysis suggests that opioid use occurs in patients with migraines [emergency department] is associated with an increased risk of future migraines [emergency department] Visits highlighting the need to optimize migraine management in emergency situations, ”the researchers concluded. “Future studies could assess the robustness of these results in a larger and more diverse population.”
Shao Q, Rascati KL, Lawson KA, Wilson JP, Shah S., Garrett JS. Impact of opioid use in the emergency room on future health resource use in migraineurs. A headache. 2021; 61 (2): 287–2 299. doi: 10.1111 / head.14071
This article originally appeared on Clinical Pain Advisor