PDG90 OPIOID USE AMONG MIGRAINE PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT (ED) OF A LARGE TERTIARY CARE INTEGRATED DELIVERY NETWORK IN TEXAS

Abstract

To describe and compare opioid and non-opioid medication use in migraine patients presenting to the emergency department (ED). This was a retrospective analysis using electronic medical records (EMRs) from Baylor Scott & White Health Plan, obtained via ReachNet, from 2010 to 2017. Records were extracted for patients aged ≥ 18 with ≥ 1 ED visit coded for migraine [ICD-9 ‘346.xx’ or ICD-10 ‘G43.xx’] with continuous records 6 months before and after their index ED visit. Descriptive statistics of patient demographics, opioid and non-opioid medication use were summarized and analyzed using SAS 9.4. The study cohort included 3,187 ED visits for 1,429 migraine patients, with an average age of 42.7 (±13.9) years, 86.8% female, 74.5% Whites, and 18.4% African-Americans. Among 1,429 patients, 712 (49.8%) patients received ≥ 1 medication during the index ED visit, 308 (21.6%) received opioids, and 492 (34.4%) received non-opioid abortive medications. For those who received opioids (n=308), the most common medications administered (frequency of patients) were morphine [n=108 (35.1%)], hydromorphone [n=106 (34.4%)], fentanyl [n=71 (23.1%)], hydrocodone [n=46 (14.9%)], and butorphanol [n=14 (4.5%)]. Of the 1,429 patients, 371 (26.0%) had opioid or abortive prescriptions written to be filled at a pharmacy after their ED visits. About one-fourth [n=374 (26.2%)] of patients had ≥ 1 prescriptions of prophylactic filled during the 6-month post-index period. Despite guidelines discouraging the use of opioids for migraine, opioids were administered for more than one-fifth of the patients during the index ED visits. The American Migraine Prevalence and Prevention (AMPP) study suggests that about 38.8% of migraine patients should use prophylactic medications, but only about one-fourth of the ED patients in the current study were prescribed prophylactic medications after their index migraine ED visit. Future research should focus on exploring factors related to opioid use and barriers to migraine prophylaxis.