PND51 Trends and Characteristics in Opioid Analgesic Use for Migraine in US Emergency Departments: Analysis of National Hospital Ambulatory Medical Care Survey 2007-2018 Data

Abstract

Opioid analgesics are commonly prescribed for migraine management in emergency departments (ED) despite clinical guidelines warning against such practice. Despite several policies and guidelines that have been implemented to prevent unsafe prescription opioid use and opioid-related adverse outcomes in the United States (US), little is known about opioid use patterns among migraine patients. We aimed to examine the trends, patient, and visit characteristics in opioid use for migraine treatment in US ED settings. A cross-sectional study of 2007-2018 National Hospital Ambulatory Medical Care Survey data was conducted for adult visits (≥18 years) with a primary ED discharge diagnosis of migraine. To obtain sufficient sample sizes and reliable national estimates, we examined the data across 3 time periods: 2007-2010, 2011-2014, and 2015-2018. We used multivariable logistic regression to examine the trends in the use of opioid and non-opioid migraine medications including ergots/triptans, antiemetics, antihistamines, acetaminophen/non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and intravenous fluids, separately. There were 10.8 million migraine-related ED visits between 2007 and 2018. The majority of migraine-related ED visits with opioids were from patients aged <50 years (78.3%), female (84.7%), White (85.0%), and having severe pain (60.7%). Approximately 40% and 25% of migraine-related ED visits prescribed with opioids were paid by Medicaid and Medicare, respectively. Among migraine-related ED visits, a significantly declining trend was observed in opioids (2007-2010: 58.0%, 2011-2014: 49.5%, and 2015-2018: 36.0%; Ptrend<0.001). Conversely, increasing trends were observed in the following medications over time (all Ptrend<0.001): acetaminophen/NSAIDs (33.2% to 53.7%), antiemetics (43.4% to 64.1%), and corticosteroids (4.0% to 9.0%) from 2007-2010 to 2015-2018. Ergot/triptan use remained stable (10.0% in 2015-2018; Ptrend=0.55). Among migraine-related ED visits in the US, opioid analgesic use substantially decreased from 2007 to 2018, while acetaminophen/NSAIDs, antiemetic, and corticosteroid use increased significantly. Migraine-specific medications (i.e., ergots/triptans) were underutilized in ED settings.