Objective:

To estimate the prevalence of acute medication overuse (AMO) in people with migraine (PwM).

Background:

AMO is a cycle of high frequency analgesic use, such as triptans and non-steroidal anti-inflammatory drugs (NSAIDs), that may result in medication overuse headache (MOH). There is limited understanding of frequency of use for medication classes across both prescription and over-the-counter drugs.

Design/Methods:

A retrospective cross-sectional study using the 2021 US National Health and Wellness Survey (NHWS, Cerner Enviza) captured diagnosed PwM with ≥1 acute medication who reported prescription and OTC medication days of use in the past 30 days as well as demographic, migraine, and clinical characteristics. AMO criteria were: 1) ≥10 days of triptans, combination analgesics, ergotamines, or opioids; or 2) ≥15 days of nonopioid analgesics, acetaminophen, or NSAIDs. AMO was separately assessed with medications used only for migraine and adding those for other indications. PwM with AMO and without AMO were compared using survey weights to represent the adult population.

Results:

Among over 14 million PwM represented by the survey, 32.7% reported AMO of migraine-specific medications. Adding medication use for other conditions, AMO prevalence was 51.9%. Over two-thirds (67.4%) met the first AMO criterion with a cumulative mean of 27.0±29.2 days and 49.6% met the second criterion with 28.2±15.0 cumulative days. PwM with versus without AMO reported higher use of triptans (45.1% vs. 39.1%), combination analgesics (42.7% vs. 18.8%), NSAIDs (38.6% vs. 20.9%), and opioids (36.7% vs. 16.0%). PwM with AMO reported 8.7±8.0 days of triptan use, 13.1±9.2 days of combination analgesics, 13.3±9.1 days of NSAIDs, and 11.8±9.8 days of opioids. People with AMO had higher migraine burden, lower quality of life, lower productivity, higher depression severity, and higher healthcare resource utilization compared to those without.

Conclusions:

AMO is common in PwM. Treatments not associated with MOH are needed in this patient population.