Opioid Use, Disability, and Cognition in Migraine: Multi-Country Results From the Chronic Migraine Epidemiology and Outcomes – International Study
Elizabeth Leroux1, Dawn Buse2, Michel Lanteri-Minet3, Fumihiko Sakai4, Manjit Matharu5, Zaza Katsarava6, Janette Contreras-De Lama7, Nicole Naccara8, Kristina Fanning9, Richard Lipton10
1Centre Medical Brunswick, 2Dawn Buse, PhD, 3CHU De Nice, 4Saitama International Headache Center, 5University College London, 6University of Duisburg-Essen, 7AbbVie, 8Abbvie, 9MIST Research, 10Albert Einstein College of Medicine
Objective:
To contrast disability and cognitive function in people with migraine who do and do not use opioids to treat their migraine in the Chronic Migraine Epidemiology and Outcomes-International (CaMEO-I) Study.
Background:
Opioids are not recommended for the acute treatment of migraine because of limitations in efficacy and safety.
Design/Methods:
CaMEO-I was a cross-sectional, web-based survey conducted from 2021-2022 in six countries. Opioid use was based on self-reported use or possession over the previous 30 days. Treatment optimization and disability were measured with the Migraine Treatment Optimization Questionnaire (mTOQ) and Migraine Disability Assessment (MIDAS) scale. Cognitive impairment was assessed using the Migraine Cognitive Impairment Questionnaire.
Results:
Of the 87.0% (12,612/14,492) of respondents with migraine who used medication for acute treatment, 23.5% (2965/12,612) used opioids (mean age 42.0 years; 62.7% female; mean BMI 27.1 kg/m2). Opioid users were more likely than nonusers to have severe disability overall (OR = 2.72 [95% CI: 2.1, 3.5]) and at each level of treatment optimization (very poor [64.7% vs 49.7%], poor [62.6% vs 46.5%], moderate [51.0% vs 35.6%], maximum [38.8% vs 19.9%]). Compared with those reporting maximum treatment optimization, the odds of moderate to severe disability increased as treatment optimization declined: moderate treatment optimization (OR=2.27 [95% CI: 2.0, 2.6]); poor (OR=3.51 [95% CI: 3.1, 4.0]); very poor (OR=3.85 [95% CI: 3.2, 4.6]). Opioid users had higher mean (SD) cognitive impairment scores than nonusers (63.3 [26.4] vs 53.8 [30.2], p<0.001).
Conclusions:
Among CaMEO-I respondents with migraine, opioid users were more likely than opioid nonusers to have moderate or severe disability, indicating a need for treatment optimization. These cross-sectional data do not allow us to determine if disability drives opioid prescribing and use or if opioids lead to worsening disability. Opioid use was associated with greater cognitive impairment.
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