OBJECTIVES : Migraine is a primary headache disorder associated with high economic burden and poor quality of life. This study aimed to 1) compare demographics, comorbidities, past opioid use, past preventive medication use, and past health resource utilization (HRU) between opioid and non-opioid users at emergency department (ED) with migraine diagnosis; 2) compare time to next migraine-related ED visit between opioid and non-opioid users.

METHODS : Electronic Medical Record (EMR) data from Baylor Scott & White Health Plan from 12/2013 to 4/2017 were utilized. The index date was the first migraine-related ED visit after >= 6 months of enrollment. Adult patients with a diagnosis for migraine who had >= 6 months of continuous enrollment before and after the index date were included. Descriptive statistics and bivariate analyses were used to compare characteristics between opioid users and non-opioid users. Cox proportional hazards regression was used to compare the risk of future migraine-related ED visits.

RESULTS : A total of 788 patients were included, with an average age of 44.5 (±14.6) years, 85.9% were female, and 76.1% were White. About one-third (n=283, 35.9%) of the patients received opioids during their index ED visit. Compared to non-opioid users, opioid users were more likely to have a diagnosis for sleep disorder (35.7% vs. 24.4%, p=0.0007) and anxiety (58.0% vs. 49.9%, p=0.03). In addition, opioid users had more past opioid use (Median 5 vs. 2 RXs, p<0.0001), and more past hospitalizations (Mean 0.82 vs. 0.58 visits, p<0.0004). Opioid users had a significantly higher hazard for future migraine-related ED visits (HR=1.49), controlling for covariates. Previous opioid use (HR=2.12), previous ED visits (HR=2.38), age (45-64 years HR=0.68), gender (Male HR=0.55), tobacco use disorder (HR=1.45), and hypertension (HR=1.46) were also significantly (p<0.05) related to future migraine-related ED visits.

CONCLUSIONS : Opioid users were more likely to have future migraine-related ED visits than non-opioid users.