OBJECTIVES: Opioids are prescribed for treatment of migraine despite lack of efficacy evidence from randomized controlled clinical trials. Clinical evidence has shown opioid use is associated with increased risk of severe headaches, opioid overuse and dependence. This study assessed the risk of migraine-related hospitalizations or emergency department (ED) visits within 90-days of prescribing an opioid for migraine compared with prescribing only non-opioid medications among Mississippi Division of Medicaid beneficiaries.

METHODS: A retrospective study was conducted using Medicaid claims from 2014 - 2016. Beneficiaries with a medical claim for a diagnosis of migraine (346.xx/G43) and a second claim with a diagnosis within 31-365 days were classified as having migraine. The first claim was considered to be the index date. Beneficiaries were excluded if age was ≤18 years on index date or were not continuously enrolled for 12 months before and 3 months after the index date. Treatment for the index event was determined by extracting opioid and non-opioid migraine medication claims occurring within the 30-day period after index date. Migraine treatments were classified as opioid or non-opioid medications only. Migraine-related hospitalizations or ED visits were identified in the 90-day follow-up period from index date. Modified Poisson regression model was used to analyze the risk of migraine-related hospitalizations or ED visits controlling for age, race, sex and chronic or episodic migraine.

RESULTS: A total of 2,727 beneficiaries were identified as having migraine with 1,728 prescribed opioids and 999 prescribed only non-opioid medications. The risk of a migraine-related hospitalization or ED visit was 1.86 times higher in those treated with opioids [Confidence Interval (CI): 1.275-2.732, p<0.001].

CONCLUSIONS: Treatment of migraine with opioids was associated with higher risk of migraine-related hospitalizations or ED visits. Providers need education to avoid prescribing opioids for migraines due to lack of efficacy, increased ED visits and hospitalizations.