2023 MSC Emerging Science Contest for Early-Career Investigators: Characterizing opioid use in a Dutch cohort with migraine.

The 2023 MSC Emerging Science Contest for Early-Career Investigators took place on December 13, 2023. Below is a written summary of one of the presentations from the contest. Read about other presentations from the event in our Early-Career Science Library.

Category: Physiology/Diagnosis/Therapeutics

Runner up: Floor van Welie, master’s biomedical science student, Leiden University Medical Center (LUMC), The Netherlands

Title: Characterizing opioid use in a Dutch cohort with migraine.

Hypothesis, methodology, findings and conclusions.

Our study, conducted in a large Dutch cohort, addressed the dearth of data on opioid use for migraine in Europe. Using a web-based questionnaire, we surveyed 3,712 individuals with migraine, revealing that 13% had used opioids for headache management. Notably, 27% used opioids for over a month, 11% for over a year. Surprisingly, 2% of users even used opioids without any prescription. General practitioners prescribed opioids to 46% of users, followed by neurologists (35%), other specialists (9%), and emergency room doctors (8%). Opioids were used acutely (63%), but also preventively (16%) or for both indications (21%). Chronic migraine patients exhibited higher opioid use compared to episodic migraine sufferers (22% vs. 12%, p<0.001), with prolonged use (>1 month) being more prevalent in chronic migraine (34% vs. 24%, p<0.003). This highlights a concerning trend, emphasizing the need for education for both healthcare providers and migraine patients and the implementation of multimodal pain management strategies to reduce opioid use in migraine treatment.

This study was very recently published; van Welie RF*, van Welie FC*, de Vries Lentsch S, Dahan A, van Velzen M, Terwindt GM. Characterizing opioid use in a Dutch cohort with migraine. Cephalalgia. 2023 May;43(5):3331024231174160. doi: 10.1177/03331024231174160. PMID: 37165775 (*Shared first authorship).

Implications for understanding migraine disease and/or its comorbidities, or how the research holds promise as a new avenue of future migraine study.

Our research underscores the urgent need for enhanced education for both healthcare providers and individuals with migraine, coupled with the implementation of multimodal pain management strategies to reduce opioid use in migraine treatment. Despite the fact that opioids are considered ineffective and are not recommended in our national treatment guideline, these medications are still prescribed, up to 11% for more than one year, and up to 22% in those who suffer from chronic migraine.

Importantly, our results stress the importance of the European guidelines from the Consensus Statement endorsed by the European Headache Federation (EHF) and the European Academy of Neurology (EAN), which warns that opioids as migraine treatment should be avoided due to questionable efficacy, adverse effects and risk of dependency. The lower number of users in Europe compared to the US can be explained by the difference in guidelines. The guidelines according to the American Academy of Neurology (AAN) state that opioid treatment can be used as a rescue therapy when migraine-specific treatments fail and recommends that the use should be limited to <9 days per month to avoid medication overuse headache (MOH) with long-term follow-up to prevent treatment complications.

Alarmingly, our study shows that opioids are not only used by migraine sufferers as treatment for acute migraine attacks, but additionally or even exclusively as prophylaxis. This is concerning, given the associated risks of MOH and the transformation from episodic migraine (EM) to chronic migraine (CM). The prevalence of opioid use for extended durations, as demonstrated in our study, raises a significant red flag, emphasizing the imperative for a comprehensive reevaluation of current practices and the exploration of alternative, evidence-based approaches in migraine management to mitigate the risks associated with opioid use.