OBJECTIVES: Opioids are not part of guideline-recommended treatment regimen for migraine; however, migraine patients are still prescribed opioids in clinical practice. The study assesses the real-world opioid utilization among migraine patients initiating on newer acute (ubrogepant, rimegepant, lasmiditan) and preventive (galcanezumab, erenumab, fremanezumab) migraine therapies and on standard of care (triptans).

METHODS: Adults aged ≥18 years with ≥1 claim for an acute or preventive migraine therapy or a triptan (brand or generic) were identified from the Optum Research Database during 01MAY2018-28FEB2022 (date of first claim=index date). Included patients had 6-month baseline and follow-up continuous health plan enrollment, ≥1 claim for migraine in baseline or follow-up, no evidence of their index drug type (acute/preventive/triptan) in baseline, and no diagnoses of pregnancy, HIV, malignancy, other headache types, and chronic pain during baseline or follow-up. Primary outcomes were opioid use and time to first opioid fill in follow-up by cohort (acute, preventive, triptan).

RESULTS: Of the 13,953 migraine patients, 270,791 and 12,892 were in the acute, preventive and triptan cohorts, respectively. Overall sample average age was 40.7 years (standard deviation [SD]=13.9), majority female (75.6%), Caucasian (75.8%), and commercially insured (92.7%). About 5.7% of triptan cohort, 9.5% of preventive cohort, and 5.2% of acute cohort had ≥1 claim for an opioid in follow-up. Patients initiating on acute treatment had the longest time to first opioid fill (mean=74.1 days, SD=67.2), followed by triptan initiators (mean=72.8 days, SD=57.2), and preventive treatment patients (mean=68.3 days, SD=57.6).

CONCLUSIONS: These findings suggest continued opioid use among migraine patients treated with both newer acute and preventive therapies and standard of care, highlighting the potential unmet pain management need for these patients.