This study investigates opioid prescribing rates for migraine patients versus matched controls in southern Israel.

Although prescription opioids are not indicated for acute or preventive migraine treatment, they are often prescribed for migraine. Opioids are associated with increased risk for migraine chronification, misuse, abuse, and dependence.

In this population-based retrospective, observational, cohort study, adult migraine patients were identified in the computerized database of the southern district of the "Clalit Health Services" Health Maintenance Organization (HMO) in Israel. Patients were identified based on recorded diagnosis (ICD-9) and/or claims for specific anti-migraine medication (triptans) during 2000-2018 and matched to non-migraine subjects by gender, age, and primary clinic. Opioid prescribing rates were evaluated during 2018.

Overall, 26,475 migraine patients and 51,221 matched controls were included. In 2018, opioid prescriptions were filled by migraine patients nearly twice as frequently as controls: ≥1-month (1,596 [6.0%] vs 1,606 [3.1%]; p<0.001); ≥2-months (619 [2.3%] vs 619 [1.2%]; p<0.001); >3-months (502 [1.9%] vs 485 [0.9%]; p<0.001). During emergency department visits, migraine patients were more likely to receive opioids than controls (1,733 [6.5%] vs 1,879 [3.7%]; p<0.001). In multivariate analysis, older age (odds ratio [OR], 1.02 [95% CI:1.02,1.03]), higher age at diagnosis (OR, 1.01 [95% CI:1.01,1.02]), comorbid depression (OR, 1.48 [95% CI:1.23,1.77), anxiety (OR, 1.19 [95% CI:0.96,1.47]), fibromyalgia (OR, 3.47 [95% CI:2.99,4.04]), and migraine preventive drug use (OR, 2.36 [95% CI:2.00,2.77]) were associated with opioid prescription.

Although we cannot establish that opioids were prescribed for migraine, these results show that migraine patients are frequently prescribed opioids in emergency and ambulatory settings, despite international treatment guidelines advising against prescribing opioids for migraine.