Acute medications for the treatment of migraine include triptans, ergots, simple analgesics (NSAIDs/acetaminophen), opioids, and barbiturates. Opioids and barbiturates are not recommended as first line therapy. The purpose of this study is to explore the utilization of acute medications in an employed migraineur population and assess the use of triptans, ergots, or simple analgesics prior to opioid or barbiturate use.
We conducted a retrospective study using claims data from the HealthCare21 Business Coalition data warehouse, which includes eight employers’ data. Beneficiaries 18-64 years old with a migraine diagnosis (index event) and continuous eligibility 1 year pre- and post-index were identified between July 1, 2013 and June 31, 2017. Patients were excluded if they had chronic pain, cancer, hospice use, pregnancy, or cardiac contraindications to triptans. Descriptive statistics examined acute medication utilization in the post-index period and use of a triptan, ergot, or analgesic medication prior to opioid or barbiturate use.
Utilization for 463 migraineurs was analyzed. Females accounted for 86% of the population and the mean age was 37 years old. In the post-index period, 116 (25%) migraineurs received opioids, 43 (9%) received barbiturates, and 144 (31%) received either opioids or barbiturates. Similarly, 134 (29%) migraineurs received triptans, 0 received ergots, 100 (22%) received simple analgesics, and 199 (43%) received either triptans or simple analgesics. Of the 144 patients receiving an opioid or barbiturate, 47 (33%) received prior therapy with a triptan or simple analgesic.
Despite recommendations, a significant proportion of migraineurs receive opioids or barbiturates for acute treatment. Of these patients, many do not have evidence of lower risk acute medications prior to initiation of opioid or barbiturate therapy. There is an opportunity for employers, payers, and pharmacy benefit managers to improve appropriate use of acute pain management medications for migraineurs.
© 2019 Published by Elsevier Inc.