Acute Medication Overuse, Symptom Severity Associated in Migraine

Acute medication overuse in migraine may be associated with greater symptom severity and pain intensity as well as higher rates of cutaneous allodynia, according to a study recently published in The Journal of Headache and Pain.

This study included 13,649 respondents with a mean age of 43.4 (SD 13.6) years and who were 72.9% women and 81.9% Caucasian. Criteria for acute medication overuse were met by 15.4% of the subjects, who by comparison with the non-overuse group were less likely to be on nonsteroidal anti-inflammatory drugs (63.3% vs 69.8%, respectively) and more likely to take ergot alkaloids (3.1% vs 0.6%, respectively), barbiturates (7.8% vs 2.7%, respectively), opioids (23.8% vs 8.0%, respectively), and triptans (31.3% vs 14.2%, respectively; P <.001 for all).

Patients with vs without acute medication overuse also experienced more monthly headache days (12.9 vs 4.3, respectively), a greater severity of migraine symptoms (17.8 vs 16.4, respectively); greater scores on pain intensity (7.4 vs 6.5, respectively), and increased rates of cutaneous allodynia (53.7% vs 37.5%, respectively; P <.001 for all). After adjusting for monthly headache days, the likelihood of acute medication overuse grew with incremental years of age (odds ratio [OR]=1.02), smoking status (OR=1.54), being married (OR=1.19), showing psychological symptoms (OR=1.62) or cutaneous allodynia (OR=1.22), increased pain intensity (OR=1.27) and acuteness of migraine symptoms (OR=1.06). The risk for acute medication overuse due to cutaneous allodynia was greater in men (OR=1.61) but not women (OR=1.08).

Criteria for eligibility in this study included presence of migraine according to the International Classification of Headache Disorders-3-beta, more than 3 monthly headache days within the past 90 days and at least one in the last 30 days, and current use of medication for acute headache. 

The study researchers conclude that “[Acute medication overuse] was present in 15% of respondents with migraine. [Acute medication overuse] was associated with higher symptom severity scores, pain intensity, and rates of cutaneous allodynia. [Acute medication overuse] was more likely in triptan, opioid, and barbiturate users but less likely in [nonsteroidal anti-inflammatory drug] users. Cutaneous allodynia was associated with [acute medication overuse] in men but not women. This gender difference merits additional exploration.”

This study was sponsored by Promius Pharma, a subsidiary of Dr. Reddy’s Laboratories, Princeton, NJ, USA.

Reference

Schwedt TJ, Alam A, Reed ML, et al. Factors associated with acute medication overuse in people with migraine: results from the 2017 migraine in America symptoms and treatment (MAST) study [published online May 24, 2018]. J Headache Pain. doi: 10.1186/s10194-018-0865-z