{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T20:44:19Z","timestamp":1792097059645,"version":"4.4.0"},"reference-count":31,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,2,18]],"date-time":"2021-02-18T00:00:00Z","timestamp":1613606400000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100006093","name":"Patient-Centered Outcomes Research Institute","doi-asserted-by":"publisher","award":["RI\u2010CRN\u20102020\u2010008"],"award-info":[{"award-number":["RI\u2010CRN\u20102020\u2010008"]}],"id":[{"id":"10.13039\/100006093","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["headachejournal.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Headache"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The purpose of this study was to evaluate the subsequent health resource utilization (HRU) between patients with migraine who received opioid medications at their emergency department (ED) visits (\u201copioid recipients\u201d) versus patients with migraine who did not receive opioid medications at their ED visits (\u201cnon\u2010recipients\u201d).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Previous studies have found that opioid use is common among patients with migraine at emergency settings. Medication overuse, especially the use of opioids, is associated with migraine progression, which can ultimately lead to substantial health resource use and costs. There is limited evidence on opioid use specifically in emergency settings and its impact on future HRU among people with migraine.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>This retrospective cohort study used electronic health record data from the Baylor Scott &amp; White Health between December 2013 and April 2017. Adult patients who had at least 6\u00a0months of continuous enrollment before (baseline or pre\u2010index) and after (follow\u2010up) the first date they had an ED visit with a diagnosis of migraine (defined as index date) were enrolled in the study. Opioid use and HRU during follow\u2010up period between opioid recipients and non\u2010recipients were summarized and compared.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 788 patients met the eligibility criteria and were included in this study. During the 6\u2010month follow\u2010up period, compared to patients with migraine who were non\u2010recipients at their index ED visits, opioid recipients had significantly more all\u2010cause (3.6 [SD\u00a0=\u00a06.3] vs. 1.9 [SD\u00a0=\u00a04.8],\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.0001) and migraine\u2010related (1.6 [SD\u00a0=\u00a04.2] vs. 0.6 [SD\u00a0=\u00a02.1],\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.0001) opioid prescriptions (RXs), and more all\u2010cause (2.6 [SD\u00a0=\u00a04.3] vs. 1.6 [SD\u00a0=\u00a02.6],\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.002) and migraine\u2010related (0.6 [SD\u00a0=\u00a01.4] vs. 0.3 [SD\u00a0=\u00a00.8],\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.001) ED visits. In addition, opioid recipients had higher risk of future migraine\u2010related ED visits controlling for covariates (HR\u00a0=\u00a01.49, 95% CI\u00a0=\u00a01.09\u20132.03,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.013). Factors that were significantly (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.05) related to future migraine\u2010related ED visits include previous opioid use (HR\u00a0=\u00a02.12, 95% CI\u00a0=\u00a01.24\u20133.65,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.007), previous ED visits (HR\u00a0=\u00a02.38, 95% CI\u00a0=\u00a01.23\u20134.58,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.010), hypertension (HR\u00a0=\u00a01.46, 95% CI\u00a0=\u00a01.07\u20132.00,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.017), age between 45 and 64\u00a0years (HR\u00a0=\u00a00.68, 95% CI\u00a0=\u00a00.48\u20130.97,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.033), female sex (HR\u00a0=\u00a01.82, 95% CI\u00a0=\u00a01.12\u20132.86,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.015), and tobacco use disorder (HR\u00a0=\u00a01.45, 95% CI\u00a0=\u00a01.07\u20131.97,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.017). Sub\u2010analyses were restricted to the group of patients who were opioid na\u00efve at baseline (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0274, defined as having \u22641 opioid RXs during the 6\u2010month pre\u2010index period). Patients who were baseline opioid na\u00efve but received opioids during their index ED visits were more likely to have future migraine\u2010related ED visits compared to patients who were baseline opioid na\u00efve and did not receive any opioids during their index ED visits, controlling for covariates (HR\u00a0=\u00a02.90, 95% CI\u00a0=\u00a01.54\u20135.46,\n                      <jats:italic>p\u00a0<\/jats:italic>\n                      =\u00a00.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Opioid use among patients with migraine presenting to the ED is associated with increased future HRU, which highlights the need for optimizing migraine management in emergency settings.<\/jats:p>\n                  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