{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T21:20:40Z","timestamp":1793049640233,"version":"4.5.0"},"reference-count":29,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2021,11,28]],"date-time":"2021-11-28T00:00:00Z","timestamp":1638057600000},"content-version":"vor","delay-in-days":27,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100006483","name":"AbbVie","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006483","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["headachejournal.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Headache"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the geographic variations in triptan and opioid prescribing patterns for patients with migraine.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Numerous guidelines recommend triptans as the standard of care for migraine attacks, yet opioids are still widely used for migraine treatment. Variation in the use of opioids and triptans for the treatment of migraine by geographic location is not well known.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using a US claims database, we conducted a retrospective cohort study of adults diagnosed with migraine between 2016 and 2018. We used a 12\u2010month follow\u2010up period to assess triptan and opioid utilization, stratified by the nine Census Bureau\u2010designated divisions. To examine the geographic factors that affect triptan and opioid use among patients, we conducted two sets of multivariable analyses. First, we analyzed the odds of a patient being a triptan or opioid user in the follow\u2010up period, defined as \u22651 triptan or opioid claim. We then analyzed the medication use rate among triptan or opioid users.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall, we had a final study population of 113,921 patients. In the follow\u2010up period, 52.9% (60,247\/113,921) [range: 48.0%\u201356.3%] of patients were triptan users and 41.0% (46,708\/113,921) [range: 28.9%\u201348.4%] of patients were opioid users with significant differences across census divisions (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). Triptan users had a mean (SD) of 4.8 (4.7) triptan claims annually with no significant differences across divisions (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.188). Opioid users had a mean (SD) of 5.4 (6.8) opioid claims annually with significant differences across divisions (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). The observed variation in opioid use stemmed from the proportion of patients using opioids in each region and not from the number of opioid prescriptions per user.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>There was a significant geographic variation in the use of opioids and to a lesser degree the use of triptans. The widespread use of opioids and the large variation in use other than triptans as the standard of care suggest that improvements could be made in the acute treatment of migraine attacks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/head.14238","type":"journal-article","created":{"date-parts":[[2021,11,28]],"date-time":"2021-11-28T23:50:13Z","timestamp":1638143413000},"page":"1499-1510","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Geographic variation in the use of triptans and opioids for the acute treatment of migraine attacks"],"prefix":"10.1111","volume":"61","author":[{"given":"Jae Hyun","family":"Lee","sequence":"first","affiliation":[{"name":"Health Economics and Outcomes Research (HEOR) Strategy AbbVie  Irvine California USA"},{"name":"The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute School of Pharmacy University of Washington  Seattle Washington 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