Teens Frequently Given Opioids for Headache

Almost half of teenagers who had recurring headaches were prescribed opioid painkillers, with those who received care in emergency departments even more likely to receive the drugs, a new study finds.

Teenagers who suffer from headaches are often prescribed opioid painkillers, despite treatment guidelines that recommend against their use, the results of a recent study finds. The observational analysis, published online on February 28, 2014, in the Journal of Adolescent Health, also found that adolescents treated in emergency departments were twice as likely to receive opioids as those who saw providers in other settings.

Using commercial medical and pharmacy claims data, the researchers analyzed opioid prescribing patterns among adolescents aged 13 to 17 who made at least 2 visits to health care providers for headache from January 2007 through December 2008. Patients were followed until December 31, 2010, for at least 1 year or until disenrollment from their health plan. Teenagers with a trauma diagnosis were excluded from the study.

Of 8373 teenagers with headache included in the analysis, 46.1% received at least 1 prescription for an opioid. Among adolescents who received opioid prescriptions, 47.8% received 1 prescription, 22.5% received 2 prescriptions, and 29.3% received 3 or more prescriptions. In addition, 25.3% of teenagers prescribed opioids were diagnosed with migraine.

During the follow-up period, teenagers who were treated with opioids had more health care visits with a headache diagnosis than those who were not treated with the painkillers; 22.0% of opioid patients visited a physician’s office at least 5 times for headache, compared with 13.5% of non-opioid patients. Adolescents who received opioids also saw more providers for headache during follow-up. On average, opioid patients visited 3.8 providers for headache, while those who did not receive opioids visited 2.9 providers for headache.

The results also indicated a strong relationship between opioid use and emergency department visits. During follow-up, 27.9% of participants who were given opioids visited the emergency department for headache, compared with just 13.5% of those who did not receive opioids. Patients who made visits to the emergency department had twice the rate of opioid prescriptions compared with those who did not visit the emergency department, and those who made 3 or more visits were 4 times more likely to receive an opioid prescription than were those who made no visits.

Although patients who visit the emergency department for headache may have more severe symptoms or may be more resistant to treatment, the increased use of opioids to treat headache may also indicate that migraines are underdiagnosed or inappropriately treated within the setting, the authors note.

“Future studies may expand on the correlation between practice patterns and opioid prescription, as well as to compare the use of opioids for headache across treatment settings, such as academic medical centers versus community hospitals,” they conclude.

Opioids do not effectively treat migraines, and may contribute to the development of chronic headaches in patients with episodic migraine. Adolescents are also at an increased risk for opioid misuse and abuse. Therefore, current guidelines recommend nonprescription analgesics and nasal sumatriptan to treat pediatric headache and migraine.