Gastrointestinal Comorbidities Representing a Relative Contraindication to NSAID Use: Results From the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study (116)

Objective: To assess the frequency of gastrointestinal comorbidities (GICs) that cause relative contraindications to nonsteroidal anti-inflammatory drug (NSAID) use among persons with migraine and to evaluate patterns of acute medication use by those with and without these GICs.

Background: NSAIDs are a commonly recommended acute treatment option for people with migraine. However, long-term NSAID use is not recommended due to serious GI side effects, and use by patients with compromised GI health may be contraindicated.

Design/Methods: In the Chronic Migraine Epidemiology and Outcomes (CaMEO) study, we evaluated acute medication use in respondents meeting modified International Classification of Headache Disorders, 3rd edition criteria for migraine with at least 1 of 3 self-reported GICs to NSAIDs: gastroesophageal reflux disease (GERD), peptic ulcer disease, and ulcerative colitis or Crohn’s disease (inflammatory bowel disease [IBD]).

Results: There were 12,810 respondents with migraine in this analysis. At least one GIC was reported by 1845 (14.4%) respondents, including treated GERD (11.0%), self-reported diagnosed ulcer (4.0%), and self-reported diagnosed IBD (1.3%). Overall, NSAIDs (prescription and over-the-counter) were the most commonly used class of acute medication among respondents with a GIC and without a GIC (62.5% vs 60.4%). Approximately twice as many respondents with a GIC as without reported use of prescription NSAIDs (17.4% vs 9.5%), opioids (21.6% vs 9.4%), or barbiturates (5.7% vs 2.4%).

Conclusions: A substantial proportion of respondents with migraine (14.4%) reported ≥1 GIC to NSAIDs; as not all GICs were captured and as we relied on self-report, this is likely to represent a lower-bound estimate. The high frequency of opioid/barbiturate use by those with GICs suggests a reliance on treatments not recommended for migraine. New migraine-specific acute treatments without GI contraindications may help address the unmet needs of people with migraine and GI comorbidity.

Disclosure: Dr. Nahas has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Allergan, Amgen/Novartis, Biohaven, electroCore, Eli Lilly, Supernus, Teva, Theranica, and Zosano. Dr. Buse has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Dawn C. Buse, PhD, has received grant support and honoraria from Allergan, Avanir, Amgen, Biohaven, Eli Lilly and Company, and Promius and for work on the editorial board of Current Pain and Headache Reports.. Dr. Buse has received personal compensation in an editorial capacity for Dawn C. Buse, PhD, has received grant support and honoraria from Allergan, Avanir, Amgen, Biohaven, Eli Lilly and Company, and Promius and for work on the editorial board of Current Pain and Headache Reports.. Dr. Buse has received research support from Dawn C. Buse, PhD, has received grant support and honoraria from Allergan, Avanir, Amgen, Biohaven, Eli Lilly and Company, and Promius and for work on the editorial board of Current Pain and Headache Reports.. Dr. Fanning has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Vedanta Research, Vedanta has received funding directly from Allergan for work on the CaMEO Study.. Dr. Fanning has received research support from Vedanta Research, Allergan, Amgen, Eli Lilly, GlaxoSmithKline, Merck & Co., Inc., and Promius via grants to the National Headache Foundation. Vedanta has received funding directly from Allergan for work on the CaMEO Study..Dr. Reed has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with OVERCOME study advisory board. Dr. Reed has received research support from Michael L. Reed, PhD, is Managing Director of Vedanta Research, which has received research funding from Allergan, Amgen, Promius/Dr. Reddy’s Laboratories, Eli Lilly and Company, GlaxoSmithKline, Merck & Co., Inc., Novartis the National Headache Foundatio.Dr. Manack Adams has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Aubrey Manack Adams, PhD, is a full-time employee of Allergan plc and owns stock in the company.. Dr. Manack Adams has received compensation for serving on the Board of Directors of Aubrey Manack Adams, PhD, is a full-time employee of Allergan plc and owns stock in the company.. Dr. Manack Adams holds stock and/or stock options in Aubrey Manack Adams, PhD, is a full-time employee of Allergan plc and owns stock in the company. which sponsored research in which Dr. Manack Adams was involved as an investigator. Dr. Manack Adams holds stock and/or stock options in Aubrey Manack Adams, PhD, is a full-time employee of Allergan plc and owns stock in the company.. Dr. Manack Adams has received research support from Aubrey Manack Adams, PhD, is a full-time employee of Allergan plc and owns stock in the company.. Dr. Lipton has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Teva Pharmaceuticals. Dr. Lipton has received compensation for serving on the Board of Directors of eNeura and Biohaven. Dr. Lipton holds stock and/or stock options in Biohaven which sponsored research in which Dr. Lipton was involved as an investigator. Dr. Lipton holds stock and/or stock options in Biohaven. Dr. Lipton has received research support from Migraine Research Foundation the National Headache Foundation and Amgen.