Reader Response: Characterizing Opioid Use in a US Population With Migraine: Results From the CaMEO Study
Citation Manager Formats
Make Comment
See Comments

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Despite guidelines directing against the use of opioids in migraine management, this analysis by Lipton et al.1 reveals that more than 36% of patients surveyed have opioids available to them. These opioid users were more likely to have allodynia and vascular risk factors including diabetes, moderate-to-severe depression, anxiety, obesity, and high MIDAS scores, and they were more likely to be men. The data in this study demonstrate that those who use opioids are worse off in many domains, but the casual directions cannot be determined. Do opioids actually make migraine worse or do the most severe patients get prescribed opioids? Is the increased use of opioids a consequence of increased headache with high MIDAS scores, central sensitization, and allodynia? This leads to a debate on which came first, and it is likely that worsening headache came first,2 leading to initial opioid use. However, did the opioids subsequently worsen and escalate the situation? A controversial concept is whether opioids have a place in migraine treatment at all, given the new treatment options (Gepants and devices) because these have not been identified as causing medication overuse. Is the real issue a lack of education about alternative treatment options, resulting in patients becoming opioid users because of misdiagnosis and poor prescribing of migraine-specific medications?
Footnotes
Author disclosures are available upon request (journal{at}neurology.org).
- © 2021 American Academy of Neurology
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
For assistance, please contact:
AAN Members (800) 879-1960 or (612) 928-6000 (International)
Non-AAN Member subscribers (800) 638-3030 or (301) 223-2300 option 3, select 1 (international)
Sign Up
Information on how to subscribe to Neurology and Neurology: Clinical Practice can be found here
Purchase
Individual access to articles is available through the Add to Cart option on the article page. Access for 1 day (from the computer you are currently using) is US$ 39.00. Pay-per-view content is for the use of the payee only, and content may not be further distributed by print or electronic means. The payee may view, download, and/or print the article for his/her personal, scholarly, research, and educational use. Distributing copies (electronic or otherwise) of the article is not allowed.
Disputes & Debates: Rapid online correspondence
NOTE: All authors' disclosures must be entered and current in our database before comments can be posted. Enter and update disclosures at http://submit.neurology.org. Exception: replies to comments concerning an article you originally authored do not require updated disclosures.
- Stay timely. Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- 200 words maximum.
- 5 references maximum. Reference 1 must be the article on which you are commenting.
- 5 authors maximum. Exception: replies can include all original authors of the article.
- Submitted comments are subject to editing and editor review prior to posting.