Abstract text (incl. figure legends and references)

Objective: To investigate opioids use among migraine subjects for treatment of their headache.

Methods: We performed a cross-sectional study using a web-based questionnaire to assess opioid use in individuals with migraine. Primary outcome was to assess opioid use among migraine subjects for treatment of attacks in a large Dutch cohort. We also quantified opioid use (duration, type of opioids, prescriber) and compared between persons with episodic (EM) versus chronic (CM). Covariates were entered as categorical or continuous variables. Descriptive statistics, unpaired T-tests, Chi-square and Mann-Whitney U tests were used.

Results: The E-questionnaire was sent to our large Dutch cohort of n=6577 migraine subjects, of whom n=4047 responded, and n=3712 completed the questionnaire (response rate 56%). In total 13% of participants reported to ever have used opioids for headache. In 46% of those who used an opioid this was on one occasion, but in 27% this was for >1 month, and in 11% for >1 year. The opioids were prescribed by physicians but 2% of opioid-users indicated that they had used without a prescription. The majority of prescribing physicians were general practitioners (46%), followed by neurologists (35%), other specialists (9%), and doctors at a first aid (8%). Opioids were reported to be prescribed for acute treatment in 63% of cases, in 16% as preventive treatment and in 21% as both acute and preventive medication. Opioid use was more often in those with CM compared with EM (22% and 12%, p<0.001). Prolonged use was more often in those with CM versus EM (> 1 month: 34% and 24%; p<0.003).

Conclusion: Despite the fact that opioids are not effective in migraine these medications are still prescribed, even up to 22% in those who suffer from chronic migraine. Of all opioid-users 2% did so without prescription. Education for doctors and migraine subjects, and providing multimodal pain management strategies are needed to reduce opioid use in persons with migraine.