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Study Title and Description

Narcotic analgesics for acute migraine in the emergency room: are we meeting Headache Societies' guidelines?



Key Questions Addressed
1 KQ1a. What is the comparative effectiveness of opioid therapy versus: 1) nonopioid pharmacologic therapy (e.g. acetaminophen, nonsteroidal anti-inflammatory drugs [NSAIDs], triptans, ergots alkaloids, combination analgesics, muscle relaxants, anti-nausea medications, and cannabis) or 2) nonpharmacologic therapy (e.g. exercise, cognitive behavioral therapy, acupuncture, biofeedback, noninvasive neuromodulation devices) for outcomes related to pain, function, pain relief satisfaction, and quality of life and after followup at the following intervals: < 1 day; 1 day to <1 week; 1 week to <2 weeks; 2 weeks to 4 weeks? KQ1b. How does effectiveness of opioid therapy vary depending on: (1) patient demographics (e.g. age, race, ethnicity, gender, socioeconomic status (SES)); (2) patient medical comorbidities (previous opioid use, body mass index (BMI); (3) dose of opioids; (4) duration of opioid therapy, including number of opioid prescription refills and quantity of pills used? KQ1c. What are the harms of opioid therapy versus nonopioid pharmacologic therapy, or nonpharmacologic therapy with respect to: (1) misuse, opioid use disorder, and related outcomes; (2) overdose; (3) medication overuse headache (MOH), (4) other harms including gastrointestinal-related harms, falls, fractures, motor vehicle accidents, endocrinologic harms, infections, cardiovascular events, cognitive harms, and psychological harms (e.g. depression)? KQ1d. How do harms vary depending on: (1) patient demographics (e.g. age, gender); (2) patient medical comorbidities; (3) the dose of opioid used; (4) the duration of opioid therapy? KQ1e. What are the effects of prescribing opioid therapy versus not prescribing opioid therapy for acute treatment of episodic migraine pain on 1) short-term (<3 months) continued need for prescription pain relief, such as need for opioid refills, and 2) long-term opioid use (3 months or greater)? KQ1f. For patients with episodic migraine being considered for opioid therapy for acute treatment, what is the accuracy of instruments for predicting risk of opioid misuse, opioid use disorder, or overdose? KQ1g. For patients with episodic migraine being considered for opioid therapy for acute treatment, what is the effectiveness of instruments for predicting risk of opioid misuse, opioid use disorder, or overdose? KQ1h. For patients with episodic migraine being considered for opioid therapy for acute treatment, what is the effect of the following risk mitigation strategies on the decision to prescribe opioids: (1) existing opioid management plans; (2) patient education; (3) clinician and patient values and preferences related to opioids; (4) urine drug screening; (5) use of prescription drug monitoring program data; (6) availability of close followup?
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Primary Publication Information
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TitleData
Title Narcotic analgesics for acute migraine in the emergency room: are we meeting Headache Societies' guidelines?
Author Wasay M., Zaki KS., Khan SU., Rehmani R.
Country Department of Neurology, The Aga Khan University, and Department of Medicine, Abbasi Shaheed Hospital, Karachi, 74800, Pakistan. mohammad.wasay@aku.edu
Year 2006
Numbers Pubmed ID: 17149566

Secondary Publication Information
There are currently no secondary publications defined for this study.


Extraction Form: Key Question 1
Design Details
Question... Follow Up Answer Follow-up Answer




Results & Comparisons

No Results found.