title: Opioid use among adolescent patients treated for headache.
abstract: OBJECTIVE
  To determine the pervasiveness of opioid prescribing for adolescents with headache and patient and provider characteristics associated with likelihood of opioid prescribing.
  
  
  METHODS
  This observational cohort analysis used commercial medical and pharmacy claims between January 1, 2007 and December 31, 2008. Included were adolescents (13-17 years of age) with newly diagnosed headache, ≥2 distinct claims for headache, and ≥12 months health plan eligibility preindex and postindex. Adolescents with a trauma diagnosis at any point were excluded. The primary outcome was current practice patterns, measured by a number of opioid claims, a percentage of patients prescribed opioids, a number of opioid prescriptions per year, a length of opioid therapy, and a frequency of specific comorbidities. A secondary outcome characterized providers and practice settings, comparing patients who received opioids with those who did not.
  
  
  CONCLUSIONS
  Of 8,373 adolescents with headache, 46% (3,859 patients) received an opioid prescription. Nearly half (48%) received one opioid prescription during follow-up; 29% received ≥3 opioid prescriptions. Of those with opioid prescriptions, 25% (977 patients) had a migraine diagnosis at index date. Among adolescents who received opioids, 28% (1,076 adolescents) had an emergency department (ED) visit for headache during follow-up versus 14% (608 adolescents) who did not receive opioids (p < .01). ED visits with a headache diagnosis during follow-up were strongly correlated with opioid use after adjusting for other covariates (odds ratio, 2.02; 95% confidence interval, 1.79-2.29). Despite the treatment guidelines recommending against their use, a large proportion of adolescents with headache were prescribed opioids. ED visits were strongly correlated with opioid prescriptions.
authors.affiliation: HealthCore, Inc., Wilmington, Delaware. Electronic address: adevries@healthcore.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: DeVries
authors.affiliation: American Academy of Pediatrics, Elk Grove Village, Illinois.
authors.forename: Thomas
authors.initials: T
authors.lastname: Koch
authors.affiliation: American Academy of Family Physicians, Leawood, Kansas.
authors.forename: Eric
authors.initials: E
authors.lastname: Wall
authors.affiliation: American Academy of Neurology, Minneapolis, Minnesota.
authors.forename: Thomas
authors.initials: T
authors.lastname: Getchius
authors.affiliation: HealthCore, Inc., Wilmington, Delaware.
authors.forename: Winnie
authors.initials: W
authors.lastname: Chi
authors.affiliation: WellPoint, Inc., Indianapolis, Indiana.
authors.forename: Alan
authors.initials: A
authors.lastname: Rosenberg
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D016497:Adolescent Health Services / Q000706:statistics & numerical data*; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D002908:Chronic Disease; D015897:Comorbidity; D017723:Drug Utilization Review / Q000706:statistics & numerical data; D020773:Headache Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007345:Insurance Claim Review; D016015:Logistic Models; D008297:Male; D008881:Migraine Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D009293:Opioid-Related Disorders / Q000453:epidemiology* / Q000209:etiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid
keywords: Administrative claims; Adolescent headache; Computed tomography scan; Headache diagnosis; Pediatric headache; Recurrent headache