title: Trends in opioid analgesic use for headaches in US emergency departments.
abstract: OBJECTIVE
  Although not recommended as first line therapy by consensus guidelines, opioid analgesics are commonly used to treat headaches. This study evaluates trends in opioid use for headaches in US emergency departments (EDs).
  
  
  METHODS
  We performed a retrospective review of the National Hospital Ambulatory Medical Care Survey, 2001 through 2010. Adult headache-related visits were identified. Medications (opioid and nonopioid) used for the treatment of headache were categorized based on medication class. Trends in ED use of the most common opioids (codeine, hydrocodone, hydromorphone, morphine, and oxycodone) were explored. The proportion of visits for which each medication was used was tabulated, and trends were analyzed using survey-weighted logistic regression.
  
  
  RESULTS
  Headache visits during which any opioid was used increased between 2001 (20.6%; 95% confidence interval [CI], 18.1-23.4) and 2010 (35.0%; 95% CI, 31.8-38.4; P < .001). Prescribing of hydromorphone, morphine, and oxycodone increased, with the largest relative increase (461.1%) in hydromorphone (2001, 1.8% [95% CI, 1.2-2.6]; 2010, 10.1% [95% CI, 8.2-12.4]). Codeine use declined, and hydrocodone use remained stable. Use of opioid alternatives, including acetaminophen, butalbital, and triptans did not change over the study period, whereas use of nonsteroidal anti-inflammatory drugs increased from 26.2% (95% CI, 23.0-29.7) to 31.4% (95% CI, 28.6-34.3). Prescribing of antiemetic agents decreased from 24.1% (95% CI, 19.6-29.2) to 23.5% (95% CI, 21.1-26.0). Intravenous fluid use increased from 20.0% (95% CI, 17.0-23.4) to 34.5% (95% CI, 31.0-38.2) of visits.
  
  
  CONCLUSIONS
  Despite limited endorsement by consensus guidelines, there was increased use of opioid analgesics to treat headaches in US EDs over the past decade.
authors.affiliation: Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC; Department of Clinical Pharmacology, Children's National Medical Center, Washington, DC. Electronic address: maryannmazer@gmail.com.
authors.forename: Maryann
authors.initials: M
authors.lastname: Mazer-Amirshahi
authors.affiliation: Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Kayla
authors.initials: K
authors.lastname: Dewey
authors.affiliation: The George Washington University, School of Medicine and Health Sciences, Washington, DC.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Mullins
authors.affiliation: Department of Clinical Pharmacology, Children's National Medical Center, Washington, DC; Department of Pediatrics, The George Washington University, Washington, DC; Intensive Care, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Pediatric Pharmacology, University Children's Hospital Basel, Switzerland.
authors.forename: John
authors.initials: J
authors.lastname: van den Anker
authors.affiliation: The George Washington University, School of Medicine and Health Sciences, Washington, DC; Department of Emergency Medicine, the George Washington University, Washington, DC.
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Pines
authors.affiliation: Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Jeanmarie
authors.initials: J
authors.lastname: Perrone
authors.affiliation: Department of Emergency Medicine, New York University, New York, NY.
authors.forename: Lewis
authors.initials: L
authors.lastname: Nelson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D004636:Emergency Service, Hospital / Q000639:trends*; D005260:Female; D006261:Headache / Q000188:drug therapy*; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid