CHICAGO – Patients who frequently call their headache specialty clinic are more likely to be taking multiple opioids in higher doses, potency, and quantity than those who do not call frequently, Karen Fisher, R.N., said at the annual meeting of the American Headache Society.
Ms. Fisher and her colleagues of the headache clinic at the University of North Carolina at Chapel Hill researched their database to identify common characteristics of patients who called frequently (at least 20 times in a calendar year) and those who did not (no calls within a calendar year). High-frequency (26) and low-frequency callers (18) were similar in age (about 42 years), marital status, ethnicity, and diagnosis. There was a nonsignificant trend for more females in the frequent-caller group. Migraine was the most frequent diagnosis in each group. All patients had been followed for at least 5 years.
Calls included requests for refills, complaints that medication was not working, and requests for different medications, among other topics.
The patients were similar in their use of triptans and botulinum toxin. But significantly more of the frequent callers were taking opioids (96% vs. 11%).
Frequent callers also were more likely to be taking multiple opioids of higher potency and dose. To further investigate the relationship of opioid strength to calling frequency, the researchers assigned morphine equivalency strength to each milligram of opioid prescribed. (See box.)
Frequent callers were taking significantly more daily morphine equivalents than nonfrequent callers were (154.4 mg vs. 1.4 mg).
“Further research is needed to explore the relative contributions of psychological characteristics, burden of illness, or other factors [that] might contribute to the excessive calling, which is associated with negative perceptions on the part of headache clinic staff and caregivers,” Ms. Fisher said.
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