DOI: 10.11648/j.cnn.20250901.12 ISSN: 2578-8930

Clinical Factors Associated with Opioid Use in Abortive Headache Treatment Among Adolescents in the Emergency Department: Who Gets Them and Why

Rhea Zahir, Olivia Gould, David Kepplinger, Rhiya Dave, Tarannum Lateef
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Background: Routine use of opioids for headache can lead to worsening symptoms and may contribute to dependence. This study’s main objective was to determine the prevalence and clinical factors associated with opioids used as abortive therapy, for adolescents presenting with headache, in a pediatric emergency room. Methods: We reviewed electronic medical records of youth aged 11 through 21 years presenting to a large suburban pediatric emergency department between January 2014 and December 2020, who were prescribed opioids for headache. Charts were analyzed for demographics, medications prescribed, clinical characteristics, and final diagnoses. Results: 204 youths were seen for headache and received an opioid abortive medication for it. Among those 70 received it for a procedure such as lumbar puncture. Of the remaining 134 patients – 126 received morphine, 28 – hydromorphone/hydrocodone, 26 – oxycodone, tramadol – 9, meperidine – 6, codeine/fiorcet/fentanyl – 8, and methadone – 1. Over half the patients (n=118, 58%) were female, 24% (n=49) had a prior headache history, 20% (n=41) seen a neurologist, and 30% (n=62) had a past psychiatric history. In terms of headache specific factors, only 15% (n=31) were on daily headache prophylaxis. Notably 46% (n=93) had a history of prior opioid use and only 9% (n=18) had used an ergot medication. Conclusion: Youth receiving opioids for headache treatment were more likely to be female, had significant mental health comorbidity, and without access to specialty neurology care. Our findings may help identify youth headache sufferers at risk for opioid use and highlight the need for early identification and referral to a neurologist.

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