Substance-related disorders in patients with chronic migraine: an exploratory, observational study

Dear Editor, Patients with chronic migraine (CM) frequently experience comorbid psychiatric conditions, including substance-related disorders, which can complicate the clinical picture and influence treatment outcomes.1,2 To date, few studies have analyzed the specific patterns of substance abuse among patients with CM.3 This gap in the literature limits our ability to fully understand how particular substances might be associated with CM. This exploratory, observational study investigates the odds of substance-related disorders among patients with CM compared with control patients with low back pain (LBP) and control patients without migraine or LBP to elucidate the complex relationship between specific substance-related disorders and CM. All data were obtained through the Epic Cosmos research platform (Epic System Corporation, Verona, WI), an aggregated de-identified database of health systems’ electronic health records throughout the United States.4 We included all patients over the age of 18 years who had at least one health system encounter between January 1, 2023, and December 31, 2024. Patients who did not meet these criteria were excluded. We then built 3 groups of patients: (1) those with an International Classification of Diseases, Tenth Edition (ICD-10) code for G43.7 “Chronic Migraine” or higher resolution but no diagnosis of M54.5 “Low Back Pain,” (2) those with an ICD-10 diagnosis of M54.5 “Low Back Pain” or higher resolution but no diagnosis of G43 “Migraine,” and (3) those who had never received a diagnosis for G43 “Migraine” or M54.5 “Low Back Pain” or higher resolution. LBP was chosen as the non–headache pain control, consistent with previous work from our group that assessed alcohol-related disorders in patients with CM.5 Depression or anxiety (F32–33, F41) and substance-related disorders (F10–F19) were also noted. Demographics for each group were recorded, including age, legal sex, and race.