Migraine’s Burden in the Workplace Is Significant

BOSTON—The impact of migraine in the workplace is significant, as more than half of patients with migraine identified through workplace screening reported moderate or severe disability and almost two-thirds of migraineurs reported having headaches on six or more days in a three-month period.

These are the findings from two analyses conducted in employer settings, the data from which were delivered at the 59th Annual Meeting of the American Academy of Neurology (AAN). The same researchers also presented data from an online employer-based migraine screener survey showing that screening can help detect undiagnosed migraineurs.

“We know from epidemiology that [migraine] is a prevalent condition, usually underdiagnosed, and usually undertreated or mistreated,” said Jennifer Hofelt Lofland, PharmD, MPH, PhD, who reported the results of a treatment trial in the workplace setting. Dr. Lofland is a Senior Health Service Analyst at the Institute to Transform and Advance Children’s Healthcare at the Children’s Hospital of Pennsylvania. “It really could be of benefit to try to identify these individuals early on and to get them the care they potentially need.”

The potential to reduce time lost from work (absenteeism) or time being unproductive while at work (presenteeism) is one argument for screening in the workplace, she said. According to the National Headache Foundation, presenteeism accounts for an estimated 89% of the total cost burden among employees with migraine/headache.

SCREENING FOR MIGRAINE

Three employers in the United States were recruited for the two studies. Employees were asked to visit a Web site (specific to their company) that described the study. After providing consent to participate, they were screened for migraine using a six-question screener based on a questionnaire that had been validated previously by Láinez et al. The migraine screener was completed by 1,463 employees, of whom 1,152 qualified for inclusion in the study based on either a diagnosis of migraine (n = 70), positive responses to at least four of the screening questions (n = 337), or both criteria (n = 745).

Among those employees who reported a previous diagnosis of migraine, 91% screened positive per the Láinez criteria. In addition, 29.2% of participants who met the Láinez screener criteria reported never having been diagnosed with migraine, found L. Clark Paramore, MSPH, and colleagues. Furthermore, many of the participants who did not qualify for the study based on the screener criteria reported specific migraine symptoms, according to Mr. Paramore, who is the Executive Director of the Center for Health Economics, Epidemiology and Science Policy, at United BioSource Corporation in Bethesda, Maryland.

For example, 53% reported frequent and intense headaches, 47% said that they had headaches that lasted longer than four hours, and approximately half of the participants reported sensitivity to light or noise and limitations to their daily living. Approximately 30% of those who screened positive reported never having been diagnosed with migraine.

ASSESSING BURDEN, IMPACT OF MIGRAINE

Using the same study population, the researchers sought to quantify the economic burden of migraine and its impact on work. Survey respondents were asked about migraine frequency and its severity (on a scale from 0 [no pain] to 10 [worst pain]) over a three-month period. They also completed the Migraine Disability Assessment (MIDAS), a survey of five questions that considered migraine-related time lost from work or school,  household duties, family, and social/leisure activities.

Included in the analysis were the estimated costs of emergency department visits, medical office visits, hospitalizations, tests, and procedures. In addition, the cost of lost productivity at work was calculated, including the cost of presenteeism based on the average number of work hours that were affected each day by headache and a percentage of effectiveness at work with headache. The burden estimates did not account for the cost of any medications taken, because detailed medication use pattern was not collected.

Among the 917 employees who completed the baseline survey, 62% reported having migraines on six or more days in the three-month period, with an average pain intensity of 7. Fifty-five percent reported moderate/severe disability based on the MIDAS criteria: 26% had moderate disability (defined as a MIDAS score of 11 to 20) and 28.6% had severe disability (defined as a MIDAS score of 21 or greater).

Per 1,000 migraineurs, there were 793 migraine-related physician visits—429 to primary care physicians, 107 to neurologists, and 72 to a headache center or pain specialist. For migraine relief, 48% reported using a prescription medication and 79% reported taking a nonprescription medication. Over the three-month period, employees missed an average of one workday because of migraine; the mean number of days worked with migraine was 8.9. Direct medical costs were $200,410 per 1,000 migraineurs. Indirect costs, including absenteeism and presenteeism, were $404,660 per 1,000 migraineurs.

Approximately 40% of employed migraineurs avoided household work for more than five days, with almost 10% missing 15 or more days of household work due to migraine. About 70% reported missing family events and social or leisure activities.

ADDRESSING THE PROBLEM

Dr. Lofland, whose study data showed the benefit of migraine prophylaxis in an employed migraineur cohort, noted that in order for employees to realize a benefit from being screened for migraine in the workplace, they must have faith that the screening is not being performed for putative reasons but to “try to get them back to what they need to do, which is working and being with their families.” The aim of screening, she said, is proper diagnosis and treatment. “If you give employees time back with their families and family activities, it could be a real benefit for them.”

Despite the high burden of headache among employed migraineurs, Mr. Paramore’s research group found that only 15% of survey responders were taking daily preventive medication.          

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