The impact of migraine on society is often underestimated, with the European Headache Federation and World Headache Alliance describing the condition as “a forgotten epidemic”.¹ The impact of migraine is, indeed, profound. Migraine is the leading cause of years lived with disability (YLDs) among individuals aged 15–49 years.¹ Migraine causes a high cumulative burden on the partners and children of those affected.² In pre-adolescent children aged 5–12 years, episodic and chronic migraine are both associated with poor school performance.³ Migraine also carries an extremely high economic burden, with one national survey in Canada identifying migraine as the third leading cause of workplace absenteeism among individuals aged 15–75 years who reported being in part-time or full-time employment in the three months prior to responding to the survey.⁴ In the United States, the combined annual direct and indirect cost associated with migraine treatment in 2018 was estimated at $8,924 per affected individual.⁵

What is the impact of migraine on individuals?

The 2016 Global Burden of Disease study estimated that migraine accounts for 5.6% of years lived with disability (YLDs) across all age groups.¹ For individuals aged 15–49 years, migraine accounts for 8.2% of YLDs, making it the leading cause of disability worldwide.¹ Among neurological disorders including epilepsy, Alzheimer’s disease, Parkinson’s disease, and motor neuron disease, migraine accounts for more than three-quarters of all neurological YLDs.¹

A decreased health-related quality of life (HRQoL) is found among individuals with migraine compared with individuals without migraine.⁶ This evidence comes from a retrospective, cross-sectional analysis of survey data from 80,600 individuals in France, Germany, Italy, Spain, and the UK.⁶ HRQoL was shown to be lower in individuals with migraine who experience 4 or more monthly headache days compared with individuals without migraine.⁶ This deficit in HRQoL included lower scores on measures of physical, mental, and overall health status.⁶

Individuals affected by migraine are also at an increased risk of mental health issues.⁷ This evidence comes from a recent literature review which highlighted the extensive body of literature associating migraine with psychiatric comorbidities.⁷ Depression was found to be almost twice as frequent in individuals with migraine compared with individuals unaffected by headache.⁷ Similarly, individuals with migraine were found to be at an increased risk of anxiety disorders compared with individuals without migraine. ⁷ Finally, migraine with aura was found to be associated with an increased risk of suicide attempts.⁷

In summary, migraine is not solely a leading cause of disability,¹ but is associated with decreased HRQoL⁶ and increased risk of psychiatric comorbidities compared with individuals without migraine.⁷

What is the impact of migraine on families?

There is increasing recognition that migraine has a substantial, widespread impact not only on affected individuals, but also on their families, including spouses and domestic partners.⁸

The Chronic Migraine Epidemiology and Outcomes (CaMEO) study was a longitudinal, web-based study of 13,064 individuals with migraine.⁸ Of the respondents, 48.2%–57.4% reported reduced participation in family activities one or more times per month, depending on headache frequency.⁸ One-third worried that their migraine may result in long-term financial insecurity.⁸ Of individuals with chronic migraine, 71% believed they would be better parents without headaches.⁸ Individuals with migraine and their spouses reported, at roughly similar rates, that migraine caused strain on their relationships, even at times when no migraine symptoms were present.⁸ And finally, 12.7% of individuals with migraine and 10.5% of spouses reported that migraine caused stress when interacting with children, even on days without active migraine symptoms.⁸ The authors concluded that there is a “substantial and pervasive impact of migraine on the family”.⁸

What is the impact of migraine on children and adolescents?

Migraine in children and adolescents is poorly understood, mainly because of the difference in clinical presentation in these populations compared with adults.⁹

In one study in the US, adolescents aged 12–17 years completed a Headache Impact Test (HIT) to measure the impact of chronic and episodic migraine on individuals.⁹ For the majority of adolescents with chronic migraine, a HIT score of above 60 was recorded, indicative of a severe impact. A mean Pediatric Migraine Disability Assessment score greater than 17 was recorded for the majority of adolescents with chronic migraine, indicative of severe headache and disability.⁹

In a population-based study involving a younger patient group of 5,671 children aged 5–12 years in Brazil, episodic migraine was reported in 9% of children, and chronic migraine in 0.6%.³ Compared with children without headache, poor performance at school was significantly more likely to be seen in children with episodic migraine and chronic migraine.³ The association was significantly influenced by the severity, duration, and frequency of the attacks.³

While the majority of the research on the impact of migraine is focused on adults, it is important to also study the impact of migraine on children and adolescents. While migraine may present differently in these populations compared with adults, we have seen that it can still have a large impact on school performance and measures of disability.^3,9

What is the impact of migraine on the workplace?

This article has so far examined the impact of migraine on individuals and families. To understand the true impact of migraine, we must also consider its effect on workplace behavior.

In a community health survey of 28,678 Canadians aged 15–75 years who reported employment in the three months prior to responding, migraine was associated with a statistically significant increase in absent workdays due to health problems compared with individuals without migraine.⁴ In those three months, the high level of absenteeism among individuals with migraine resulted in migraine accounting for a productivity loss of CAD $245 million, making it the third leading chronic disease contributing to workplace productivity loss.⁴

These results from Canada have been replicated in a sample of individuals of working age in Spain, with 10.3% of individuals with migraine reporting workplace absenteeism of 1 or more days per month.¹⁰ These associations were strongest in younger workers (aged 18–34 years) compared with older workers (aged 35 or older).¹⁰

As previously discussed, migraine contributes to a large number of YLDs for affected individuals,¹ and also has a substantial impact on their families and children.⁸ By examining the impact of migraine on workplace absenteeism, we learn that it also has a substantial economic burden on workplaces.^4,10

What is the impact of migraine on the economy?

It is difficult to estimate the economic burden of migraine. Indeed, this depends on each country's healthcare system structure, and includes both direct and indirect healthcare costs. There have, however, been studies conducted in several countries that have demonstrated the substantial economic burden of migraine.^5,11

In the US, a retrospective, observational cohort study conducted between January 2008 and June 2013 on patients with migraine has estimated annual direct all-cause healthcare costs to be $6,575 higher than those of matched individuals without migraine ($11,010 vs $4,436).⁵ Similarly, estimated indirect costs were $2,350 higher in patients with migraine compared with matched individuals without migraine ($11,294 vs $8,945).⁵

In Europe, a cross-sectional survey of individuals in 8 European countries was used to estimate per-person annual healthcare costs.¹¹ This study approximated a per-person cost of migraine of €1,222, which contributed to an estimated total annual cost of migraine of €111 billion in the European Union.¹¹ The authors concluded that headache disorders, including migraine, are “prominent health-related drivers of immense economic losses for the EU,” with immediate implications for healthcare policy.¹¹ 

These findings gathered across two continents demonstrate the immense economic burden of migraine.

Migraine has an extensive impact on individuals and society

Migraine has a significant impact on individuals, including years lived with disability,¹ health-related quality of life,⁶ and psychiatric comorbidities.⁷ The impact of migraine extends to the family, with spouses and children being affected by migraine, even on days when the patient is not experiencing symptoms.⁸ Migraine has a significant impact on the economy, with workplace absenteeism being one of the many contributors to the high direct and indirect costs of migraine observed across the world.^4,10 The impact of migraine is far-reaching and needs to be considered by all stakeholders, including healthcare practitioners, friends and family of patients with migraine, and healthcare decision-makers.

References

1. Steiner TJ, et al. Migraine is the first cause of disability in under 50s: will health politicians now take notice? J Headache Pain 2018;19:17.
2. Steiner TJ, et al. The impact of headache in Europe: principal results of the Eurolight project. J Headache Pain 2014;15:31.
3. Arruda MA, et al. Migraine and migraine subtypes in preadolescent children. Neurology 2012;79:1881–1888.
4. Zhang W, et al. The relationship between chronic conditions and absenteeism and associated costs in Canada. Scand J Work Environ Health 2016;42:413–422.
5. Bonafede M, et al. Direct and indirect healthcare resource utilization and costs among migraine patients in the United States. Headache 2018;58:700–714.
6. Vo P, et al. Patients’ perspectives on the burden of migraine in Europe: a cross-sectional analysis of survey data in France, Germany, Italy, Spain and the United Kingdom. J Headache Pain 2018;19:82.
7. Antonaci F, et al. Migraine and psychiatric comorbidity: a review of clinical findings. J Headache Pain 2011;12:115–125.
8. Buse DC, et al. Impact of migraine on the family: perspectives of people with migraine and their spouse/domestic partner in the CaMEO study. Mayo Clin Proc 2016;91:596–611.
9. Lipton RB, et al. Prevalence and burden of chronic migraine in adolescents: results of the chronic daily headache in adolescents study (C-dAS). Headache 2011;51:693–706.
10. Mesas AE, et al. The association of chronic neck pain, low back pain, and migraine with absenteeism due to health problem in Spanish workers. Spine 2014;39:1243–1253.
11. Linde M, et al. The cost of headache disorders in Europe: the Eurolight project. Eur J Neurol 2012;19:703.

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