Migraine's Impact on Productivity, Quality of Life

Merle Diamond, MD, AQH, director, Diamond Headache Clinic and inpatient headache unit at Saint Joseph Hospital, offers insight into the prevalence and burden of migraine, as well as risk factors that can cause migraine to progress from episodic to chronic.

For more on on this topic, see "Access to Acute Treatments for Migraine Can Reduce Costs for Employers, Health Care System"

Read the full transcript:

Welcome back to PopHealth Perspectives, a conversation with the Population Health Learning Network where we combine expert commentary and exclusive insight into key issues in population health management and more.

In this podcast, Dr Merle Diamond shares how migraine impacts quality of life and work productivity.

Hi, I'm Dr Merle Diamond. I am the director at the Diamond Headache Clinic in Chicago, Illinois, and also the director of the inpatient unit at AMITA Health Saint Joseph Hospital. I've been doing headache work for about 32 years.

How prevalent is migraine in the United States, and what is the symptom burden?

Migraine is incredibly common. It affects about 12% of the United States population. It preferentially impacts women—about 20% of women, 1 in 5, and about 7% or 8% of men.

It is disabling when you have an attack. Migraine accounts for more missed hours and disability than any other condition besides low back pain. So it's very impactful.

In terms of burden, what happens is many patients miss time at work. Kids miss time at school, and families are disrupted because the person with migraine disease may not be able to function. We find that it has a significant impact, not just on the patient, but on their whole family life.

We really want to try to change that. And I think part of it is disease recognition, getting a name for what you have and then getting the right therapy.

What risk factors influence the progression of migraine from acute to chronic?

In the United States, most patients have between 2 and 4 migraine attacks per month, but about 6% to 8% will have something we call chronification. Chronification means they go from having a few episodes of migraine per month, which are still disabling and difficult to manage, to having more than 15 days of headache per month, at least 8 of which are migraine.

As you can imagine, the more frequent migraine attacks you have, the less normal your life will be and the more disabling your disease is. There are some factors that seem to play a role in chronification, or going from just having episodes to having chronic migraine.

The most common is something we don't have a lot of control over, which is the genetic burden, the phenotypic burden. Migraine is generally inherited. If you have 1 parent with it, you have about a 50% chance. And if you have 2 parents, it's about 75% chance, so we see whole families with migraine.

If your headaches are frequent, more than 2 to 4 attacks per month, you are at greater risk to chronify. So we talk about intervening a little more quickly with therapies for patients who have this. Obesity, sleep disturbance, and access to health care play a role.

The duration of the headaches is important. Most migraines last around 8 hours. But if you're one of those unfortunate people that get 2- to 3-day migraines, you’re at greater risk of chronification. Trauma can cause migraine to chronify, and it doesn't have to be physical trauma. It could be emotional or sexual trauma. And overuse of any of the medications that we use acutely can cause more chronification.

It's a long laundry list, but they're all important things to think about when we see patients.

Thank you for that insight, Dr Diamond. How does migraine impact patient quality of life and work productivity?

Well, obviously, quality of life is super important for patients. I was just talking to a patient with chronic migraine, and all her energy goes into making sure she has the kids set for the day because she may not be available later. That’s a common theme we see in migraine.

When we look at migraine in the workplace, a lot of times, people with migraine don't take or even get promotions because they're viewed as unreliable. Many patients will go to work, but the migraine attacks limit their productivity. We call that presenteeism. They're there, they're present, but the quality and quantity of their work is obviously limited by that migraine attack.

So it has a pretty profound impact, not just at home and on the family, but also in the workplace.

Thank you. And what acute treatments do you most often recommend patients?

Here's the good news, in terms of acute treatments. Back in 1992, we got our first migraine-specific acute therapy with sumatriptan, and we now have 7 of those drugs out on the market.

The second piece of good news: some patients either don't tolerate those medicines because of a side effect profile, or they don't work well enough for them, and we have a whole new group of medicines that have come out for the acute treatment of migraine, including CGRP.

CGRP is calcitonin gene-related peptide. There are drugs called gepants. And these drugs are much more tolerable for most patients than triptans, so they've been a big boon to our patients. We've also had a ditan, which works on serotonin, approved for migraines.

Some patients use nonsteroidals, and we have some creative ways of getting nonsteroidals to work more quickly. So there are a lot more options in that toolbox when a patient gets a migraine.

Is there anything you feel we've missed that you wanted to add today?

I think the important thing is patient advocacy.

Sometimes, it's hard to find a clinician that's interested in headache and also willing to try things, and if they don't work, try other things. Having good communication with your provider and finding someone who’s willing to be a team with you to get your headaches controlled are really, really important.

Last but not least, learning to do some self-care: good sleep, regular exercise if you can, not skipping meals, no excessive caffeine, healthy things that you can do to help improve or reduce the number of migraines. They're not curative, but they are helpful.

Thanks for tuning in to another episode of PopHealth Perspectives. For similar content or to join our mailing list, visit populationhealthnet.com.