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logoFocus on the person A guide to supporting people with migraine
A broad impact. Appreciating the wide-reaching effect of migraine on individuals, families, the healthcare system and society as a whole
IMPACT ON THE INDIVIDUAL: QUALITY OF LIFE

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The functional impact of migraine is worsened by more severe pain, more frequent attacks and higher burden in the interictal period (between attacks).1-4

Functional
disability

53.7%
 

of 18,968 people with migraine reported severe impairment or the need for bed rest during a migraine attack.5

Disruption of daily activities

53.5%
 

of 4,022 people with migraine reported significantly reduced involvement or enjoyment in family activities each month.2

Impact on career

32.7%

of 13,061 people with migraine reported that migraine had adversely affected their career.6

 

Financial worry

32.1%

of 13,061 people with migraine reported worry about long-term financial security. 22.8% reported worry about losing their job.6

 

Stigma

50.1%

of 441 people with headaches reported that their colleagues did not accept their headaches.7

 

IMPACT ON THE INDIVIDUAL: COMORBIDITIES

Migraine can be associated with many medical comorbidities, occurrence of which may be related to frequency of migraine attacks.8-11

Comorbidities may exacerbate migraine, complicate diagnosis and treatment and increase migraine-related disability.9

This list is not exhaustive
IMPACT ON SOCIOECONOMICS

The indirect costs of migraine due to work loss and reduced productivity at work are much larger than the direct costs.12,13

Indirect costs

Work productivity is reduced for people with migraine versus people without migraine.9,14

Direct costs

Equivalent workdays lost due to absenteeism and presenteeism:15

86 million per year in the UK = 11.4 days per person per year

 

Based on data from 2016.15

Estimated cost to the UK economy due to absenteeism and presenteeism:15

£5.6 billion - £8.8 billion per year
 

Based on data from 2016.15

The direct costs of migraine include cost of:12

  • pharmaceutical treatments
  • diagnostic tests
  • primary care appointments
  • referral to secondary care
  • A&E visits and hospitalisations

It is estimated that the NHS spends around £150 million per year on treating migraine16

HEALTHCARE ECONOMICS
Oxfordshire headache pathway17

In a pathway developed and trialled in Oxfordshire, a headache consultant triages referrals to allow patients with migraine to be diagnosed and treated in the community.

In the 3-month pilot:

  • 89% of all headache referrals were directed away from the outpatient department:
    • 73% attended community headache clinic
    • 11% received written advice
    • 5% received imaging without an appointment
  • 979 first outpatient neurology appointments were freed up
  • Estimated to result in a 65% reduction in outpatient department headache costs over a year (a reduction of £268,000 in Oxfordshire)

Most patients are now seen in the community clinic

94% of patients receive a diagnosis of migraine; 25% are diagnosed with medication overuse headache

81% of patients rated their care in the community clinic as 'excellent' in a satisfaction survey

References

Buse D C, Rupnow M F, Lipton R B. Assessing and managing all aspects of migraine: migraine attacks, migraine-related functional impairment, common comorbidities, and quality of life. Mayo Clin Proc 2009;84(5):422-435Buse D C, Scher A I 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(5):596-611Lipton R B, Baygani S K et al. A close association of freedom from pain, migraine-related functional disability, and other outcomes: results of a post hoc analysis of randomized lasmiditan studies SAMURAI and SPARTAN. J Headache Pain 2021;22(1):101Renjith V, Pai M S et al. Clinical profile and functional disability of patients with migraine. J Neurosci Rural Pract 2016;7(2):250-256Lipton R B, Bigal M E et al. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology 2007;68(5):343-349Buse D C, Fanning K M et al. Life with migraine: effects on relationships, career, and finances from the Chronic Migraine Epidemiology and Outcomes (CaMEO) study. Headache 2019;59(8):1286-1299Zebenholzer K, Andree C et al. Prevalence, management and burden of episodic and chronic headaches--a cross-sectional multicentre study in eight Austrian headache centres. J Headache Pain 2015;16:531Buse D C, Manack A et al. Sociodemographic and comorbidity profiles of chronic migraine and episodic migraine sufferers. 
J Neurol Neurosurg Psychiatry 2010;81(4):428-432
Buse D C, Yugrakh M S et al. Burden of illness among people with migraine and ≥ 4 monthly headache days while using acute and/or preventive prescription medications for migraine. J Manag Care Spec Pharm 2020;26(10):1334-1343Minen M T, Weissman J, Tietjen G E. The relationship between migraine or severe headache and chronic health conditions: a cross-sectional study from the National Health Interview Survey 2013-2015. Pain Med 2019;20(11):2263-2271Buse D C, Rains J C et al. Sleep disorders among people with migraine: results from the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study. Headache 2019;59(1):32-45Agosti R. Migraine burden of disease: from the patient's experience to a socio-economic view. Headache 2018;58 Suppl 1:17-32Linde M, Gustavsson A et al. The cost of headache disorders in Europe: the Eurolight project. Eur J Neurol 2012;19(5):703-711Ashina M, Katsarava Z et al. Migraine: epidemiology and systems of care. Lancet 2021;397(10283):1485-1495The Work Foundation. Society's headache: the socioeconomic impact of migraine, April 2018. Available at: lancaster.ac.uk. Accessed August 2022NHS news. Improved NHS migraine care to save thousands of hospital stays, 1 January 2020. Available at: england.nhs.uk. Accessed August 2022National Institute Health and Care Excellence (NICE). NICE shared learning database. Oxfordshire headache pathway for the efficient diagnostic and management support of headache disorders, October 2018. Available at: nice.org.uk. Accessed August 2022Biggin F, Howcroft T et al. Variation in waiting times by diagnostic category: an observational study of 1,951 referrals to a neurology outpatient clinic. BMJ Neurol Open 2021;3(1):e000133NHS RightCare. Headache and migraine toolkit optimising a headache and migraine system, December 2019. Available at: england.nhs.uk. Accessed August 2022
PP-NNT-GBR-0092. November 2022
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