REVIEW
The Impact of Migraine and the Effect of Migraine Treatment on Workplace Productivity in the United States and Suggestions for Future Research

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Evidence suggests that migraine is associated with decreased productivity. This article describes the results of a systematic literature review of peer-reviewed publications that measured the impact of migraine on workplace productivity in the United States and provides recommendations for future research. A MEDLINE search was conducted from January 1, 1990 to July 31, 2008. Articles were included if the results were from a prospective or retrospective study that reported work-specific productivity outcomes in adults with migraine in the United States. Twenty-six studies were included. Nine studies found that diagnosed and/or undiagnosed migraine had a negative impact on worker productivity. Although one migraine prophylactic study found a statistically significant improvement in worker productivity for topiramate-treated patients, another found an insignificant difference in lisinopril-treated patients. Fifteen studies compared the impact of triptan therapy with a control group. The control groups in these studies differed with regard to recall periods, time to follow-up, and types of questionnaires used. Almost all studies found that triptan therapy was associated with a statistically significant improvement in loss in worker productivity vs the control group. Health care professionals can reduce the impact of migraine on worker productivity with appropriate therapy. Researchers should collect presenteeism and absenteeism data, report results in units of time, use a validated instrument, carefully consider recall periods, and report worker productivity separately. In addition, patients with undiagnosed migraine should be included in disease burden studies. When evaluating effects of treatment on productivity, researchers should target well-controlled, double-blind studies and conduct productivity research for new treatments.

Section snippets

METHODS

A search of MEDLINE (January 1, 1990 to July 31, 2008) was conducted to identify articles that assessed the impact of migraine on work productivity in the United States. The following keywords were combined to identify appropriate citations: migraine disorders OR migrain$ AND absenteeism, productivity, presenteeism, task performance and analysis, sick leave, efficiency, workplace, occupational health, employment, efficiency, organizational, disability, work, economics, cost and cost analysis,

RESULTS

More than 1600 titles and abstracts were reviewed. Twenty-six studies published in 24 manuscripts met all inclusion criteria.5, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35 Studies were grouped by the type of results reported, including burden of migraine, effect of prophylaxis, placebo-controlled studies of the effect of episodic migraine treatment, and pretest and posttest studies of episodic migraine treatment. Pretest and posttest studies were

DISCUSSION

Studies have shown that migraineurs experience lower quality of life than the general population40, 41, 42 and that attack frequency is inversely related to quality-of-life scores.42 Studies have also shown that effective treatment of migraine has a positive impact on health-related quality of life.13, 14, 19, 23, 26 Other studies have described the cost-effectiveness of migraine treatment.43, 44 Several of the publications that met the inclusion criteria for this review of workplace

RECOMMENDATIONS FOR RESEARCHERS

The following are 9 recommendations for future research studies with the objective of measuring the burden of migraine and/or the impact of interventions on worker productivity.

First, estimates of the impact of migraine on worker productivity for a population should include a method for identifying individuals with undiagnosed migraine. Studies have estimated that approximately one-quarter of migraineurs have not had their condition diagnosed.1, 12 One method for identifying individuals with

CONCLUSION

Migraine has a substantial negative impact on worker productivity. Both health care professionals and employers are stakeholders in providing effective treatment that can reduce that impact in most migraineurs. Employers have an opportunity to reduce the economic impact of migraine on worker productivity by implementing effective disease management programs. Such programs should include patient education on lifestyle changes that may affect the frequency and duration of migraine and, when

Acknowledgments

We acknowledge Ron C. Kessler, PhD, for his contribution to the design of this study.

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  • GlaxoSmithKline provided funding to Relevant Health Outcomes, Inc, for conduct of the research and development of the submitted manuscript.

    This article is freely available on publication because the authors have chosen the immediate access option.

    1

    Dr Burton has served on an advisory board and received research support from Merck & Co and has received honoraria from GlaxoSmithKline, Merck & Co, Pfizer, and Johnson & Johnson. Dr Landy has served on speakers' bureaus for GlaxoSmithKline, Merck & Co, and Cephalon; has served on advisory boards for GlaxoSmithKline, Merck & Co, Pfizer, Cephalon, and Allergan; and has received research support from GlaxoSmithKline. Ms Downs has received support from GlaxoSmithKline. Dr Runken is an employee of GlaxoSmithKline.

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