Burden of Migraine

Migraine is often invisible, yet it affects every aspect of an individual’s life. It poses a significant burden to that individual, their family and the wider society.

In fact, according to the Global Burden of Disease Study, 2018, over the past 28 years, migraine (and other headache disorders [1]) has remained the 2nd top cause of Years Lived with a Disability (YLDs). This is a trend which seems to be rising in tandem with socioeconomic development, according to a 2021 paper by Goadsby et al. What is worrying is that our lifestyle may be contributing to a greater incidence of migraine and headache, and that headache disorders, including migraine, are being increasingly reported among school aged youth and children.

Migraine has an enormous negative impact on our society, economy, families and individuals. The effects of Covid-19, while not comprehensively studied to date, are likely to compound the problem. Education of individuals and the wider medical community is necessary to empower those living with migraine and to alleviate the burden for both individuals and society in general.

To concentrate on the Australian situation, in 2018, Deloitte Access Economics produced a whitepaper on migraine in Australia. The findings of this report are overwhelming.

Who lives with migraine?

4.9 million people in Australia (20.55% of the population) live with migraine;
71% of these people are women;
86% are of working age.
Of the 4.9 million, 7.6% or around 400,000 experience chronic migraine (≥15 migraine days per month).

Number of persons with episodic and chronic migraine by age and gender

Source: Deloitte Access Economics, 2018

What does migraine cost the economy?

According to Deloitte Access Economics the total economic cost of migraine in Australia is $35.7 billion per year. This is made-up of:

$14.3 billion of health system costs; including hospital, testing, treatment and pharmaceuticals, GP, specialist consultations and allied health professional services;
$16.3 billion of productivity costs made up of absenteeism and presenteeism (reduced productivity while at work) and reduced workforce participation;
$5.1 billion of other costs such as carer costs (when family members take time off work to care for someone with migraine) and wider costs to society arising from loss of taxation revenue due to reduced workforce participation.

For chronic migraine, the economic costs per person is $21,706, while for episodic migraine, it is $6,137. Most of these costs are incurred by people between the ages of 20 and 64 – their most productive years.

How does migraine affect wellbeing?

Disability-adjusted life years (DALYs), developed by the World Health Organisation, are a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death. Each disease is assigned a weight where zero (0) is a year lived in health, while one (1) represents death. So, for example, a disability weight of 0.3 represents a 30% loss in the quality of life.

On the whole, people with migraine in Australia experienced 201,000 DALYs overall, or around 0.18 DALYs per person with chronic migraine and 0.03 DALYs per person with episodic migraine – a loss of almost 20% in the quality of life for chronic migraine and 3% for episodic migraine

Using this measure the total burden of disease from migraine in 2018 was estimated to be $40.0 billion.

Moreover:

Migraine is associated with an increased risk of cardiovascular disease and cerebrovascular events.
Migraine is often comorbid with a number of other conditions, e.g.: hypothyroidism, asthma, endometriosis, irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, Meniere’s disease, epilepsy, interstitial cystitis, and with psychological conditions including depression and anxiety (Note: this does not mean that everyone who lives with migraine also experiences these other conditions, but they frequently occur together.)
Migraine causes varying levels of physical, cognitive and emotional impairment and disability which affects the individual and can also affect their family and friends. Severe migraine limits a person’s ability to engage in day-to-day, family and self-care activities, requiring others to do these things for them.
In an attempt to reduce migraine attacks, people may alter their lifestyles, which can impact their families, professional working lives and social circles; e.g. dietary changes, reducing social interactions, avoiding certain triggering environments, etc.
Migraine is subject to significant stigma among the wider population, often leading to a sense of isolation and a reluctance to seek treatment. In some cases, people living with migraine will self-treat with “over-the-counter” (OTC) medications, at times causing a worsening of the condition.
People with migraine tend to worry about disappointing others or feel embarrassed about having migraine and the impact it has on them; which in turn, may affect their ability to maintain relationships and friendships.

What are the effects of migraine on working lives?

People who live with migraine can experience reduced employment. This may happen because they are disadvantaged in job-seeking (e.g. they have difficulty in searching for work, working part-time only, or not keeping a job due to frequent absences). They may also consciously NOT apply for jobs which they fear may be impacted by migraine or their migraine condition may be worsened by a given job (e.g. shift-work; jobs in a bright, noisy or noxious environment; promotions within their existing work place).

This in turn may lead to lost wages and other personal costs such as reduced social engagement or career advancement.

References

Deloitte Access Economics, (2018). Migraine in Australia Whitepaper Prepared for Novartis Australia 2018. https://www2.deloitte.com/content/dam/Deloitte/au/Documents/Economics/deloitte-au-economics-migraine-australia-whitepaper-101018.pdf

Goadsby, P. J., Lantéri-Minet, M., Michel, M. C., Peres, M., Shibata, M., Straube, A., . . . Hitier, S. (2021). 21st century headache: mapping new territory. The Journal of Headache and Pain, 22(1). doi:10.1186/s10194-021-01233-7

James, S. L., Abate, D., Abate, K. H., Abay, S. M., Abbafati, C., Abbasi, N., . . . Murray, C. J. L. (2018). Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet, 392(10159), 1789-1858. doi:10.1016/s0140-6736(18)32279-7

[1] In the 2018 study, migraine and other headache disorders (e.g. tension type headache, MOH) were combined. In previous years they were separately considered.