Burden of illness among people with migraine and ≤4 monthly headache days while using acute and/or preventive prescription medications for migraine

BACKGROUND: Migraine is a chronic disease that reduces health-related quality of life. Little is known about the burden of migraine in individuals who are potential candidates for preventive treatment with ≥4 monthly headache days currently using migraine medications. OBJECTIVE: To characterize the burden of migraine among patients reporting ≥4 monthly headache days while taking acute and/or preventive migraine medications. METHODS: In this retrospective, cross-sectional study, data from the 2016 U.S. National Health and Wellness Survey (N=97,503) compared the burden of migraine among individuals self-reporting a diagnosis of migraine by a health care professional and ≥4 monthly headache days while using acute and/or preventive prescription migraine medications to matched nonmigraine controls. Propensity score matching across different variables (e.g., age, gender, and body mass index) was used to identify matched controls from respondents who did not self-report a diagnosis of migraine. Migraine-associated burden was measured by impairment in work productivity and daily activities (Work Productivity and Activity Impairment questionnaire), all-cause health care resource utilization (HRU), and all-cause direct and indirect costs. RESULTS: This analysis included 197 treated migraine patients with ≥4 monthly headache days and 197 matched nonmigraine controls. Greater proportions of treated migraine patients reported comorbid depression (58.4% vs. 27.9%, P<0.001) or generalized anxiety disorder (15.2% vs. 8.6%, P=0.043) and were on long-term disability (13.7% vs. 5.6%, P=0.003). Absenteeism (11.8% vs. 6.3%, P=0.030); presenteeism (36.0% vs. 17.5%, P<0.001); overall work impairment (41.0% vs. 20.9%, P<0.001); and activity impairment (45.4% vs. 25.4%, P<0.001) were greater in treated migraine patients versus nonmigraine controls. Treated migraine patients had higher all-cause HRU and higher all-cause direct ($24,499.90 vs. $15,318.91, P=0.013) and indirect ($14,770.57 vs. $5,764.93, P<0.001) costs than nonmigraine controls. CONCLUSIONS: Treated migraine patients with ≥4 monthly headache days reported significantly reduced work productivity and increased all-cause HRU and cost despite migraine treatment compared with nonmigraine controls. These findings highlight unmet needs in the treatment and management of migraine.