Burden of migraine in Finland: health care resource use, sick-leaves and comorbidities in occupational health care

DOI: https://doi.org/10.1186/s10194- 019- 0964- 5

Abstract-Summary Electronic medical records were assessed for overall and migraine related health care visits, sick-leaves and comorbidities.

Prophylactic medication was prescribed to 13% of migraine patients and exclu-

sively acute medication to 37%.

Although migraine related visits and sick-leave days were significantly lower than overall visits or sick-leave days, both increased by prophylactic treatment line. The number of visits rose from 13.8 to 26.2 and sick-leave days from 16.8 to 30.4

per patient-year, in those without prophylaxis vs. ≥3 prophylactic treatments.

Migraine patients had 1.7-fold increase in visits and 1.8-fold increase in sick

leave days on average per patient-year, when compared to the control population.

Depression and anxiety were 1.8-fold more common among patients with

migraine, and the frequency also increase by treatment line.

Migraine burden increased by each failed treatment line and was associated with

increased comorbidity.

Migraine patients had significantly higher extent of visits and sick-leave days as well as extent of comorbidities when compared to their age- and gender-matched counterparts.

Extended: Electronic medical records (EMR) of a private health care provider

Terveystalo were utilized in this retrospective register-based study.

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Personal and Societal Burden

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Introduction Regardless of monthly migraine days, chronification of migraine is associated with substantially increasing individual and social burden.

The burden of migraine has been elucidated in multiple surveys and studies [10, 138, 172, 193–198] and recently Silberstein and others showed that disease disabil- ity, health care resource use (HCRU), and direct costs increase concomitantly with increasing number of headache days [199].

None of the current prophylactic treatments have originally been developed for

migraine, and their specific mechanisms of action in migraine are not known.

The attention has recently thus turned into revealing the true impact of migraine disease burden also for patients in the need or failing prophylactic treatments [195, 200].

Several surveys and studies have been conducted on the burden of migraine, and

some of them also using data from Finland [194, 201, 202].

The main aim of the present study was to examine the burden of migraine and evaluate HCRU, sick-leaves and comorbidities among migraine patients compared to a control population in occupational health care setting.

Methods 17,623 of the patients had migraine according to ICD-10 code (G43*, on a three- character level) and were included in the primary cohort.

Each patient was followed from the first G43* diagnosis in the EMR, or from the first fulfilment for any of the criteria for the extended cohort, until 31st December 2017.

Patients in the primary cohort were divided into groups based on medication

prescribed at the health care provider.

In the health care provider’s register on 31st December 2017, the point preva- lence for migraine was calculated by gender in 5-year age groups in the primary and extended cohorts.

To assess the impact of migraine in subjects with high HCRU, migraine patients were divided into quartiles based on either overall visits or sick-leaves in patient-years.

For each patient, the total number of visits and sick-leave days were defined and divided by the total patient-wise follow-up time, where after the cohort was divided into quartiles.

Results This was reflected both in total visits (prophylactic vs. acute vs. no prescription: 18.4 vs. 15.0 vs. 12.9 visits per patient-year, p < 0.001) and migraine specific visits (2.4 vs. 1.3 vs. 0.8 per patient-year, p < 0.001), as well as in total sick leave days (22.5 vs. 17.4 vs. 16.4 per patient-year, p < 0.001) and migraine specific sick leave days (2.1 vs. 0.7.

A 2.1-fold increase in migraine related sick leave days was found in subject with

botulinum toxin prescriptions.

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A comparable increase in sick-leave days was observed: overall sick leave days (no prophylactic prescriptions, vs. ≥3 prophylactic treatments: 16.8 vs. 30.4 sick leave days per patient-year) and disease specific sick leave days (no prophylactic prescriptions, vs. ≥3 prophylactic treatments: 0.6 vs. 6.7 per patient-year). Discussion In this extensive registry-based retrospective study using EMRs of Finland’s largest private occupational health care provider, 17,623 migraine patients with G43- diagnosis were identified.

Botulinum toxin treatment was associated with 11.9 migraine related sick-leave days per patient-year, also in line with approximately 10  days previously reported [203].

The effect of prophylactic treatment lines on disease burden has been poorly investigated and the incremental increase of all-cause sick-leaves and visits per additional prophylactic treatment line, underlines that migraine related disease bur- den cannot solely be assessed by migraine related visits or sick-leaves, but should be considered in a larger perspective.

This study also investigated the migraine burden per se compared to age and gender matched controls, where all-cause sick-leaves were 1.8 and visits 1.7 more frequent in the migraine population than in the controls per patient-year.

Conclusions Migraine patients show a substantially higher extent of comorbidities, sick-leave days and health care visits compared to their age- and gender-matched counterparts.

Unresponsive or undertreated migraine, evidenced by an increase in failed treat- ment lines, increases morbidity and inevitably leads to productivity losses that pose an increased burden on the health care system and society.

Acknowledgement A machine generated summary based on the work of Korolainen, Minna A.; Kurki, Samu; Lassenius, Mariann I.; Toppila, Iiro; Costa-Scharplatz, Madlaina; Purmonen, Timo; Nissilä, Markku. 2019 in The Journal of Headache and Pain.

The burden of headache disorders in Ethiopia: national estimates from a population- based door-to-door survey