A cross-sectional study on the burden and impact of migraine on work productivity and quality of life in selected workplaces in the Philippines

DOI: https://doi.org/10.1186/s10194- 020- 01191- 6

Abstract-Summary This study aimed to evaluate the burden and impact of migraine on work productiv- ity in selected workplaces in the Philippines.

Volunteer employees were screened for migraine using the ID-Migraine™ test. Eligible employees were tested for migraine severity and impact on work pro-

ductivity using the Migraine Disability Assessment (MIDAS) questionnaire.

Multiple logistic regression was used to identify significant predictors of

migraine disability (high—MIDAS Grade III/IV vs. low—MIDAS Grade I/II).

Differences in quality of life scores by migraine disability were measured using

multiple linear regression.

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Productivity costs lost to migraine disability were calculated as the number of days lost to migraine multiplied by the self-reported wage rate, and costs according to migraine severity were measured using a two-part generalized linear model. A total of 511 positive migraine screens were included in the final sample. Females comprised two-thirds of all positive migraine screens and were more likely to have high migraine disability (odds ratio: 1.60, 95% CI: 1.03–2.49) than males.

Those with high migraine disability scored lower on role limitations compared to

those with low migraine disability.

Mean annual productivity costs lost due to migraine disability were PHP27 794

(USD556) per person.

Migraine poses a significant threat to work productivity in the Philippines. Extended: A total of 954 respondents provided consent and attempted to respond

to the survey, or a response rate of around 4.1%.

Migraine poses a significant burden to employee productivity in the Philippines, with annualized costs due to migraine costing as much as PHP40 000 (USD826) per person for those with high migraine disability and PHP10 000 (USD200) per person for those with low migraine disability.

Introduction While several population-level studies on migraine have been conducted in the past few years, there remain countries with little information on the burden of migraine, specifically in the Asia-Pacific region [8].

A systematic review and meta-analysis on chronic migraine found only seven population-level studies in the Asia-Pacific region estimating chronic migraine prevalence to be approximately 6–17 people per 1000 population [316].

The expectation of worry on the next migraine attack is in itself negatively affect-

ing work productivity and quality of life [317].

This implies that migraine poses a significant economic burden and various stud-

ies in the past have tried to quantify the economic impacts of migraine.

In a literature search, this was the only published study found to present data on

the burden of migraine in the Asia Pacific region.

Given this, the present study assessed the burden and impact of migraine and

work productivity and daily activities in selected workplaces in the Philippines.

Methods To determine predictors of migraine disability, adjusted odds ratios (OR) and their 95% confidence intervals (CI) were calculated for high vs. low migraine disability for the following socio-demographic factors: gender, age, educational attainment, employee rank, and gross monthly income from the company.

Given that not all migraine positive screens reported absenteeism and presentee- ism, a two-part model was used to determine the economic costs of migraine between low and high migraine disability: the first part was a logistic regression model that determined the probability of reporting any economic cost of migraine, while the second part was a generalized linear model (GLM) fit with a log link func- tion and gamma (for absenteeism) or Poisson distribution (for presenteeism and

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total days and cost lost to migraine), with the function and distribution confirmed using the box-cox test and modified Park test, respectively [318].

Results Between low and high migraine disability, differences in demographics were appar- ent in females, where a higher proportion of females was reported among those with high migraine disability (68.2%) than low migraine disability (57.3%, p = 0.029).

One in five (20.4%) reported having undergone laboratory tests in the past three months, one in three (30.3%) reported visiting the hospital emergency room for headache symptoms in the past 12 months, and one in six (17.6%) reported being hospitalized for a migraine emergency in the past 12 months.

Costs significantly differed between migraine disability: monthly costs lost due to migraine for those with low disability averaged around PHP865.1 (USD17) (95% CI: 754.3–975.9) while costs quadrupled for those with high disability at PHP3 440.8 (USD69) (95% CI: 3323.4–3558.3).

Discussion This study provided a comprehensive view of how migraine affects employees in selected workplaces in the Philippines.

The mean annual cost was at USD500 per employee for those with low migraine

disability and USD800 per employee for those with high migraine disability.

Those with high migraine disability were only expected to take a sick leave for

about 12 days a year due to migraine.

Since all employees in the sample had generous company-provided private health insurance and medicine allowances, health care utilization rate for migraine was higher than the national health care utilization rate for any type of service, which was 8% based on the 2017 Demographic and Health Survey [319].

Employers must also be educated on the burden and impact of migraine in the workplace, and results from this study may begin that important conversation for the benefit of employees and companies overall.

Conclusion Migraine poses a significant burden to employee productivity in the Philippines, with annualized costs due to migraine costing as much as PHP40 000 (USD826) per person for those with high migraine disability and PHP10 000 (USD200) per person for those with low migraine disability.

Quality of life was significantly lower among those with high migraine disability

than those with low migraine disability across all eight SF-36 domains.

Most medication taken for migraine remain OTC medicines for symptom relief, and further research is needed to gauge willingness of employers to pay for preven- tive medication for migraine.

Acknowledgement A machine generated summary based on the work of Haw, Nel Jason; Cabaluna, Ian Theodore; Kaw, Germaine Erika; Cortez, Joanna Feliz; Chua, Maria Pamela; Guce, Kristel. 2020 in The Journal of Headache and Pain.

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Reliability and validity of the 6-item Headache Impact Test in chronic migraine from the PROMISE-2 Study