My Migraine Voice survey: disease impact on healthcare resource utilization, personal and working life in Finland

DOI: https://doi.org/10.1186/s10194- 020- 01185- 4

Abstract-Summary A global My Migraine Voice survey was conducted in 31 countries among 11,266 adults who suffered from ≥4 monthly migraine days (MMD).

Comorbidities, migraine-related emotional burden and impact on daily living

and work productivity and activity impairment (WPAI) were assessed.

Subgroup analysis on healthcare resource utilization (HCRU) due to migraine was assessed by visits to healthcare practitioners (HCPs) during the past 6 months and by hospitalizations and emergency room (ER) visits during the past 12 months. The association between HCRU and MMD and number of comorbidities was

assessed using negative binomial regression analysis.

Chronic migraine (CM, MMD ≥ 15) was reported in 19.5% of the respondents. The negative impact on daily functioning and emotional burden increased sig-

nificantly by migraine frequency.

Mean number of comorbidities was 2.4, and mean number of HCP visits during

the previous 6 months was 5.9.

Increase in migraine frequency and comorbidities was associated with

higher HCRU.

Over previous month, the mean number of missed working days for all respon- dents was 2.8 days of which 54% were paid sick leave days, and in CM up to 6.0 days and 30%, respectively.

The emotional and functional burden was high, and the societal burden increased by frequency and severity of migraine, as shown by higher HCRU and reduced work productivity.

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Extended: Increase in migraine frequency was associated with greater productiv- ity loss and use of healthcare resources as well as the effects conveyed to personal and societal level.

We assume that our findings can be generalised to most individuals having either

episodic or chronic migraine.

Background EM is defined as fewer than 15 monthly migraine days (MMD), and CM as 15 or more days with headache, of which ≥8 are considered migraine days.

The classification has been challenged by a recent study arguing that patients suffering from high frequency migraine (MMD ≥8) should be considered to have CM [441].

Regardless of EM or CM, the disability and burden of migraine increases along with increasing headache frequency [199, 320], and increasing number of migraine days equally enhances the risk for chronification of migraine [442].

Surveys across European and other countries have shown the impact of migraine on work, healthcare resource utilization (HCRU) and QoL, among other domains [10, 44, 50, 138–267, 374, 443, 444].

In order to further understand the burden of migraine in a Finnish sub cohort, disease severity was assessed as MMD frequency and impact of reported comorbidities.

Methods Detailed outcome parameters assessed in the survey including sociodemographic factors, impact on working productivity and healthcare utilization is described in detail in a report by Martelletti and others [195] For the purposes of this study, information was included for age, gender, family and employment status.

Information on healthcare resource utilization based on reported number of migraine-related visits to health care practitioners (HCP) in the past 6 months as well as emergency room (ER) visits and inpatient days (IPD) in the past 12 months were also included.

The impact of migraine on work productivity and daily activities among employed respondents was evaluated by using the Work Productivity and Activity Impairment (WPAI) questionnaire [445] and complemented with additional work- related questions.

Before the analyses were carried out the participants were categorized into three groups: 4 ≤ MMD < 8, 8 ≤ MMD < 15 and MMD ≥ 15, according to the reported mean monthly migraine days (MMDs) (determined by the self-reported number of migraine days in the past 3 months and divided by 3).

Results The number of respondents in subgroups according to the self-reported average number of migraine days experienced in the previous 3 months were 133 (39.3%) for 4 ≤ MMD < 8 and 139 (41.4%) for 8 ≤ MMD < 15 corresponding to EM, and 66 (19.5%) for MMD ≥ 15 corresponding to CM [80].

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The mean age was 44 years, the majority were female (93%), had children (66%) and reported a family history of migraine (86%), with no significant difference between the subgroups.

Users in all subgroups reported improved control over migraines in total of

39.2% and improved quality of life in 48.8%.

Mainly individuals in MMD ≥ 15 group reported having lost their job due to

migraine (27%, p < 0.001).

Fifty-three percent of the survey participants reported impairment in daily activi- ties including homework, shopping and hobbies, and the outcome tended to differ between the subgroups (p = 0.06).

Discussion Our main results drawn from the Finnish subset of global My Migraine Voice survey data showed a tendency towards worse outcomes in a wide set of domains assessing migraine burden, consistent with increase in migraine frequency detected by MMDs. These studies, the global My Migraine Voice survey and other observations [138, 444, 446] indicate that individuals with episodic or chronic migraine report worse health status and negative impact on activities and working life.

In our data, the common WPAI domains assessing indirectly the economic bur- den of migraine showed that over half of the respondents reported overall work impairment (absenteeism and presenteeism), and the results corroborate the reported loss in overall work productivity in other studies [10–444].

Our results on increasing HCP visits, inpatient days and ER visits by both sever-

ity of migraine and comorbidities are consistent with these studies.

Other comorbidities frequently related to migraine are painful musculoskeletal disorders reported in a Finnish study among working aged suffering from migraine [447].

Conclusion The cohort characterized a population where migraine exhibited the strongest effect both on working and personal life.

Increase in migraine frequency was associated with greater productivity loss and use of healthcare resources as well as the effects conveyed to personal and soci- etal level.

The results point to the need to lessen this burden and to consider more active use

of effective prophylactic treatments.

Acknowledgement A machine generated summary based on the work of Sumelahti, Marja-Liisa; Sumanen, Markku; Sumanen, Merika S.; Tuominen, Samuli; Vikkula, Johanna; Honkala, Sanna M.; Rosqvist, Stina; Korolainen, Minna A. 2020 in The Journal of Headache and Pain.

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Impact of migraine on workplace productivity and monetary loss: a study of employees in banking sector in Malaysia