Log Out
 

Migraine poses a significant burden not only for people living with the disease, but also for their families, friends, employers and society as a whole.

Indeed, migraine is the second leading cause of years lived with disability worldwide (responsible for 5.6% of years living with disability) and is the leading cause of disability among 15–49-year-olds.1,2 80% of people report severe or extremely severe pain during a migraine attack, with three quarters always needing to lie down for at least part of the attack and half requiring time off work.3

Migraine prevalence is highest during the most productive ages of adulthood (20–50 years old).4 As such, it generates significant direct and indirect economic and societal costs. For example, sufferers may be unable to work or attend school at all (absenteeism) or may continue to try to work or study but be less effective than during headache-fee periods (presenteeism).3,5

How does migraine affect people’s lives?

Migraine has a significant impact on the personal lives of those living with the disease.

Figure 1: The fundamental areas where migraine affects people’s lives.

Migraine has a significant impact on relationships with family and friends6,7

Approximately half of those with migraine (48.2–57.4% depending on migraine frequency) report reduced participation in family activities at least once a month because of migraine.Up to three-quarters have reduced involvement or enjoyment in their children’s activities, and many believe that they could be better parents if they did not experience headaches.Half of migraine sufferers report that they are more likely to argue with their partners (50%) and children (52%), and up to 73% believe that their family relationships suffer because of their migraine.7

Migraine reduces productivity at work and school3,5,8

Eighteen percent of males and 28% of females report losing more than 10 days of work in a 3-month period.5 About half of migraine sufferers (51%) report a reduction in work or school productivity by at least 50%.8 Reduced productivity can have a major impact on career advancement, reflected in a portion of those with migraine believing that their headaches have made them less successful at their careers.5

Migraine significantly affects socialising and other activities5,7

Nearly one-third (32%) of people with migraine avoid planning activities because they fear having to cancel due to migraine.Most people suffering from migraine (85%) are unable to do household work and chores at times because of headache,7 with one study showing that men lose 1 day and women lose 2 days of housework time per month to migraine.5

Those with migraine experience substantial fear of future attacks10

Patients who suffer from migraine at higher frequency are more likely to experience cephalalgiaphobia – fear of a migraine attack.10

Migraine is associated with medication overuse, which further exacerbates disability11,12

More than half of those with migraine feel that they are using too much pain medication.11 Medication overuse can substantially increase disability, and affect work productivity and mood states of people with migraine.5,12

People with migraine suffer from sleep disturbances13

Migraine has a bidirectional association with sleep disturbance, where headache both causes and is triggered by a disturbed night’s sleep.13 Approximately half of those with migraine experience occasional symptoms of insomnia and 38% report sleeping for less than 6 hours per night. Sleep disturbance increases with migraine frequency, with chronic migraine sufferers experiencing insomnia almost every night.13

Migraine is associated with an increase in other health issues14–20

Migraine is associated with comorbidities, including stroke, coronary heart disease, hypertension, psychiatric diseases, restless legs syndrome, epilepsy and asthma.14 In particular, psychiatric disorders, such as depression, anxiety disorder, bipolar disorder, and suicide ideation and attempt, are frequently comorbid with migraine and result in a significant burden of disease, including poorer quality of life and reduced earnings.14,15,17,18 Dawn Buse discusses the management of comorbidities in migraine on NeurologyBytes

Migraine creates financial uncertainty5,6

One-third of people experiencing migraines worry about long-term financial security for both themselves and their family because of their headaches, and one-quarter of those who are employed worry about losing their jobs.6 Approximately 30% are concerned about meeting household expenses,6 and a portion of employed people report lower earnings as a result of living with migraine.

Helping patients recognise and describe the impact of migraine on their lives

See also Talking to Your Patients

 

A migraine diary helps people to keep track of their migraine attacks and can provide valuable information to:

Encourage your patients to use a migraine diary; templates can be downloaded and printed out or the patient can use a digital app, such as Migraine Buddy, to record the details of their migraine and gather information about their attacks, such as triggers to avoid.

Tools are available  to assess the level of disability and impact of migraine on quality of life. Regular use of such assessments can highlight the need to adjust treatment and perhaps introduce preventive therapies where a patient has begun to rely too much on acute medicines with diminishing impact on their headache.

References

  1. GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328
    diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017;390:1211–1259.

  2. Steiner TJ et al. Migraine is first cause of disability in under 50s: will health politicians now take notice? J Headache Pain 2018;19:17.

  3. A Report of the All-Party Parliamentary Group on Primary Headache Disorders (APPGPHD). Headache Disorders – not respected, not resourced. Available at
    https://www.migrainetrust.org/wp-content/uploads/2015/12/2010Mar-APPGPHD_REPORT_Headache_Disorders-NotRespNotReso.pdf (last accessed October 2018)

  4. Stovner LJ et al. Epidemiology of headache in Europe. Eur J Neurol 2006; 13(4): 333–345

  5. Steiner TJ, Stovner LJ, Katsarava Z, et al. The impact of headache in Europe: principal results of the Eurolight project. J Headache Pain 2014;15:31.

  6. Buse DC, Scher AI, Dodick DW, et al. Impact of migraine on the family: perspectives of people with migraine and their spouse/domestic partner in the CaMEO study.
    Mayo Clin Proc 2016; pii: S0025-6196(16)00126-9.

  7. Lipton RB et al. The family impact of migraine: population-based studies in the USA and UK. Cephalalgia 2003;23(6): 429–440

  8. Lipton RB et al. Prevalence and burden of migraine in the United States: data from the American Migraine Study II. Headache 2001;41(7): 646–657

  9. Sokolovic E, Riederer F, Szucs T, Agosti R, Sándor PS. Self-reported headache among the employees of a Swiss university hospital: prevalence, disability, current
    treatment, and economic impact. J Headache Pain 2013;14:29.

  10. Giannini G et al. Cephalalgiaphobia as a feature of high-frequency migraine: a pilot study. J Headache Pain 2013;14(1): 49.

  11. Dekker F, Knuistingh Neven A, Andriesse B, et al. Prophylactic treatment of migraine; the patient’s view, a qualitative study. BMC Fam Pract 2012;13:13.

  12. Raggi A, Leonardi M, Giovannetti AM, et al. A 14-month studyof change in disability and mood state in patients with chronic migraine associated to medication overuse. Neurol Sci 2013;34:139-140

  13. Fernandez-de-las-Penas C, Fernandez-Munoz JJ, Palacios-Cena M, Paras-Bravo P, Cigaran-Mendez M, Navarro-Pardo E. Sleep disturbance in tension-type headache and migraine. Ther Adv Neurol Disord 2017;11

  14. Wang S-J, Chen P-K, Fuh J-L. Comorbidities of migraine. Front Neurol 2010;1.

  15. Arita JH, Lin J, Pinho RS, et al. Adolescents with chronic migraine commonly exhibit depressive symptoms. Acta Neurol Belg 2013;113:61–65.

  16. Raggi A, Covelli V, Schiavolin S, et al. Psychosocial difficulties in patients with episodic migraine: a cross-sectional study. Neurol Sci 2016;37:1979–1986.

  17. Zebenholzer K, Lechner A, Broessner G, et al. Impact of depression and anxiety on burden and management of episodic and chronic headaches – a cross-sectional
    multicentre study in eight Austrian headache centres. J Headache Pain 2016;17.

  18. Fornaro M, De Berardis D, De Pasquale C, et al. Prevalence and clinical features associated to bipolar disorder-migraine comorbidity: a systematic review. Compr
    Psychiatry 2015;56:1–16.

  19. Sacco S, Kurth T. Migraine and the risk for stroke and cardiovascular disease. Curr Cardiol Rep 2014;16:524.

  20. Doulberis M, Saleh C, Beyenburg S. Is there an association between migraine and gastrointestinal disorders? J Clin Neurol 2017;13:215–226.

  21. Silberstein SD. Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the Quality Standards Subcommittee of
    the American Academy of Neurology. Neurology 2000; 55(6):754–762.

  22. National Institute for Health and Care Excellence. Headaches in over 12s: diagnosis and management. Clinical guideline 150. September 2012 (updated 2015).