Coverage from EHF 2019

Patients with migraine report diminished functioning and well-being on health-related quality of life measures.1 Underdiagnosis and undertreatment means that the magnitude of the clinical economic burden to individuals, relatives and society may be underestimated.2 During a session at the 13th annual congress of the European Headache Foundation – chaired by Prof. Paolo Martelletti (University of Rome, Italy) and Dr Mark Braschinsky (University of Tartu, Estonia) – the invited faculty discussed the societal burden of migraine.

“If we want women to be leaders, we need to treat their migraines.”

– Prof. Gisela Terwindt, Leiden University Medical Centre, the Netherlands

Migraine burden and barriers

Prof. Gisela Terwindt (Leiden University Medical Centre, the Netherlands) began her talk by highlighting that while migraine is the second most disabling disorder worldwide,3 it affects men and women very differently. She observed that not only is lifetime prevalence of migraine much higher in women than in men (33% vs. 13%, respectively),4 the risks associated with migraine are far greater for women. Migraine is a risk factor for stroke in women,5 with the presence of aura, smoking and regular use of oral contraceptives cumulatively increasing this risk. Similarly, women with migraine are at increased risk of white matter lesions compared with healthy controls, while men with migraine are not.6 Prof. Terwindt concluded by highlighting the disabling debilitating effect of migraine on women, especially those of working age. As such, migraine represents a significant barrier to the progression of women in the workforce.

Impact on working activity

Continuing the discussion of the societal impact of migraine, Prof. Paolo Martelletti emphasised the impact of migraine on working activity. Chronic migraine is associated with increased absenteeism, including missed work days and productivity loss.7 In Prof. Martelletti’s opinion, the fact that absenteeism is greater in young workers aged 18–34 years is of utmost concern.8 He concluded that the general population does not consider migraine to be a disability, despite the effects of migraine on workplace productivity and absenteeism being comparable with other major public health problems.

Economic cost of migraine

Prof. Paul McCrone (King’s College London, United Kingdom) finished the session by discussing the cost of migraine from a health economics perspective, and reviewing attempts to quantify and predict the economic cost of migraine for patients referred to specialists. In the UK, self-report data on healthcare resource use and lost employment over a 4-month period were acquired and used to estimate the economic costs of migraine.9 Prof. McCrone explained that alongside expenditure on healthcare services including inpatient, emergency department and other specialist care, individuals incurred large costs related to informal care. The latter accounted for 74% of the total migraine-related cost per person of £6588 over 4 months.

A need for greater evidence explaining the full cost of migraine

During the question and answer session, all speakers agreed that there is a need for more evidence on the economic cost of migraine. However, the optimal way of presenting this evidence to regulatory and reimbursement bodies is still being debated.


  1. Terwindt GM, et al. The impact of migraine on quality of life in the general population. Neurology. 2000;55:624–629.
  2. Agosti R. Migraine burden of disease: from the patient’s experience to a socio-economic view. Headache. 2018;58:17–32.
  3. Vos T, et al. 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.
  4. Launer LJ, et al. The prevalence and characteristics of migraine in a population-based cohort: the GEM study. Neurology. 1999;53:537–542.
  5. MacClellan LR, et al. Probable migraine with visual aura and risk of ischemic stroke: the stroke prevention in young women study. Stroke. 2007;38:2438–2445.
  6. Palm-Meinders IH, et al. Structural brain changes in migraine. JAMA. 2012;308:1889–1897.
  7. Zhang W, et al. The relationship between chronic conditions and absenteeism and associated costs in Canada. Scand J Work Environ Health. 2016;42:413–422.
  8. Mesas AE, et al. The association of chronic neck pain, low back pain, and migraine with absenteeism due to health problem in Spanish workers. Spine. 2014;39:1243–1253.
  9. Osumili B, et al. The economic cost of patients with migraine headache referred to specialist clinics. Headache. 2018;58:287–294.