Workplace productivity loss as a result of absenteeism and presenteeism in chronic and episodic migraine: a scoping review

Purpose

Migraine consists of a chronic neurological disorder with episodic attacks. Migraine prevails in people of their most productive working age, followed by difficulties at work and social functions. This scoping review aims to analyze the economic burden on a workplace due to chronic migraine compared to episodic migraine by focusing on the indirect costs of absenteeism and presenteeism and addressing the research gaps in this field.

Design/methodology/approach

According to the PRISMA Extension for Scoping Reviews, a comprehensive electronic literature search was carried out from 2010 to 2020 using the Google Scholar and Medline/PubMed databases.

Findings

The findings confirm that chronic and episodic migraine harm the workplace's productivity, escalating with the frequency of migraine attacks. Differences occur between presenteeism and absenteeism rates among chronic and episodic migraine, and higher presenteeism than absenteeism rates.

Originality/value

This review sheds new light on the indirect burden of migraine. It shows the gaps in the explored research area and the need for more targeted and extended research that could provide a deeper understanding of the workplace's hidden costs of migraine. The issues discussed are important as they can raise awareness of the interested parties, policymakers, employers and vocational rehabilitation specialists on the work disability associated with migraine.

The impact of migraine and the effect of migraine treatment on workplace productivity in the United States and suggestions for future research

Evidence suggests that migraine is associated with decreased productivity. This article describes the results of a systematic literature review of peer-reviewed publications that measured the impact of migraine on workplace productivity in the United States and provides recommendations for future research. A MEDLINE search was conducted from January 1, 1990 to July 31, 2008. Articles were included if the results were from a prospective or retrospective study that reported work-specific productivity outcomes in adults with migraine in the United States. Twenty-six studies were included. Nine studies found that diagnosed and/or undiagnosed migraine had a negative impact on worker productivity. Although one migraine prophylactic study found a statistically significant improvement in worker productivity for topiramate-treated patients, another found an insignificant difference in lisinopril-treated patients. Fifteen studies compared the impact of triptan therapy with a control group. The control groups in these studies differed with regard to recall periods, time to follow-up, and types of questionnaires used. Almost all studies found that triptan therapy was associated with a statistically significant improvement in loss in worker productivity vs the control group. Health care professionals can reduce the impact of migraine on worker productivity with appropriate therapy. Researchers should collect presenteeism and absenteeism data, report results in units of time, use a validated instrument, carefully consider recall periods, and report worker productivity separately. In addition, patients with undiagnosed migraine should be included in disease burden studies. When evaluating effects of treatment on productivity, researchers should target well-controlled, double-blind studies and conduct productivity research for new treatments.

Quality of care measures for migraine: a comprehensive review

Migraine headache is a highly prevalent, chronic, episodic disorder that is associated with high direct and indirect costs. Migraine headache impacts not only patients, but also their employers due to substantial decreases in workplace productivity. Despite the prevalence and clinical and economic burdens of migraine, no national efforts to develop and implement standardized measures of quality of care have been made. The objective of this study was to collect and report on existing quality of care measures for migraine that could be suitable for quality measurement at the health-plan level. Published literature, the Agency for Healthcare Research and Quality's National Quality Measure Clearinghouse, and resources available from quality organizations (eg, the National Committee for Quality Assurance) were examined to identify existing quality indicators that can be used to assess the quality of care delivered to migraine sufferers at the health-plan level. Among the results of the study were the following: Quality of care measures for migraine include patient-reported measures and non-patient reported, diagnosis-related, prevention-related, and treatment-related indicators. Most existing measures have been developed by the Institute for Clinical Systems Improvement or summarized and reported by the RAND Corporation. Few of these measures can be used to assess migraine quality of care at the health-plan level. In conclusion, many measures exist, but they are not intended for use at the health-plan level. Incorporation of valid and reliable quality of care measures may increase the ability of migraine disease management programs to conform to clinical care guidelines. Significant effort is needed to determine what and how to measure quality among health plans to improve the quality of care delivered to individuals with migraine.

Impact of topiramate migraine prophylaxis on workplace productivity: results from two US randomized, double-blind, placebo-controlled, multicenter trials

OBJECTIVE

We conducted this study to determine whether topiramate at 100 mg/d for the treatment of migraine headache is associated with improved productivity in the workplace.

METHODS

Results were derived from two randomized, double-blind, placebo-controlled trials among migraineurs. The number of hours of absenteeism (A), presenteeism (P), and total lost productivity (TLP) (A + P) were calculated. Results were not adjusted for multiplicity.

RESULTS

A total of 325 (162 in the topiramate group and 163 in the placebo group) of 449 subjects were included. Per person mean monthly A rate was only significantly less for individuals within the topiramate group (1.0 hours per person) versus those in the placebo group (1.5 hours per person) for month 3 (P < 0.05). Per person mean P and TLP rates were significantly lower for individuals in the topiramate group versus those in the placebo group for months 1 through 5 (P < 0.05).

CONCLUSIONS

Findings suggest that topiramate, compared with placebo, is associated with decreased workplace presenteeism and TLP.

Migraine disorder: workplace implications and solutions

Migraine disorder is disabling, costly, underdiagnosed, and undertreated. It affects employees' quality of life and ability to work or attend school, potentially decreasing their earning ability. Migraine disorder impacts the workplace substantially through absenteeism and presenteeism and increases health care costs. Although research on migraine disorder is expansive, no systematic research tool or design exists within population studies. This may account for the different prevalence rates seen, especially in African studies, which rely on verbal interviews instead of mail or telephone surveys. Women have a higher prevalence rate throughout the research, but they seek help more often than men. This may contribute to their higher rates, although hormones also play a role. Occupational health nurses can affect the outcome of migraine disorder for employees and employers. They can assist in identifying those employees with migraine disorder who are not diagnosed, those who have not investigated the various available medications, or the lifestyle changes that would decrease the intensity and frequency of migraine attacks. Research is needed to quantify the cost savings of workplace intervention in identifying employees with migraine disorder and its effect on absenteeism, presenteeism, and health care use. Occupational health nurses can determine the effectiveness of education by measuring motivation, lifestyle changes, and workplace modification against the intensity and frequency of migraine attacks. This, in turn, will yield measurable results in reducing absenteeism and presenteeism in the workplace. Occupational health nurses can spread this information through employees to their families. As more undiagnosed and undertreated individuals with migraine become educated and pursue diagnosis, treatment, and lifestyle changes, a measurable decrease in health care use and costs may occur. The economic impact of migraine disorder, in terms of workplace absenteeism and presenteeism and increased health care use by employees, continues to be of great concern. This impact may motivate employers to support workplace interventions that educate, screen, and refer migraineurs to appropriate care. Employers may also be motivated to request that a managed care model for migraine be included in health and welfare programs, which would allow for assignment of a nurse case manager with automatic referral to a neurologist. The workplace is an ideal environment for identifying and referring migraine sufferers who only self-treat for symptoms. Prompt and effective treatment, in and out of the workplace, will decrease the frequency and intensity of migraine attacks and increase the quality of life.

Rizatriptan: an update of its use in the management of migraine

Rizatriptan is an orally active serotonin 5-HT(1) receptor agonist that potently and selectively binds to 5-HT(1B/1D) subtypes. Earlier clinical trials demonstrated that rizatriptan 5 or 10mg is more effective than placebo at providing pain relief and a pain-free state, relieving associated symptoms of migraine, normalising functional ability and improving patient quality of life, and showed that rizatriptan provides faster freedom from pain and reduces nausea to a greater extent than oral sumatriptan. More recently, rizatriptan 10mg was shown to be more effective than zolmitriptan 2.5mg or naratriptan 2.5mg at producing a pain-free state 2 hours postdose. Furthermore, compared with naratriptan, significantly more patients who received rizatriptan were pain free or had pain relief from 1 hour onwards. The number of patients with normal functional ability at 2 hours was significantly higher after rizatriptan than after naratriptan or zolmitriptan. Rizatriptan was also generally more effective than zolmitriptan or naratriptan at relieving migraine-associated symptoms. Rizatriptan is generally well tolerated and adverse events are usually mild and transient. The most common adverse events associated with rizatriptan in recent randomised trials were asthenia/fatigue, dizziness, somnolence and nausea. There was a trend towards a lower incidence of adverse events with rizatriptan compared with zolmitriptan (31.2 vs 38.8%). However, rizatriptan was associated with a significantly higher incidence of adverse events than naratriptan (39 vs 29%). The incidence of chest pain was similar after the administration of rizatriptan, zolmitriptan or naratriptan (2 to 4%).

CONCLUSION

Rizatriptan is an effective drug for the acute treatment of moderate or severe migraine. Oral rizatriptan 5 and 10mg have shown greater efficacy than placebo in providing pain relief, an absence of pain, relief from associated symptoms, normal functional ability and an improvement in patient quality of life. Earlier results showed that rizatriptan provides faster freedom from pain and reduces nausea to a greater extent than oral sumatriptan. More recent studies have shown that rizatriptan 10mg provides faster pain relief and a higher percentage of patients with an absence of pain and normal functional ability at 2 hours than naratriptan 2.5mg or zolmitriptan 2.5mg. The efficacy of rizatriptan is retained when used in the long term and the drug is generally well tolerated. Although well designed studies comparing rizatriptan with almotriptan, eletriptan and frovatriptan would further define the position of rizatriptan, current data suggest rizatriptan should be considered as a first-line treatment option in the management of migraine.

Almotriptan: a review of its use in migraine

Almotriptan is a selective serotonin 5-HT(1B/1D) receptor agonist ('triptan'). Its efficacy and tolerability have been assessed in a number of randomised, controlled trials in over 4800 adults with moderate or severe attacks of migraine. Oral almotriptan has a rapid onset of action (significant headache relief is observed 0.5 hours after administration of a 12.5mg dose) and efficacy is sustained in most patients who respond by 2 hours. The drug is significantly more effective than placebo as measured by a number of parameters including 2-hour headache response and pain-free response rates. Other symptoms of migraine, including nausea, photophobia and phonophobia, are also alleviated by almotriptan. The efficacy of oral almotriptan appears to be maintained over repeated doses for multiple attacks of migraine treated over a long period (up to 1 year). High headache response rates were reported over all attacks without tachyphylaxis. For the relief of single attacks of migraine, oral almotriptan 12.5mg had similar efficacy to oral sumatriptan 50mg. Patients given almotriptan report less concern with adverse effects than patients given sumatriptan. The lower incidence of chest pain following treatment with almotriptan than with sumatriptan may lead to a reduction in direct costs, with fewer patients requiring management of chest pain. Almotriptan is well tolerated. Most adverse events were of mild or moderate intensity, transient, and generally resolved without intervention or the need for treatment withdrawal. The most common adverse events associated with oral almotriptan 12.5mg treatment were dizziness, paraesthesia, nausea, fatigue, headache, somnolence, skeletal pain, vomiting and chest symptoms. The incidence of adverse events did not differ from placebo and decreased in the longer term. Almotriptan can be coadministered with drugs that share a common hepatic metabolic path; in addition, dosage reduction is required only in the presence of severe renal or hepatic impairment.

CONCLUSIONS

Almotriptan is an effective drug for the acute treatment of moderate or severe attacks of migraine in adults. An oral dose of almotriptan 12.5mg has shown greater efficacy than placebo; current data indicate that efficacy is similar to that of oral sumatriptan 50mg, and is maintained in the long term (<or=1 year). Almotriptan has a good adverse event profile and a generally similar overall tolerability profile to sumatriptan; of note, almotriptan is associated with a significantly lower incidence of chest pain than sumatriptan. However, further clinical experience is required to clearly define the place of almotriptan among the other currently available triptans. Nevertheless, because triptans have an important place in various management regimens, and because the nature of individual patient response to triptans is idiosyncratic, almotriptan is likely to become a useful treatment option in the management of adults with moderate or severe migraine headaches.