Document Type

Article

Publication Date

10-27-2020

Abstract

Background

Migraine imposes a substantial personal and economic burden to many working age individuals. This study aimed to evaluate the burden and impact of migraine on work productivity in selected workplaces in the Philippines.

Methods

A cross-sectional survey was conducted among employees suspected or diagnosed with migraine February to May 2020. Volunteer employees were screened for migraine using the ID-Migraine™ test. Eligible employees were tested for migraine severity and impact on work productivity using the Migraine Disability Assessment (MIDAS) questionnaire. Quality of life was measured using the Short Form-36 (SF-36) questionnaire and additional questions on triggers, coping mechanisms, workplace assistance, and health care utilization were asked. 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. 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.

Results

From around 24,000 employees who were invited to participate in the survey, 954 respondents provided consent and attempted to respond to the survey resulting to a response rate of around 4.1%. 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. Stress and looking at computer screens were cited as the top trigger for migraine, while sleeping enough hours and getting a massage were cited as top coping mechanisms. Three in four (77%) visited their company clinic within the past 3 months, which meant that most doctors seen for migraine-related symptoms were general practitioners. Five in six (85%) took medication for migraine, almost all of which were over-the-counter medications. Mean annual productivity costs lost due to migraine disability were PHP27 794 (USD556) per person.

Conclusion

Migraine poses a significant threat to work productivity in the Philippines. Many opportunities, such as disease management and introduction of alternative options for migraine treatment, may be introduced to help address these issues.

Introduction

Migraine is a neurological disorder recognized as one of the leading causes of disability in the world, estimated to impact anywhere between one in ten [1] and one in six individuals [2]. 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 [2]. 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 [3]. In the Philippines, the last known national-level migraine prevalence survey was in 2003, which found that 7.9% of the population screened positive for migraine [4]. However, in 2017, the Institute for Health Metrics and Evaluation (IHME) reports that headache disorders which include migraine has a prevalence estimate of about 17.3% [5].

Migraine is associated with significant impact on daily living, such as work, school, and personal activities [6]. Migraine patients consistently report poorer quality of life scores than healthy individuals on aspects of physical well-being, while chronic migraine patients consistently report poorer quality of life scores than episodic migraine patients on aspects of emotional well-being [7]. Additionally, the expectation of worry on the next migraine attack is in itself negatively affecting work productivity and quality of life [8].

Sex and age are significantly associated with migraine burden, with females at least twice as likely to report having migraine [1] and working-age individuals more likely to report having migraine than younger or older individuals [9]. This implies that migraine poses a significant economic burden and various studies in the past have tried to quantify the economic impacts of migraine. The European Eurolight project estimated that more than 90% of economic losses associated with migraine were attributable to indirect costs such as sick days and reduced work productivity as compared to less than 10% of direct costs such as medicines and outpatient consultation [10]. A systematic review from the United States found that on average around 2 to 3 workdays per month were lost due to migraine, with women reporting twice more workdays affected than men [11]. A Malaysian study found similar results with mean days affected by migraine being 5.6 days over the past 3 months among banking sector employees, with monetary losses potentially reaching as much as USD3000 annually for those with the most severe forms of migraine [12]. 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. Focusing on those having migraine, this study explored the migraine patient journey regarding the frequency and severity of migraine attacks, triggers in the workplace, workplace assistance programs, availability and utilization of health care services, and quality of life. Finally, this study also measured monetary estimates on lost productivity.

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