Stigma, coverage barriers preventing proper treatment of migraine

While 2.7 million Canadians suffer from migraine, the condition can be subdivided based on its frequency, said Dr. Esma Dilli, neurologist and clinical assistant professor at the University of British Columbia, during Benefits Canada’s 2019 Vancouver Mental Health Summit on Dec. 12.

Episodic migraine is defined by less than 15 headache days a month, whereas chronic migraine is more than 15 during that time. According to U.S. studies, the prevalence of chronic migraine is about one to three per cent — and approximately seven per cent of the population has more than four migraines a month.

Read: Most Canadians believe employers have role in helping staff manage migraines: study

However, stigma is contributing to the under-diagnosis of migraines because individuals are hesitant to seek medical help, said Dr. Dilli. As well, only about a third of people are diagnosed with migraine because health-care providers don’t have the knowledge to make the diagnosis.

“One in seven people globally are affected by migraine and it’s the second-leading cause of disability worldwide,” she said. “However, only 42 per cent of Canadians diagnosed with migraine took a prescription medication for their condition in the last three months.”

Dr. Dilli also noted that migraine tends to peak in the most productive years of a person’s life, which leads to a loss in workplace productivity. Referring to a Canadian study of people with migraine, she said 26 per cent experienced pain that limited their work, social or household activities; 76 per cent were prevented from getting a good night’s rest; 36 per cent missed at least one day of work in the previous three months; and 18 per cent changed their work activities, including their hours, type of work or stopped working altogether.

Other U.S. studies have shown the associated health-care burden and lost productivity costs are as high as $28-36 billion annually, she said, noting migraine sufferers spend 112 million days per year bedridden. “The quality of life scores are significantly lower in this population, as well. And this is strongly associated with lost productivity time — both presenteeism and absenteeism.”

Read: How employers can better support workers suffering from migraines

An average year in the life of a migraine sufferer includes 26 days of missed work and 10 sick days, noted Dr. Dilli. Further, people went to work an average of 76 days with a migraine, which reduced their productivity by 53 per cent. “On average, in a year, if you take a look at the high-frequency, episodic and chronic migraine population groups, more than $1,000 of lost wages occur per year due to unpaid days taken for migraine.”

In addition, patients with both migraine and mental-health concerns have worse outcomes compared to those migraine sufferers without a psychiatric illness, she said, noting adverse events in childhood, previous depression and being female all increase the risk of developing frequent and severe headaches as an adult.

“Chronic migraine sufferers are two to four times more likely to have doctor visits, twice as likely to have depression, two times more likely to have anxiety, more likely to suffer from chronic pain, more likely to be occupationally disabled, more likely to experience low levels of income, more likely to miss days of work or school and have a higher risk of developing cardiovascular disease.”

In terms of migraine therapy, there are two major sub-categories — pharmacological and non-pharmacological therapy, noted Dr. Dilli. For pharmacological therapy, the two major categories are acute therapy, which is designed to treat current headaches, and preventative therapy, which is taken on a regular basis to reduce frequency.

Read: The comorbidity link between migraine and mental health

For non-pharmacological treatment, the cornerstone starts with migraine education, said Dr. Dilli, which includes the patient, their families and health-care provider. “This is equally important. You need to understand, from a physician perspective, how that headache and migraine is impacting the quality of that person’s life.”

But there are also barriers to migraine care, she noted, including: empathy barriers, which consist of poor awareness and downplaying migraine symptoms; barriers to self-care, including a lack of availability on migraine information, a lack of understanding the triggers, the disability that occurs during a migraine attack and the effect on sick days and absenteeism; and treatment barriers, which arise because not enough specialists are interested in migraine.

Currently, private insurance provides a range of different coverage for migraine, but when it comes to newer treatments, some insurers have stricter coverage, said Dr. Dilli. “Forty-four per cent of patients have difficulty securing coverage for migraine therapy and there needs to be an increased coverage in Canada. . . . The cost of migraine is substantial for the patient, employer and society and we need to improve access to care by providing education, resources and optimizing the therapies available.”

Read more from the 2019 Vancouver Mental Health Summit.