Although migraine is disabling, it’s also very common, with 2.7 million or 8.3 per cent of Canadians suffering from the condition, according to Dr. Farnaz Amoozegar, a neurologist and clinical assistant professor at the University of Calgary.
The condition affects one in seven people and is the second-leading cause of disability worldwide, she said during a session at Benefits Canada’s 2019 Calgary Drug Trends Summit on Oct. 24. In addition, women are two to three times more likely to be affected by migraine than men.
With only about a third of migraine headaches actually diagnosed, the reasons include barriers to treatment, such as poor access to physicians, especially neurologists or headache specialists; the high costs associated with medications and treatments; medication overuse; and lack of physician empathy.
“Unfortunately, migraine is still not very well understood, even sometimes by family members or friends of a suffering patient,” said Dr. Amoozegar. “Awareness continues to be an issue. We need to provide more education.”
Episodic migraines — when a patient experiences less than 15 days of headache each month — occur in about seven per cent of the population, while chronic migraines — when a patient experiences more than 15 days of headache each month — occur in about one to three per cent, she said. Among people who have a migraine diagnosis and are eligible for prescription medications, only about 42 per cent actually receive these drugs.
In studies, 44 per cent of patients indicated they’ve had difficulty securing coverage for migraine treatment, she said. “Certainly, we need to optimize further medication coverage for migraine in Canada.”
Also, Dr. Amoozegar noted migraine is most common during life’s reproductive years, when people are in their early 20s to age 50, so the condition peaks when patients are busiest with family life and employment. Among Canadians with migraine who were surveyed, 26 per cent said they experience pain that prevents activity; 76 per cent said they can’t sleep well; 36 per cent said they missed at least one day of work in the last three months; and 18 per cent said it drastically altered their work or school activities.
In the U.S., the health-care cost of migraine is phenomenal, she said, noting about $28 billion to $36 billion is lost annually in productivity costs because migraine affects physical, social and occupational functioning. “In the U.S., this estimation is somewhere around more than 110 million days where patients are bed-ridden per year. Quality of life scores are much lower for this patient group, and it’s strongly associated with presenteeism and absenteeism in the workplace.”
Looking at a year in the life of a migraine sufferer, the average patient will miss an average of 26 days of work or school, said Dr. Amoozegar, noting this includes 10 extra sick days, which leads to lost wages of more than $1,000 annually. Further, she added, these patients will attend work and/or school despite suffering from migraine 76 days of the year. During these instances, their productivity decreases by about 53 per cent.
In addition, people affected by migraine are also more likely to experience a mental-health issue. Patients who suffer from both have a lower quality of life, social and work function, higher health-care utilization and poor response to migraine intervention and/or treatments, said Dr. Amoozegar. In fact, patients who suffer from both a mental-health condition and migraine have worse outcomes in general compared to patients who suffer from migraine alone.
Patients with migraine plus another co-morbidity are three to four times more likely to go to the doctor, she added. “They’re two times more likely to have depression and anxiety, more likely to suffer from other chronic pain conditions, more likely to be occupationally disabled, have a higher likelihood of cardiovascular disease and much more likely to miss days of work and/or school, meaning they’ll also experience lower income levels.”
Read more coverage of the 2019 Calgary Drug Trends Summit.