5 Things About the Impact of Migraine on Work and Health

In the United States, nearly 50 million Americans suffer from migraine, most of whom are in their prime working years. About 75% of patients who suffer from migraines are women. A year ago, the FDA approved the first in a class of calcitonin gene-related peptide (CGRP) inhibitors, which are injectable biologics that prevent migraine.

Here are 5 ways migraines impact patients, from workplace issues to other related health conditions.

1. Migraines and work

With migraines striking people during their work years, it’s no surprise that this condition is looked at in economic terms. Estimates of the cost of migraine in the United States range from $22 billion to $28 billion or more. Workers with migraine miss about 8.9 days of work annually because of the disease.

With females making up the majority of migraine sufferers, perhaps it is no surprise that some organizations look at this as a women’s workplace issue. The Aimed Alliance, for instance, has a brochure about how women can talk to their employer about accommodations. But one survey found that most women don’t have very much trust in either their insurance or their employers.

2. Insurance coverage of CGRPs

There are 3 CGRPs on the market, and given their expense, most plan sponsors are requiring step therapy or prior authorization before they can be prescribed. A report from the Pharmacy Benefit Management Institute said plan sponsors want to see certain outcomes from CGRP inhibitors as they make future drug benefit decisions, including an improvement in the number of migraine days, improvement in migraine severity, reduced use of narcotic analgesics, and improvements in emergency department/urgent care use.

The European Headache Foundation recently said there is not enough evidence to support a guideline for the drugs, although the American Headache Foundation includes the class in an updated consensus statement.

The 3 drugs are erenumab (Aimovig), fremanezumab (Ajovy), and galcanezumab (Emgality).

3. Migraine and eye conditions

Is migraine a risk factor for eye conditions, or is it related to underlying disease? Recent studies have looked at the possible associations with migraine and eye conditions. The exact pathophysiology behind migraine is unknown, but the condition has been associated with neurovascular dysfunction due to changes in blood vessels, hypoperfusion disorders, and microembolization.

One study suggests that migraine is associated with a higher risk of open-angle glaucoma (OAG) compared with patients with no migraine. Migraine has been linked to endothelial dysfunction and therefore is considered a systemic vasculopathy, which is also present in patients with glaucoma.

Another study looked at the association between migraine and dry eye disease (DED). Researchers used a database of deidentified patient data from visits to University of North Carolina—affiliated healthcare facilities from May 1, 2008, through May 31, 2018. The retrospective case-control study included 72,969 patients.

After accounting for confounders, the odds of having DED with a diagnosis of migraine headaches was at least 20% higher than that of individuals without a diagnosis of migraine headaches. While mechanisms between migraine headaches and DED are not exactly known, inflammatory processes play a role in both.

4. Migraine and weight/exercise

Some studies have suggested that losing weight or exercising more often can have a positive impact on migraines.

One recent meta-analysis indicated that losing weight could help decrease migraine frequency, pain, and duration, according to a presentation at ENDO 2019. While mechanisms linking obesity, weight loss, and migraine headache remain unclear, alterations in chronic inflammation, adipocytokines, obesity comorbidities, and behavioral and psychological risk factors. Migraine and obesity are both highly prevalent in chronic diseases, and other research has shown that obesity may influence frequency and severity of migraine attacks and is a risk factor for migraine progression.

Researchers have also found some moderate evidence that aerobic exercise could improve migraines.

5. Migraines and mood/emotions

Researchers are exploring how migraines intersect with mood disorders like depression and anxiety. One study found that duration and frequency of migraine were associated with these disorders. Doctors aren't sure if depression and anxiety cause migraines, or if it is the other way around. Treatment options could include cognitive behavioral therapy, biofeedback, or relaxation techniques, according to the American Migraine Foundation.