How Do Headache-Free Days Impact Migraine-Related Disability?

A higher number of headache-free days (HFDs) is associated with decreased headache-related disability among individuals with migraine, while interventions that increase the total number of HFDs may reduce the burden and cost of migraine, according to a study published in the Journal of Managed Care & Specialty Pharmacy.

After low back pain, migraine is the second leading cause of years lived with disability worldwide. Functional impairment associated with migraine includes physical, emotional, and economic ramifications, which can affect occupational, academic, social and family life.

In addition, “individuals with migraine have significantly lower health-related quality of life (HRQOL) than those in the general population with no chronic conditions, and their employers incur substantial indirect costs,” authors wrote.

Estimates from the National Health and Nutrition Examination Survey show the total annual cost of the condition in the United States is roughly $78 billion (in 2014 U.S. dollars).

To determine the relationship between HFDs and the burden of disease among individuals with chronic migraine (CM) and those with episodic migraine (EM) at risk of developing CM, researchers analyzed data from Kantar Health’s cross-sectional 2016 U.S. National Health and Wellness Survey (NHWS).

The self-administered, internet-based questionnaire included information from 97,503 US adults aged 18 or older, 372 of which reported migraine diagnosis. All participants completed an in-depth demographic registration profile and the composition of the study sample was matched to the demographic composition of the US population. Any individuals with ≥ 4 headache days in the past month were considered at risk of developing CM.

The number of workdays missed, and the number of household activity days missed due to migraine throughout the previous 6 months were collected and migraine effect was determined using the Headache Impact Test (HIT-6) questionnaire.

As HFDs was a continuous variable, “each additional HFD was associated with a 0.15-point reduction in HIT-6 scores, a 5% reduction in both number of workdays and household activities missed, and a 4% reduction in indirect costs; thus, a 5-day increase in HFDs would lead to a 0.75-point reduction in HIT-6 scores, 25% reduction in days of work or household activities missed, and 20% reduction in indirect costs,” researchers explained.

Analyses revealed:

• Respondents experiencing 21 to 26 HFDs had lower HIT-6 total scores than those with 0 to 10 HFDs (adjusted means: 66.59 vs. 63.91; P = .001) or those with 11 to 20 HFDs (65.66 vs. 63.91, P = .015)
• Respondents experiencing 21 to 26 HFDs missed fewer workdays than those with 0 to 10 HFDs (4.44 vs. 1.46, P = .002) or those with 11 to 20 HFDs (3.36 vs. 1.46, P = .009)
• Respondents with 11 to 20 HFDs (22.99 vs. 9.72, P < .001) and those with 21 to 26 HFDs (22.99 vs. 7.34, P = .001) were associated with fewer days of household activities missed due to migraine compared with respondents with 0 to 10 HFDs
• Respondents with 21 to 26 HFDs per month had significantly lower indirect costs ($16,975 vs. $6,919, P = .025) than those with 0 to 10 HFDs

“A treatment that increased HFDs per month by 5 could produce a 0.75-point decrease in the HIT-6 and a substantial 25% reduction in days of work or household activities missed,” researchers said. “By extension, a treatment that increased HFDs per month by 15 could produce a clinically significant 2.3-point decrease in the HIT-6.”

Because the sample was comprised of individuals who were recruited through a web-based consumer panel, authors caution results cannot be generalized to the entire migraine population. Information on temporal sequence was also not available, limiting causal inferences.

The investigation was funded by Teva Pharmaceutical Industries.

Reference:

Lipton RB, Lee L, Saikali NP, et al. Effect of headache-free days on disability, productivity, quality of life, and costs among individuals with migraine. J Manag Care Spec Pharm. Published online July 17, 2020. doi:10.18553/jmcp.2020.20103