Migraine: costs and consequences
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Bandolier 59 examined numbers needed to treat for treatments for acute migraine,
but there's more to migraine than that. There is a large economic burden, mostly
outside the NHS, and interesting and important associations with depressive
illness and suicide risk.
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Costs
Health economic papers are usually impenetrable, but a superbly sensible and
readable report examines the burden of migraine in the United States [1]. It draws on
a wide range of data sources to do its computations, and the major assumptions on
migraine are interesting:
- Migraine prevalence is about 7% in men and 20% in women over the ages 20 to
64.
- The average number of migraine attacks per year was 34 for men and 37 for
women.
- Men will need nearly four days in bed every year. Women will need six.
- The average length of bed rest is five to six hours.
- Only about 1 in 5 sufferers seek help from a doctor.
The bottom line on the costs is given in Table 1. Only 8% of costs were for medical
care - and the bulk of this was in physician visits and prescribed drugs. Most of the
burden was in missed workdays and lost productivity. The figures used to calculate
these were not out of line with the British equivalent (average wage cost was lower,
for instance), and translated on a population basis the equivalent figure for the UK
would be £1,913 million. This is about as much as a 1p on the standard rate of
income tax, or about 0.5% of GDP. A Dutch summary of a number of economic analyses on
migraine confirms that the US experience is shared with other developed economies
[2].
Table 1: Economic burden of migraine in the USA
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US$ million
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|
Cost element
|
Men
|
Women
|
Total
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| Medical |
193
|
1,033
|
1,226
|
| Missed workdays |
1,240
|
6,662
|
7,902
|
| Lost productivity |
1,420
|
4,026
|
5,446
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| Total |
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|
14,574
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Consequences
Perhaps more like very important association than consequence, but an
epidemiological study of young adults linking migraine to psychiatric disorder
and suicide attempts [3] is worth considering.
This study examined 1,007 young adults aged 21 to 30 years old who were part of
an HMO in Michigan. The participated in a structured interview which used the
International Headache Society definitions of migraine and the National Institute
of Mental Health diagnostic interview schedule to gather information on
psychiatric disorders.
The results showed a lifetime prevalence of migraine of 7% in men and 16% in
women. There were higher lifetime rates of psychiatric disorders in persons with
migraine. For instance, major depression occurred in 9% of people without
migraine, but in 22% of people with migraine without aura and in 32% of people
with migraine with aura. Panic occurred 10 times more frequently, at 17%, than in
people without migraine. Anxiety occurred in 21% of people without migraine and
54% of people with migraine.
Perhaps the most startling result, though, was that suicide attempts were very
much higher in migraine sufferers, especially in those with aura (Figure).
Figure 1: Suicide rates in men and women according to type of migraine
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When stratified according to the type of migraine and the presence and absence of
major depression, the figures confirm this remarkable trend (Table 2).
Table 2: Association between migraine, depression and suicide attempts
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Migraine
|
Depression
|
Number
|
Suicide attempts/100
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| None |
None |
786 |
2.2 |
| Migraine/no aura |
None |
51 |
5.9 |
| Migraine/aura |
None |
33 |
9.1 |
| None |
Major |
91 |
16.5 |
| Migraine/no aura |
Major |
18 |
22.2 |
| Migraine/aura |
Major |
26 |
38.5 |
Comment
Confirmation of the association between migraine, depression and suicide
attempts could not be found in a search of the literature, so this 1992 paper
stands on its own as far as
Bandolier
can see. It looks sufficiently important to require replication in a UK context,
especially when suicide has become a health improvement target, and migraine is
so common. Clearly there is much more to migraine than expensive and effective
new drugs, and a significant economic drag on the economy.
References:
- XH Hu et al. Burden of migraine in the United States. Archives of Internal
Medicine 1999 159: 813-8.
- MD Ferrari. The economic burden of migraine to society. Pharmacoeconomics
1998 13: 667-76.
- N Breslau et al. Migraine, psychiatric disorders, and suicide attempts: an
epidemiological study of young adults. Psychiatry Research 1992 37: 11-23.
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