More Than a Headache: The Economic Impact of Migraines

April 8th, 2020

Migraine is a neurological condition that affects 12 to 15 percent of the entire world’s population. In the United States alone, it is estimated that every 10 seconds, someone seeks emergency care for a severe headache. Migraine is the most common diagnosis after a headache-related emergency visit. Even though migraines aren’t as publicized or talked about as other conditions, this disorder is more prevalent than asthma, diabetes, and epilepsy combined.

As is the case with other disabling conditions, the economic burden of migraines in the United States is significant. The Migraine Research Foundation estimates that more than 90 percent of people who suffer from migraines are unable to function normally during an attack. That means that every day, tens of thousands of individuals have to miss work or school as a direct consequence of migraines. In households with at least one migraine sufferers, healthcare costs are estimated to be up to 70 percent higher.

To calculate the individual and public expenditure for any particular condition or disease, experts use the concept of direct and indirect costs. Direct costs are the costs that can be attributed to healthcare services. Emergency room visits, lab tests, and diagnostic exams, and office visits are all examples of direct costs. Indirect costs, on the other hand, include short and long-term disability, absenteeism (missing work or school), and loss of productivity.

The Real Cost of Migraines

Based on the frequency of the attacks, migraines are divided into two broad categories: chronic and episodic. Chronic migraines are categorized as having 15 or more headaches, with at least eight meeting the criteria for migraine with or without aura, per month for a period of at least three months. Episodic migraines are defined as having 14 or fewer headaches per month, with at least one fulfilling the criteria for migraine.

Both chronic and episodic migraines pose a substantial economic burden, though chronic migraines are more disabling, and thus more expensive. In a research study published by the American Headache Society’s journal Headache, a group of researchers collected data from 2,143 chronic and episodic migraine patients using a web-based survey to understand the direct and indirect costs associated with migraines.

For the study, respondents were asked to provide information on the number of times in the past three months where they were admitted to the hospital, underwent diagnostic testing, visited the emergency room or urgent care, or visited their healthcare provider due to their headaches. Other questions included the number of days the subjects had to miss work or school because of headaches, and the number of days the participant saw their productivity at work or home reduced by half.

The results of the study confirmed the substantial economic burden of migraine headaches for American migraineurs, particular among those who suffer from chronic migraines. On average, episodic migraines had an annual per-person cost of $2,649. The vast majority of that expenditure came from direct expenses, including visits to a primary care physician, neurologist, and nurse practitioner, or physician assistant.

As expected, the direct, indirect, and total costs were substantially higher in the chronic migraine group. Study participants in the chronic migraine group reported more primary care and specialist visits, more headache-related diagnostic testing, and greater losses in productivity. Chronic migraineurs were also more likely to miss work or school due to a migraine attack.

Comorbid conditions also drive up the costs for chronic migraineurs. According to the American Migraine Foundation, chronic migraine sufferers are at an increased risk of having at least one more chronic condition (comorbidity) like depression, anxiety, sleep disorders, and stroke. The annual per-person cost of chronic migraines was estimated to be around $8,243.

Other sources estimate that the collective cost of chronic and episodic migraines in the United States amounts to $36 to $41 billion annually. Medications and preventive migraine therapies also account for a significant portion of the total expenditure. In a 2005 study published in the Journal of Managed Care, abortive medications in the triptan class of drugs accounted for the highest medication costs of migraines.

Migraine continues to be somewhat of a mystery in the medical community. It is believed that nearly half of migraine sufferers are never officially diagnosed with migraines, which means that the cost of this neurological condition could be even higher than estimated.