The functional impairment associated with migraine can cause physical, emotional, and economic ramifications that can affect occupational, academic, social, and family life. Understanding the relationship between headache-free days (HFDs) and the disease burden of migraine may help with decisions regarding treatment and management of migraine.
To determine the relationship between burden of disease measures and HFDs among individuals with migraine experiencing ≥ 4 headache days in the previous 30 days.
The 2016 U.S. National Health and Wellness Survey (N = 97,503) was self-administered to a nationally representative sample of adults. Respondents with a migraine diagnosis who reported ≥ 4 headache days a month were included in the analysis. The primary independent variable was the number of HFDs assessed as both a continuous (HFDs in the previous 30 days) and categorical (0-10, 11-20, and 21-26 HFDs) measure. HFDs were used to predict outcomes using separate generalized linear models. Outcomes included effect on functional status and well-being, measured by the 6-item Headache Impact Test (HIT-6) score; number of days of work and/or household activities missed due to migraine; annualized indirect costs due to work productivity loss (assessed via the Work Productivity and Activity Impairment questionnaire); and annualized direct costs due to health care resource use (health care provider visits, emergency room visits, and hospitalizations).
The survey included 372 respondents with diagnosed migraine and ≥ 4 headache days per month. Using HFDs as 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 work days 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. Analyzing HFDs as a categorical variable, respondents experiencing 21-26 HFDs had lower HIT-6 total scores than those with 0-10 HFDs (adjusted means: 66.59 vs. 63.91; = 0.001) or those with 11-20 HFDs (65.66 vs. 63.91, = 0.015). Respondents experiencing 21-26 HFDs missed fewer work days than those with 0-10 HFDs (4.44 vs. 1.46, = 0.002) or those with 11-20 HFDs (3.36 vs. 1.46, = 0.009). Similarly, respondents with 11-20 HFDs (22.99 vs. 9.72, < 0.001) and those with 21-26 HFDs (22.99 vs. 7.34, = 0.001) were associated with fewer days of household activities missed due to migraine compared with respondents with 0-10 HFDs. Respondents with 21-26 HFDs per month had significantly lower indirect costs ($16,975 vs. $6,919, = 0.025) than those with 0-10 HFDs.
A higher number of HFDs is associated with decreased headache-related disability among those with migraine. Interventions that increase the total number of HFDs may reduce the burden and cost associated with migraine.
This study was funded by Teva Pharmaceutical Industries (Petach Tikva, Israel). Cohen is an employee of Teva Branded Pharmaceutical Products R&D (USA); Bell was employed by Teva Pharmaceutical Industries at the time of this study and has stock/stock options in Teva Pharmaceutical Industries. Lee is employed by Kantar, which received payment from Teva Pharmaceutical Industries for data analyses performed for this study. Lipton has received research support from the NIH, the Migraine Research Foundation, and the National Headache Foundation. He has reviewed for the NIA and NINDS; holds stock options in eNeura Therapeutics and Biohaven Holdings; and serves as consultant, advisory board member, or has received honoraria from the American Academy of Neurology, Alder, Allergan, American Headache Society, Amgen, Autonomic Technologies, Avanir, Biohaven, Biovision, Boston Scientific, Dr. Reddy’s, electroCore, Eli Lilly, eNeura Therapeutics, GlaxoSmithKline, Merck, Pernix, Pfizer, Supernus, Teva, Trigemina, Vector, and Vedanta. Saikali serves on the advisory board and as speaker for Allergan, Amgen, Promius, Supernus, and Teva Pharmaceuticals. He serves as a speaker for Assertio, Avanir, Cefaly, Egalet, Eli Lilly, Gammacore, and Pernix. This study has been presented as a poster at the American Academy of Neurology 2018 Annual Meeting, April 21-27, 2018, in Los Angeles, CA; Headache Update 2017, July 13-16, 2017, in Lake Buena Vista, FL; and the American Headache Society 2017 Annual Meeting, June 8-11, 2017, in Boston, MA.