The Economics of Migraine
Recently, results regarding the direct costs of chronic migraine (CM) and episodic migraine (EM) in the United States and Canada became available from the International Burden of Migraine Study (IBMS)1. This internet-based survey included data from 1,204 Americans and 681 Canadians with migraine, who were asked to document all medical services utilized in the preceding three months, including headache-specific medications, ER visits, headache provider visits, and diagnostic testing. Medicare fees were used to estimate costs of physician visits and diagnostic testing; in cases where there were multiple potential costs, the most conservative and least expensive option was always selected.
Per the IBMS, the mean headache-related direct cost over a 3-month period for individuals in the United States with CM was $1,036/person compared to $383/person for those with EM. For Canadians, the mean 3-month cost for participants with CM was $471/person versus $172/person for episodic migraineurs.
Taking into account that 6-9% of men and 18-24% of women in North America suffer from migraine, with approximately 2.2% of the adult population meeting criteria for chronic migraine, it can be estimated that there are approximately 44.5 million adult migraineurs in the United States and 4.9 million in Canada. Furthermore, pediatric epidemiology studies demonstrate that 6-11% of adolescents suffer migraine, with 0.79-1.75% meeting criteria for chronic migraine2,3. More than 5% of children with migraine experience moderate to severe headache-related limitations on their abilities to function in their school, home, leisure, and play activities3. The financial and societal implications of migraine are substantial.
These findings support what we already know about the economic burden of migraine. In 2009, the American Migraine Prevalence and Prevention (AMPP) study reported on both the direct and indirect costs of migraine4. This national, longitudinal, survey-based study used data from 7,796 individuals with migraine who completed the 2006 questionnaire. The results documented that the average annual costs per person, including both direct costs (physician visits, ER visits, diagnostic testing, headache-specific medications, etc.) and indirect costs (lost work days, decreased productivity at work, etc.) were 4.4-fold greater for individuals with chronic/transformed migraine than for those with EM ($7,750 vs. $1,757). These statistics are tangible – the economy loses more than $13 billion each year from the 113 million lost workdays due to headache and migraine.
Despite these daunting numbers and the widespread impact migraine has on individual lives and society as a whole, there is a serious lack of funding for migraine research, including money for valuable projects that aim to improve our understanding of the disorder and to develop new treatments. Currently, the NIH has devoted $9 million, or less than 0.03% of the annual NIH research budget, to migraine research. The above epidemiology studies demonstrate that the current allocation of resources is inadequate. Supporting research on migraine and potential treatments is an important part of reducing migraine-related disability and associated costs. Health care providers, researchers, and patients need to advocate for increased funding for migraine research.
Rashmi Halker, MD
Mayo Clinic College of Medicine
Phoenix, AZ
1Stokes M et al. Cost of health care among patients with chronic and episodic migraine in Canada and the USA: results from the International Burden of Migraine Study (IBMS). Headache 2011;51:1058-1077.
2Lipton RB et al. Prevalence and burden of chronic migraine in adolescents: results of the chronic daily headache in adolescents study (C-dAS). Headache 2011;51:693-706.
3Fuh J-L et al. Headache disability among adolescents: a student population-based study. Headache 2010;50:210-218.
4Munakata J et al. Economic burden of transformed migraine: results from the American Migraine Prevalence and Prevention (AMPP) study. Headache 2009;49:498-508.