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Migraine: costs and consequences

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.

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:


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

  US$ million
Cost element Men Women Total
Medical 193 1,033 1,226
Missed workdays 1,240 6,662 7,902
Lost productivity 1,420 4,026 5,446
Total     14,574

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



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

Migraine Depression Number Suicide attempts/100
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:

  1. XH Hu et al. Burden of migraine in the United States. Archives of Internal Medicine 1999 159: 813-8.
  2. MD Ferrari. The economic burden of migraine to society. Pharmacoeconomics 1998 13: 667-76.
  3. 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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