Q&A: Optimizing Acute Migraine Treatment Increases Productivity by More Than 50%

An analysis of CaMEO study data shows that optimizing treatment for acute migraine increased productivity by more than 50%.

Results from the Chronic Migraine Epidemiology and Outcomes (CaMEO) study, a longitudinal, Internet-based survey that aimed to describe the course of migraine over 1 year in a diverse group of individuals representative of the US population, included findings related to employment and productivity. A study focusing on the employment and productivity results was published in the Journal of Occupational and Environmental Medicine.

Physician’s Weekly discussed these findings with study coauthors Richard B. Lipton, MD, Edwin S. Lowe Chair in Neurology; vice chair, the Saul R. Korey Department of Neurology; director, Montefiore Headache Center; and professor in the department of psychiatry and behavioral sciences and the department of epidemiology and public health at Albert Einstein College of Medicine and Montefiore Medical Center; Dawn C. Buse, PhD, clinical professor of neurology at Albert Einstein College of Medicine and assistant professor in the clinical health psychology doctoral program at Ferkauf Graduate School of Psychology, Yeshiva University; and Aubrey Manack Adams, PhD, therapeutic area lead for therapeutic neurotoxins and migraine at AbbVie.

Physician’s Weekly: Why study the impact of migraine on productivity?

Dr. Lipton: Despite numerous approved treatment options, many people with migraine report dissatisfaction with acute treatment due to limited effectiveness (either not taking away headache/symptoms or recurrence of headache/symptoms), unwanted side effects, or general poor tolerability. Non-optimized acute treatment can result in uncontrolled attacks, use of inappropriate treatments, or overuse of acute medications, which can lead to medication overuse headache and other undesirable outcomes. 

In people with migraine, as headache frequency goes up, migraine-associated disability also rises. Less is known about the influence of acute treatment on workplace productivity. Clarifying this relationship highlights the importance of optimizing acute treatment. Benefits inure to people with migraine, their families, their employers, and more broadly to society.

PW: How was the study conducted?

Dr. Buse: The objective was to characterize whether the level of optimization of a person’s acute migraine treatment was related to work productivity. We evaluated this question across the migraine spectrum, ranging from people with migraine who reported headache on a couple of days per month up to people who reported headache during days on half the month or more. The CaMEO Study dataset we analyzed included 2,455 people with migraine who reported use of prescription acute medications for migraine and full-time employment. To characterize the degree to which an acute treatment was “optimized,” we used the 5-item Migraine Treatment Optimization Questionnaire. To evaluate the spectrum of migraine, we grouped individuals based on the number of headache days they reported per month: 3 or fewer days, between 4 and 7 days, between 8 and 14 days, and 14 or more days.

PW: What were the primary results?

Dr. Adams: The main finding was that people with migraine whose acute treatment was well optimized had less lost productive time, or combined absenteeism and presenteeism, compared with people whose acute treatment was not well optimized or not at all optimized. This effect was observed across the entire study population and was most pronounced in those with 15 or more headache days per month (or people with chronic migraine). In this subgroup, very poorly optimized treatment was associated with a mean of 30.4 days of lost productive time over the past 3 months. However, in this same subgroup, respondents who reported that their acute treatment was well optimized reported a mean of 7.1 days of lost productive time in the past 3 months. Well optimized acute treatment increased days of productivity by more than 50%.

Dr. Lipton: The data show that when acute treatment is optimized, people with migraine experience less lost productive time as measured by absenteeism (missed work) and presenteeism (reduced effectiveness at work). Notably, the subgroup reporting that their acute treatment was not at all optimized showed nearly three times more total lost productive time over the prior 3 months compared with the subgroup with fully optimized acute treatment group (12.5 days vs 4.4 days, respectively).

PW: What are the implications of your findings?

Dr. Buse: We hope our results help emphasize the importance of acute treatment optimization and stress how detrimental a lack of optimization can be on an individual’s work life. Unfortunately, undertreatment and suboptimal acute treatment of migraine is common. It is important for clinicians to work with their patients to periodically assess the efficacy and tolerability of their acute treatments, as well as preventive treatments, if indicated, to progress toward optimization of the patient’s overall treatment regimen.

PW: What should future research focus on?

Dr. Adams: Research is needed to explore the actions that people with migraine, their clinicians, and their employers can take to improve the overall health and well-being, and thereby the productivity, of people with migraine in the workplace. Over the past few years, the shift toward remote work in some fields has changed the experience of some people with migraine. While this change may be associated with several benefits, such as greater flexibility and the ability to limit potential triggers, this change may also present new challenges that should be studied. Additionally, our study evaluated the relationship between acute treatment optimization and lost productive time in separate subgroups of CaMEO respondents who reported low and high treatment optimization. Evaluating the impact of an improvement in acute treatment optimization across time in the same group of people would expand our results.