Study Summary: The Effects of Headache-Free Days on Quality of Life, Work, and Healthcare Use Among Patients With Migraine



Migraine is a common and potentially disabling type of primary headache disorder that may be either episodic (occurring <15 days/month) or chronic (≥15 days/month for <3 months). The results of previous studies have shown that migraine can be associated with decreased health-related quality of life (HRQOL), decreased work productivity and activity levels, and increased healthcare resource utilization (HRU). The objective of this European study involving patients with migraine was to assess the association between the number of headache-free days and patient-reported HRQOL, work productivity and activity levels, and HRU.1


Patients in this retrospective cross-sectional study were drawn from individuals who took part in the 2017 National Health and Wellness Survey (NHWS). The study included adults aged at least 18 years from France, Germany, Italy, Spain, and the United Kingdom. To qualify for the study, survey participants had to have a migraine diagnosis from their physician, at least 1 migraine episode in the previous month, and 4 or more headache days in the previous month. Along with sociodemographic and general health characteristics, the following outcomes were evaluated: HRQOL (evaluated by the Medical Outcomes Study 12-Item Short-Form Survey Instrument, version 2, and the EuroQoL-5D), work productivity and activity impairment (evaluated by the General Health version of the Work Productivity and Activity Impairment questionnaire), and HRU.1


Of the 62,000 total respondents to the NHWS, 1569 met the inclusion criteria and were included in the study. The analyses indicated weak to significant associations between headache-free days and certain sociodemographic and general health characteristics. More headache-free days were experienced by respondents who were employed, married, and/or educated at the university level than by those who were not. Also, more headache-free days were experienced by respondents who had fewer comorbidities and a lower body mass index.1

One headache-free day was shown to be associated with improvements in HRQOL. An increase of 1 headache-free day also showed an anticipated decrease in healthcare provider visits, work absences, impaired work, and diminished activity; these outcomes further improved with 5 headache-free days.1


Prior studies have typically focused on the relationship between patient-reported outcomes and migraine by comparing people with migraine with those without migraine, or by comparing people with chronic migraine with those with episodic migraine. This study expands existing knowledge about HRQOL and migraine by exploring the relationship between headache-free days and patient-reported outcomes of HRQOL, work productivity, and use of healthcare resources.1

The results of previous studies support the current study’s findings: An increase in migraine days results in an increase in work productivity loss, absenteeism, and impairments experienced while at work. These results also show that people with migraine use more healthcare resources (and thus experience higher healthcare costs) due to more visits to their healthcare providers compared with controls without migraine.1

Therapeutics and lifestyle measures exist to manage migraine. The goal for prophylactic therapy is to decrease frequency and severity of migraine with the goal of increasing HRQOL and alleviating some of the healthcare economic burden for migraine patients. Certain migraine medications have demonstrated the ability to alleviate symptoms and improve outcomes. A systemic review of the literature also indicated that improving physical health can decrease the number of migraine days experienced by patients.1

This study has several potential limitations. The study was conducted via an online survey, which means that a chance exists that certain populations were excluded due to lack of internet access (eg, elderly people, institutionalized patients, and those with severe comorbidities and disabilities). In addition, the study data were self-reported. Therefore, there is no way to confirm diagnoses or healthcare visits. The severity and duration of migraine episodes were not assessed; however, they may be important variables in the study.1


The results of previous studies have shown decreased HRQOL and productivity among patients with migraine. This study shows for the first time that an increase in headache-free days is associated with improved productivity and HRQOL and decreased healthcare costs. Therefore, using medications and other measures to increase the number of headache-free days for migraine patients may provide benefit to both patients and society.1


1. Doane MJ, Gupta S, Vo P, Laflamme AK, Fang J. Associations between headache-free days and patient-reported outcomes among migraine patients: a cross-sectional analysis of survey data in Europe [published online July 26, 2019]. Pain Ther. 2019. doi: 10.1007/s40122-019-0133-1.