Study Underscores Migraine's Substantial Economic Impact on Employers

Study results highlight the economic toll of migraine on employers in Japan.

Results of a cross-sectional employee population survey conducted at a Japanese information technology (IT) company revealed a high prevalence and disease burden among employees with migraine associated with substantial losses in productivity and employer cost. The findings were published in The Journal of Headache and Pain and indicated presenteeism caused more economic loss than absenteeism.

Although migraine accounts for the global leading cause of days lost due to disability among those younger than 50 years, a paucity of evidence exists on the impact of the condition and other headache disorders on cost and productivity losses in the workplace, authors wrote.

According to the World Health Organization, approximately 958.8 million individuals suffer from migraine worldwide. In Japan specifically, around 8 million people are affected by migraine and the condition costs the nation’s economy $3 billion in US dollars each year.

“Workers of IT companies have been engaging in intellectual and cognitively challenging work and are considered to be a suitable population for our initial study on the impact on work productivity as a result of headache disorders,” researchers wrote.

The survey was conducted between May and September 2018 and participants completed a comprehensive questionnaire to determine prevalence and disability caused by migraine and tension-type headache (TTH). To measure the severity of impact on work and daily life, participants completed the Migraine Disability Assessment Score (MIDAS) and Work Productivity and Activity Impairment (WPAI) questionnaire.

“To estimate the economic loss due to headache, we calculated the number of days of headache, moderate or severe headache, the days off work due to headache, the half-days off work due to headache, and when work efficiency was reduced to less than half due to headache, using MIDAS,” authors wrote. “The economic loss due to absenteeism and presenteeism caused by headache was calculated using the age-specific wage in the IT industry according to the Basic Survey on Wage Structure in 2018 by the Ministry of Health, Labor and Welfare.” Presenteeism was defined as an individual’s loss of work productivity resulting from health conditions and disease symptoms.

A total of 2458 cases were included in the final analyses, of which individuals with migraine accounted for 13%, those with TTH for 53%, migraine and TTH (M/TTH) for 4%, other headache groups (HA) 15%, and no headache 15% (NHA). Baseline analyses found the mean age of those with migraine and HA was significantly younger compared with those with TTH, while body mass index (BMI) of the M group was significantly lower than that of the TTH group.

The majority of those surveyed were male (n=1963) and ages ranged from 25 to 65. All results are in US dollars. Analyses revealed:

  • The number of days when productivity at work was reduced by half or more because of headache was significantly higher in migraine compared with TTH (P < .05)
  • The norm-based scoring of the 12-item short-form health survey second edition (to measure health-related quality of life) was significantly lower in M/TTH and migraine than TTH (P < .05)
  • The economic loss due to absenteeism for migraine was calculated to be $238.3 /year/person for day-off and $90.2/year/person for half-day off using MIDAS
  • The economic loss due to presenteeism for migraine was calculated to be $375.4 /year/person using MIDAS and $2217/year/person using WPAI
  • Estimated cost of productivity loss associated with presenteeism using WPAI was calculated at $21.3 billion/year in Japan as a whole
  • 40% of those with migraine had interictal symptoms, and the impact of these symptoms on work was significantly higher in the migraine group compared with the TTH group
  • The number of days with presenteeism was significantly higher in those with chronic migraine compared with episodic migraine
  • 72% of individuals did not seek medical consultation for migraine while 63% of patients indicated that they could not cope with their illness

Overall, compared with individuals with NHA or TTH, those with migraine “had significantly more missed workdays, and experienced a greater impact on work productivity, physical and mental health and economic cost to the employer,” authors wrote. Findings also showed migraine can even have an impact on work efficiency and economic losses when employees work on days without headache.

Of those surveyed, 98% of migraine sufferers had never been treated with preventive medications. In East Asia, many migraineurs tend to use over the counter instead of prescription medication, researchers said. “Therefore, in order to improve the economic loss due to migraine, it is important to improve awareness around the availability and importance of using preventive treatments that reduce attack frequency and improve interictal burden in those patients with an unmet treatment need.”

Previous research has also found educational and counseling support programs within an employee population can decrease migraine-related disability and promote disease self-management. Authors also noted the role stigma plays in the burden and economic loss due to migraine as they wrote “individuals with migraine reported a significant lack of understanding of headache in the workplace, impaired relationships due to headache, and guilt about burdening bosses and colleagues with headaches.”

In total, findings “support the development and implementation of workplace programs to raise awareness and understanding, reduce stigma, improve migraine management and reduce the burden and costs associated with lost workplace productivity,” researchers concluded.


Shimizu T, Sakai F, Miyake H, et al. Disability, quality of life, productivity impairment and employer costs of migraine in the workplace. J Headache Pain. Published online April 21, 2021. doi:10.1186/s10194-021-01243-5

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