Migraine is defined by the International Headache Society as a ‘common disabling primary headache disorder’ with two major subtypes: migraine without aura, and migraine with aura. Each subtype is identified according to the specific features of the headache and the preceding or accompanying symptoms. In addition, migraine can be classified as episodic or chronic by frequency of occurrence (International Headache Society, 2013).
Epidemiological studies have documented a high prevalence, socio-economic impact and personal burden of migraine (International Headache Society, 2013). Globally, over 10% of the population is estimated to suffer from migraine with an estimated lifetime prevalence of 14% (Stovner et al., 2007; Vos et al., 2016; Woldeamanuel & Cowan, 2017). The high prevalence is also accompanied by a significant burden; the Global Burden of Disease Survey 2010, ranked it the third most prevalent disorder and seventh-highest specific cause of disability worldwide (International Headache Society, 2013).
Migraine is known to more commonly affect women than men while the prevalence peaks in the third decade of life, regardless of gender (Bigal et al., 2006; Lipton et al., 2007; Woldeamanuel & Cowan, 2017).
Migraine affects quality of life and a patient’s functional ability during, immediately after, and between migraine episodes. In the 2014 Eurolight Study, around 28% of females and 18% of males reported losing more than 10% of days in the preceding 3 months due to migraine (Steiner et al., 2014).
Personal, family and economic burden associated with migraine appears to worsen with increased frequency of attacks (Blumenfeld et al., 2011; Stuginski-Barbosa et al., 2012; Bera et al., 2014).
Table 1: The personal burden of migraine
In the American Migraine Prevalence and Prevention study of >18,000 individuals with migraine (Lipton et al., 2007):
Migraine is associated with high societal and economic burden, a fact evidenced by studies employing the Years Lived with Disability (YLDs) scale, as well as reported costs associated with the condition (Stovner et al., 2008; Linde et al., 2012; Olesen et al., 2012).
YLDs are defined as the number of years of healthy life lost due to disability caused by the non-fatal experience of disease or injury in a population. Migraine ranks amongst the 10 leading causes for YLDs worldwide, higher in comparison to epilepsy (ranked 29th) and Alzheimer's (ranked 26th). Migraine also significantly affects the lives of younger adults living with the condition; it was the third leading cause of YLDs worldwide within the 25–39-year age bracket in 2015 (Vos et al., 2016).
Migraine is estimated as the greatest burden among the following eight chronic neurological conditions in Europe (Raggi & Leonardi, 2015):
In addition, as migraine is associated with significant healthcare-resource utilisation, overall economic burden of the condition is high. There are several contributors to annual healthcare costs (Munakata et al., 2009; Stokes et al., 2011; Bloudek et al., 2012; Linde et al., 2012), including:
In a recent US cost analysis study, mean annual direct all-cause healthcare costs were $6,575 higher than those of matched patients without migraine (p<0.01) (Bonafede et al., 2018).
Furthermore, the associated indirect societal costs of migraine, such as absenteeism and loss of productivity at work, can be significant (Munakata et al., 2009).
In the US, productivity loss accounted for 55.7% of total costs for migraine (69.6% for patients who developed chronic migraine) (Munakata et al., 2009).
The annual cost of migraine in Europe is ~ €18-27 billion and ~77- 93% of the total costs are indirect (Stovner et al., 2008; Linde et al., 2012; Olesen, 2012).