BOSTON—Most migraines occur in the morning and result in absenteeism or reduced work productivity, according to a study presented at the 50th Annual Scientific Meeting of the American Headache Society.
To determine the time of migraine onset and the impact of time of migraine attacks on work productivity, Stephen H. Landy, MD, who is a Clinical Professor of Neurology and the Director of the Wesley Headache Clinic in Memphis, and colleagues invited 200 people 18 and older to complete a 20-item Web-based survey. The survey was designed to collect information about patients’ migraine history within the past three months and most recent migraine attacks. Inclusion criteria were a physician diagnosis of migraine, at least one migraine attack during the past month, full-time employment, and use of an oral prescription or OTC medication to treat their migraine.
Timing and Impact of Migraine
Participants reported an average of 8.4 migraine attacks during the previous three months, with an average of 3.7 occurring prior to the subjects arriving at work. Migraine onset was bimodally distributed, with peaks occurring at 10 am and 3 pm. Fifty-four percent of migraines occurred between 4 am and 11 am, and 58% occurred during daytime work hours (ie, 8 am to 5 pm).
Seventy-nine percent of participants had their most recent migraine attack on a workday. Migraine started before work in 24% of these patients, at work in 46%, and after work in 9%. Among people whose most recent migraine occurred before work, 70% went to work with a migraine, 15% did not go to work, and 11% went to work late. Among those whose most recent migraine occurred at work, 77% stayed at work, while 23% went home.
“When asked whether their most recent migraine impacted work performance, 73% responded ‘Yes,’” said Dr. Landy and colleagues. “Of those subjects, 74% reported productivity levels below 80%, and 39% reported levels below 60%.”
For their most recent migraine attack, 73.5% of participants reported moderate to severe pain at onset; 51.5% used an OTC medication first, and 26% used an oral triptan first. Although the study did not evaluate the use of OTC medications versus triptans in relation to subsequent work productivity, the literature suggests that “physicians should feel confident that prescribing triptans instead of OTCs will have a positive effect on workplace productivity,” Dr. Landy told Neurology Reviews.
“Results of this pilot study appear to support previous studies on migraine chronobiology, with most recent migraine attacks occurring during the morning hours,” commented the researchers. “In addition, this study suggests the time of onset of migraine does not predict the extent of absenteeism or [reduced work productivity].
“Further research with larger populations, longer study durations, and shorter recall periods is recommended,” Dr. Landy’s group concluded.
—Karen L. Spittler