The Astronomical Costs of Migraine in Canada
by Shelagh, Ross,
World Headache Alliance
More patients who visit the doctor complain of headaches than any other
single disorder. In fact, the World Health Organization now lists
migraine among the world's top 20 of all recognized disorders, with an
impact that extends far past the suffering individual, to the family and
community. And yet, headache disorders continue to be under diagnosed,
misdiagnosed, and mistreated. Although headache is clearly a major
significant health burden, the public and many health care professionals
see it as a somewhat trivial complaint. As a result, the physical,
emotional, social and economic burdens of headache are poorly
acknowledged compared with those of other, less prevalent, neurological
disorders.
Who is Affected?
It has been estimated that 2.6 million adult Canadian women and just
under one million adult men suffer from migraine, but only half are
likely to have been adequately diagnosed by a doctor despite excellent
access to healthcare and prescription medications. As well,
approximately 10% of children and 28% of adolescents have migraine
headaches. Although many headache sufferers seek medical attention at
some time, many do not return for follow-up medical supervision,
choosing instead to self-treat with over-the-counter (OTC) medications
and alternative therapies. And many headache sufferers who take OTC pain
medication to treat headaches don't realize that over-use can lead to
"rebound" headache which can result in addiction to medications, more
severe pain when they wear off, and possible serious side effects.
The impact of headache, therefore, is substantial; migraine is
considered to be a hidden epidemic. A Canadian survey shows that 92% of
migraine sufferers have disability ranging from diminished function to
requiring bed rest. Sufferers feel isolated, misunderstood, and often
desperate.
The Economic Costs
The greatest costs of headache are often related to “direct costs” -
hospital admissions, diagnostic tests, and therapies - while the most
important individual “indirect costs” are related to the loss of
workdays or reduced time spent working during a workday, due to
headache. Approximately three-quarters of migraine sufferers have to
temporarily stop normal work activity and many must leave work
altogether when they have a migraine. In the U.S. alone, the annual cost
of migraine is estimated to be between $5.6 and $17.2 billion in lost
work productivity. In Canada the cost of migraine in the workplace is
approximately $500 million annually and in Ontario, the average overall
annual cost due to migraine is estimated to be $3,025/patient, mostly
due to indirect costs.
The Domestic/Emotional Costs
Because migraine is misunderstood, often misdiagnosed and under-treated,
family members too can experience confusion, anger and frustration. It
has been shown that the majority of migraineurs experience a substantial
reduction in their ability to participate in household work and chores.
Many report missed family, social and leisure activities, and avoid
making plans for fear they will have to cancel due to headaches. Many
say they argue with their partners and children because of their
migraine and believe they would be better partners if they did not
suffer from migraines. Similarly, many partners of migraineurs feel they
argue more because of headaches and report other negative effects on
their relationships at home.
As well, recurrent headaches impact a child’s life in many ways: school
absences and reduced performance, and fewer interactions with family
members and friends. Because migraines come with little advance warning,
it is difficult to plan for school absences. Children with migraine may
spend a lot of time catching up on assignments while at the same time
learning new material.
To complicate matters, the addition of depression or anxiety to migraine
(common comorbidities of migraine) has a huge impact on healthcare
costs. Regardless of the age of the sufferer, co-existing psychiatric
disorders markedly increase the cost of treatment for migraineurs. All
of this emphasizes the importance of diagnosis and treatment to
effectively relieve pain and restore the sufferer’s ability to function.
What Can be Done?
Lack of awareness that headache disorders are real, burdensome, and
treatable, is a major problem throughout the world. As a result, a
number of initiatives have been developed to raise awareness and support
for headache sufferers so they will be encouraged to seek support and
get access to up-to-date therapies. These include the establishment of
World Headache Awareness Month (WHAM), which is held annually in
September, global conventions that involve training and support for
governmental agencies, websites that offer informative, up-to-date
headache information for sufferers, and representation of headache
organizations and experts at international health conferences.
While headache disorders continue to slowly gain recognition as a major
health burden, dispelling the myths and overcoming stigma remain key
challenges. Headache sufferers, their friends and families must make
their voices heard to make sure governments allocate the necessary
resources to ensure the availability of newer and more effective
treatment options.
“Never doubt that a small group of thoughtful, committed people can
change the world. Indeed, it’s the only thing that ever has.” Margaret
Mead
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