MEDICATIONS: TREATMENT TO PREVENT MIGRAINES BOOSTS WORK PRODUCTIVITY

April 5, 2007 — For workers with migraines, taking a daily medication to prevent headache attacks can reduce lost productive time on the job, reports a study in the March Journal of Occupational and Environmental Medicine, official publication of the American College of Occupational and Environmental Medicine (ACOEM).

Led by Jennifer H. Lofland, Pharm.D., M.P.H., Ph.D., of Thomas Jefferson University in Philadelphia, the researchers analyzed data on 325 working adults with a history of migraine attacks. This study is believed to be the first to measure the effect of a migraine preventive medication on both absenteeism and presenteeism (days employee is at work but performing at less than full capacity), using data from multiple randomized, double-blind, placebo-controlled clinical trials. Half of the workers were randomly assigned to daily treatment with a prophylactic medication, topiramate, an anti-convulsant used frequently for the prevention of migraines, while the other half took an inactive placebo. The analysis was based on previous studies showing topiramate's effectiveness in reducing the frequency of migraine attacks but did not measure the number of hours worked with migraine headache (presenteeism).

Treatment with topiramate had only a small effect on work absenteeism. Average missed work time was one hour per week for workers taking topiramate, compared to 1.5 hours per week for those taking the placebo.

Topiramate had a much greater effect on presenteeism. When reductions in presenteeism and absenteeism were added together, total lost productive time per month decreased significantly for workers taking topiramate. Use of topiramate resulted in an increase of 9.5 hours of work productivity from a loss of 14.6 hours before treatment to 5.1 hours during treatment.

However, lost productive time also decreased for workers taking the inactive treatment, reflecting a significant "placebo effect" in studies of topiramate. Nevertheless, the gain in productivity remained higher with topiramate — especially in terms of reduced presenteeism.

Like other chronic diseases, migraines can cause substantial losses in worker productivity. Migraines are particularly important because they are most common among people in their thirties and forties, a time when they are active members of the workforce. Migraines carry high costs for employers — in addition to direct health care costs of $1.25 billion per year (in 2003 dollars); costs due to migraine-related lost productivity have been estimated at up to $28.7 billion.

Taking topiramate to prevent migraine attacks reduces lost productive time for working patients, the new results suggest. Most of the productivity benefit of topiramate results from decreased presenteeism — as in previous studies of medications used to stop migraine attacks once they have started. "The results of our study suggest that employers should have treatments available for their employees with migraines that reduce both presenteeism and absenteeism in the workplace," the researchers conclude.