Migraine and Work-Disability: New Treatments Reduce Work-Related Burden Among Migraine Population

Migraine's economic burden is mostly due to reduced work productivity, which is underestimated by commonly used patient-reported outcome measures (PROMs). In this prospective, multicentric, real-world study, we used the HEADWORK questionnaire (HWq), a disease-specific work-related PROM, to assess the impact of anti-calcitonin gene receptor peptide (anti-CGRP) monoclonal antibodies (mAbs) on work-related limitations.

Migraine patients eligible for treatment with anti-CGRP mAbs were enrolled from three headache centers: IRCCS C.Besta, Mondino Foundation and Policlinico Campus Bio-Medico. Migraine days per month (MMDs), monthly acute medications (MAMs), and HWq were collected every 3 months up to 12 months of follow-up. A GLM design was used to address change in HWq scales' score (primary endpoint), MAMs and MMDs; we also tested whether change in HWq differed across responders' group and defined minimum clinically important difference (MCID) for HWq.

Out of 175 patients (130 females, mean age 48.9 ± 8.8) 152 completed the study. Among them: 37 (24.3%) were non-responders, 69 (45.4%) were responders, and 46 (30.3%) were super-responders. A reduction in all endpoints was observed since the first 3 months of treatment and maintained up to 12-month follow-up. Time*group interaction showed a superior effect, both in HWq scales and MAMs, with super-responders achieving the best outcome.

A significant reduction in MMDs and MAMs and an improvement in both HWq scales in patients under mAbs treatment was found from the 3-month follow-up onwards. The positive impact on work-related disability should be taken into consideration in planning cost-effectiveness evaluations and drug policy strategy.