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TELUS Health Conference 2024: Reducing the impact of migraine in the workplace

For employees with migraine disease, workplace accommodations and quicker access to more effective, higher-cost therapies can significantly improve productivity, emphasized two physicians during TELUS Health’s annual conference on April 30.

“I see the suffering and the stigma, and it just breaks my heart to see how patients, if they had been treated properly, could have worked better. [Instead] some of them are off work, some of them retired early,” said Dr. Elizabeth Leroux, a Montreal-based neurologist and President of Migraine Canada, who participated in a panel discussion on the impact of illness in the workplace, with a focus on migraines.

Perhaps most important for employers is the level of presenteeism among migraine sufferers who continue to work. “These are people that will go to work no matter what and they will do their best to get through their day,” said Leroux, adding that “a lot of the burden of migraine is hidden [because] a lot of patients do not want their migraine to show.”

Leroux noted that migraines and severe headaches are more prevalent in the workplace than arthritis, diabetes and depression. She then presented results from two recent Canadian studies that seek to quantify the impact of migraine in the workplace. In one study, released in 2022, people with migraine were as likely to report reduced productivity (61 per cent), or presenteeism, as they were missed time from work (61 per cent), or absenteeism. Researchers estimated the total direct and indirect annual cost for the employer was between $15,600 and $25,700, depending on the frequency of the migraines.

Another recent study by researchers at the University of British Columbia, still to be published, calculated average annual costs for employers of between $9,200 and $15,200. These figures were based on an hourly wage of $33.55, the average in Canada at the time of analysis in 2023.

The British Columbia study also found that presenteeism accounted for between 57 per cent and 78 per cent of the lost productivity, depending on the severity of the migraine (the more severe the migraine, the more the productivity loss was due to absenteeism rather than presenteeism).

“We have to do a better job of supporting these patients,” said panelist Dr. Christine Lay, Professor of Neurology and Founding Director of the Headache Program, University of Toronto. “We have to change the workplace environment...[and], very importantly, we have to get targeted therapy available to these patients.”

Lay presented a third Canadian study by IQVIA Canada, which surveyed migraine patients in 2023. It calculated the average annual cost to employers due to productivity loss ranged from $36,800 to $42,500. It further calculated that presenteeism accounted for 77 per cent or 67 per cent of these costs, respectively.

In summary, presenteeism was consistently responsible for more than half of the total costs to employers, while the costs ranged widely between the three studies, from $9,200 to $42,500 annually.

These types of real-world studies are increasingly important to help determine coverage criteria for the growing number of higher-cost drugs and whether the drug will be covered at all, noted panelist Neda Nasseri, Director, Product, Desjardins Insurance.

“Real-life productivity data can be interesting, via patient-reported outcomes, to illustrate the impact of the drug on patients’ daily lives, their work productivity and even overall wellbeing. We also welcome patient testimonials,” said Nasseri.

However, real-world data brings their own challenges. A big one is “the lack of standardization in the collection of the data and therefore variability in how presenteeism and absenteeism are measured across studies. That makes it super challenging to compare findings and draw consistent conclusions, and this was demonstrated here today [with these] great Canadian studies,” stated Nasseri.

Nonetheless, “we’re definitely going to look at that data,” she reiterated.

Doctors Leroux and Lay hope the Canadian studies so far make the case for quicker access to coverage for the newer migraine drugs, which generally cost $5,000 to $7,000 annually and debuted in Canada in 2018. “I know a lot has been said about the costs of these different treatments and we do have to fill a lot of forms to justify those treatments, but if you look at…those [productivity] costs, it seems reasonable,” noted Leroux.

She added: “It’s almost a miracle what we see in our clinics with these new drugs. I just wish we could treat way more people and demonstrate the impact.”

Lay echoed Leroux. “If you get them on the proper acute therapy, that migraine attack could go down to three hours instead of three days. And immediately you see a benefit of return-to-work, and reductions in presenteeism and absenteeism. These individuals see a 50 per cent, 60 per cent or even 75 per cent reduction in their migraine attacks.”

Lay also recommended a simplified prior authorization process for these drugs, especially for patients who suffer severely despite having tried other migraine drugs.

All three panelists agreed that employers can take immediate action by improving their workplace environment. “Schedule flexibility is appreciated by everyone but for a person with migraine, it can make a massive difference,” said Leroux.

In addition to flexible work hours, employers can do the following to prevent migraine triggers in the workspace:

  • Dimmable lighting and natural light (replacing fluorescent lighting)
  • Water stations and healthy snacks
  • A designated area or room that is quiet with dim lighting
  • Scent-free offices and the limiting of odours and loud noises in industrial spaces
  • Ergonomic workstations
  • Mini breaks as needed
  • Remote work
  • Low-stress environments and stress management programs

Education is also key to removing stigma. “Do some education in the workplace so that colleagues understand what [people with migraine are] experiencing,” said Leroux. “Why perhaps they now have a desk lamp and why they might be on flexible hours. So that rather than discounting this person as a weak employee, they understand that they’re really battling a brain disease and doing their best.”

View the conference presentation: