Migraine Presenteeism Creates More Lost Work Time

Patient Expert

PO119 Employment and work impact

"Migraine sufferers come to work or stay there while enduring extremely severe pain, thinking it's better to be at work than staying at home. But Migraine suffering in the workplace has a significant negative impact on productivity and lost time too. In other words, 'presenteeism' leads to more lost work time than absenteeism." ~ Dr. Stephen H. Landy, lead author2

We all know we're less productive when we have a Migraine, but new research shows it may be even worse than we think. Study data has shown that employees who go to work with a Migraine or stay at work with a Migraine are less productive than if they had stayed or gone home. Two studies have recently demonstrated this particular aspect of living with Migraines.

I'll summarize at the end of this article. Here are details from the two studies:

Stewart et al study:1

Study objective: To compare the work productivity and employment status of chronic Migraine sufferers to those Migrainuers with less frequent Migraine attacks.

Study background: Chronic Migraine (CM) has been recognized as significantly more disabling than episodic Migraine (EM), but the work impact of chronic Migraine has yet to be quantified.

Study methods:

• In 2005, questionnaires were mailed to 24,000 severe headache sufferers identified from a previous US population survey.

• Data were from 11,624 respondents defined as having Migraine (by ICHD-II standards) who completed the employment questions were analyzed.

• Four groups were compared:

  • chronic Migraine (CM): Migraine with 15 or more days of headache/month, 640 participants
  • high-frequency episodic Migraine (HFEM): Migraine with 10-14 days of headache/month, 587 participants
  • moderate-frequency episodic Migraine (MFEM): Migraine with 4-9 days of headache/month, 3,715 participants
  • low-frequency episodic Migraine (LFEM): Migraine with 0-3 days of headache/month, 6,682 participants

• Lost Productive Time (LPT) was defined as the sum of missed hours plus reduced productivity hour equivalents.

• The cause of LPT was self-defined by the respondent.

• Employment status was self-reported

Study results:

• For employed individuals with Migraine, the average LPT per worker/week specifically due to Migraine was 4.5 hours for those with CM compared to 1.2 hours/worker/week for those with LFEM.

• LPT due to non-Migraine causes was similar among the Migraine frequency groups.

• The 9.1% of employed Migraine sufferers with HFEM and CM account for 20.7% of the overall LPT from individuals with Migraine. However, when including those on medical leave, the 10.4% of employable Migraineurs with HFEM and CM account for 34.7% of the overall lost work time.

Study conclusions: "Among those with Migraine, the occupational impact of CM and HFEM are substantial and - further - will be underestimated if the effect of unemployment is not taken into account."1

**Landy et al study:**2

Study objectives: To assess Migraine characteristics in relation to work as well as the impact of Migraine on work productivity, considering both absenteeism and presenteeism.

Study background: "The impact of Migraine on lost work productivity has been well researched through clinical trials and survey instruments. Previous research has demonstrated that presenteeism is a greater contributor to lost work time than absenteeism, however, quantifying these differences remains controversial."2

Study methods:

• included a baseline survey and three follow-up, 48-hour post-Migraine surveys that collected data on respondents' next three Migraine attacks.

• study inclusion criteria: US residency and citizenship, minimum age of 18, employed fulltime, self-reported healthcare provider diagnosis of Migraine, average of 2-8 Migraines per month with fewer than 15 headache days per month, and treatment with prescription or over-the-counter oral Migraine medications.

• Data were weighted to be representative of adults in the US who are diagnosed with Migraines.

Study results:

• 509 Migraineurs participated in the study, resulting in 1,527 Migraine attacks.

• 64% of Migraines occurred on a workday.

• 32% of Migraines began up to five hours prior to work

• 40% of Migraines began while at work

• 28% of Migraines occurred after work.

• 28% of workday Migraines resulted in absenteeism

• 11% of workday Migraines resulted in a full day of work lost, 5% led to a late arrival, 12% led to leaving work early

• Workday Migraines beginning before or during work hours accounted for 974 total hours lost due to absenteeism, which comes to 1 hour and 24 minutes lost per Migraine.

• Presenteeism was observed in 62% of workday Migraines, resulting in an average of 25% work productivity loss.

• 1,301 hours were lost due to presenteeism.

• Presenteeism accounted for 57% of total work time lost.

Study conclusions: "Migraines occurring on a work day resulted in substantial lost work productivity as a result of both absenteeism and presenteeism. Our research supports previous findings that presenteeism leads to more lost work time than absenteeism. Pain severity at peak was a key contributor to both of these work-related consequences of Migraines. Addressing these and other Migraine-related issues that impact work productivity will help Migraineurs to better manage their condition, improve their ability to get to work or stay at work, and to function better while at work."2

Summary and comments:

Let me summarize the findings of these studies:

  • 28% of Migraines occurring on workdays, resulted in absenteeism: 5% late arrival, 12% leaving early, and 11% in a full day taken off.
  • 62% of Migraines that occurred on workdays resulted in presenteeism, which is staying at work with a Migraine.
  • Migraineurs who have chronic Migraine (15 or more Migraine days per month) experience nearly four times more productive time lost than those with episodic Migraine.
  • The average lost productive time due to Migraine per worker/week was 4.5 hours for those with chronic Migraine and 1.2 hours/worker/week for those with episodic Migraine.
  • If Migraineurs who were on medical leave were included, 10.4% of employed Migraineurs with high-frequency episodic Migraine and chronic Migraine accounted for 34.7% of overall lost work time.

The conclusion of the Landy et al study bears repeating:

"Migraines occurring on a work day resulted in substantial lost work productivity as a result of both absenteeism and presenteeism. Our research supports previous findings that presenteeism leads to more lost work time than absenteeism. Pain severity at peak was a key contributor to both of these work-related consequences of Migraines. Addressing these and other Migraine-related issues that impact work productivity will help Migraineurs to better manage their condition, improve their ability to get to work or stay at work, and to function better while at work."2

Indeed. Addressing these issues is vital, yet very challenging. Migraine is still all too misunderstood by the public, by co-workers, by employers. Migraineurs often fear the loss of their jobs if the call off work, and I believe the presenteeism demonstrated in these studies is often a direct result of that fear. Hopefully, this type of research can be used to enlighten those in authority who often make life so much more difficult for Migraineurs.


Resources:

1 Stewart, WF; Woods, GC; Manack, A; Buse, DC; Varon, SF; Scher, AI; Serrano, D; Reed, M; and Lipton RB. "Employment and work impact of headache among episodic and chronic Migraine sufferers: results of the American Migraine prevalence and prevention (AMPP) study." 14th International Headache Congress. Philadelphia. September, 2009.

2 Landy, SH; Runken, MC, Bell, CF, Haskins, LS, and Higbie, RL. "Impact of Migraine occurrences on work productivity." 14th International Headache Congress. Philadelphia. September, 2009.

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