Evidence Table 6Work loss due to chronic headache

StudyDates and MethodsHeadache DefinitionPatient PopulationNResults
Celentano, Stewart, Lipton, et al., 1992

American Migraine Study

Mail survey
IHS migraineRepresentative sample of 15,000 US households. Obtained responses from 20,468 people age 12–80.N =2,422Headache Related Disability:
Don’t Know1.01.1
As disability level increased, prescription medication used increased

Moderate or severe disability was defined as the need for bed rest, absence from work or school, and inability to do usual activities
Clarke, MacMillan, Sondhi, et al., 19965/94–6/94IHS migraineQuestionnaire mailed to 4,200 employees of the Royal Hull Hospitals Trust (UK). Of 1,903 surveys returned 158 (8.3%) were migraine.N =15876% reported no time lost from work, 13% were absent one day, 6% two days, 6% three to five days, and 1% reported being absent more than six days

The mean absence rate was 0.49 days per month or 2 days per year

Employees with migraine spent 15.5 days per year at work with an attack, and were only 56% effective for an equivalent of 5.5 additional days of work lost

An average of two days’ absence per year due to headache would be equivalent to about 20% of all the sickness related absence in the NHS
Edmeads, Findlay, Tugwell, et. al., 19934/89–4/90

Survey and diary
IHS migraine tension- typeDiarv Study—done 3 months after Prevalence and Interview studies (1/90–3/90). 95 migraine and 55 tension-type headache sufferers completed diaries about their headaches.Diary N = 15011% of the migraine and 4% of tension-type headache occurrences caused the person to leave or not attend work
Green, 19771975–1976

Self-reported migraineEngland: surveys distributed to people in managerial positions, members of Parliament, office and factory workers, school children, and bank and insurance agency employees.N = 14,893 respondentsJust over 1/3 of males and just under 1/3 of females said they were never absent from work due to migraine

Migraineurs were absent from work approximately 4 days/year due to headache
Jones and Harrop, 19808/79

Self-reported migraineEmployees of General Foods Ltd. (UK). Surveyed 2,100 employees, 895 responses returned. Of the 895, 20% reported migraine at some time.N =895 respondentsOver 8 months, 98 employees lost 281 work days due to migraine

Mean number of days absent, 2.87; extrapolated to 1 year, the mean number of days lost would be 4.30

36/111 migraine attacks during the study period occurred at work
Kryst and Scherl, 1994Spring 1990

Telephone survey
Modified IHS migraineStudy questions included as part of the Kentucky Health Survey. Sample households contacted through random digit dialing. Data on only primary respondents included as part of this analysis.N = 55 migraine

N = 32 serious non-migraine
56.3% reported that headache affected their ability to work efficiently (outside or inside the home)

37.9% reported that headache affected their attendance at work or school

Many respondents continued to attend work or school even though they had a headache
Linet, Stewart, Celentano, et al., 1989

Migraine Prevalence Study

(Washington County Study)

Telephone survey and diary
Migraine1Washington County, Maryland residents age 12–29. Sample of all households with telephone.N=10,169

Not all subjects answered all questions
Work or school missed:
1/2 day6.110.2
all day1.83.7
Disability was most pronounced among women ages 24–29; this was the least affected age group in males
Micieli, Frediani, Cavallini, et al., 19951/90–1/91

IHS migraine tension-type clusterPatients recruited from the Headache Research Centers of the Neurological Institute of the University of Pavia and the University of Milan (Italy). 70% had been referred from general practice and 30% were self referred.N =400Headache during work hours was reported to be completely disabling by 58.5% episodic headache patients, 70.6% of chronic tension-type headache patients, and 30.4% of migraine + tension-type headache patients

Missed work days per month 5.1 for episodic headache patients, 3.7 for chronic tension-type headache patients, 2.4 for mixed migraine + tension-type headache patients
Mounstephen and Harrison, 1995Dates unknown

IHS migraineQuestionnaire distributed to a random sample of 476 employees of a chemical production and research facility. The sample was stratified by age and sex. The overall rate of work absence was validated by the company’s human resources database. There were 423 respondents to the questionnaire, 62 of the 423 were classified as having IHS migraine.N = 62Based on the duration and frequency of migraine attacks, the authors calculated that women would experience 144 hours of headache per year and men 44 hours. Some of these hours would be during work, but they did not collect this information specifically.
Newland, Illis, Robinson, et al., 19787/73–2/74

Mail survey
Self-reported headachePopulation based sample in Southampton, EnglandN = 2,066 respondentsAmong 655 men reporting any headache in the past year, 42 (6%) reported work loss averaging 3.7 days. All work loss occurred among men reporting headaches associated with at least one feature of migraine (unilateral distribution, warning, or nausea).
Osterhaus, Gutterman, and Plachetka, 19921986–1991

Mail survey
IHS migrainePatients previously enrolled in 1 of 2 clinical trials of a headache medication. Patients had been diagnosed by a physician as having migraine according to the IHS criteria. Patients were age 18 or over and had at least a 1-year history of migraine.N = 64829/56 males reported missing work in 1 month, they were absent an average of 2.5 days per month

250/445 females reported missing work in 1 month, they were absent an average of 2.1 days per month

55/56 men reported reduced work effectiveness; 60% as effective

430/445 women reported reduced work effectiveness; 56.3% as effective

Of the 56% of employed respondents who reported missing work due to headache, a mean of 2.2 work days were missed

Employed respondents worked an average of 5.8 days with migraine in the previous month

Annual cost of lost labor (including benefits) men: $6,864 and $3,600 for women
Rasmussen, Jensen, and Olesen, 19921/89–7/89



Physical examination
IHS migraine tension-typeRandomly selected people age 25–64 living in the western part of Copenhagen County (Denmark).N = 740

N = 119

migraine N = 578 tension-type
29/67 (43%) of gainfully employed migraineurs said they had been absent from work at least one time in the last year due to headache

91 % were absent less than 7 days, but 9% said they were absent 7–14 days

56/472 (12%) of tension-type headache sufferers said they had been absent from work at least one time in the last year due to headache

16% said they were absent more than 14 days

Women had a higher absence rate than men, but not significantly so

Absence rate among migraineurs was significantly higher than among tension-type headache sufferers
Stang and Osterhaus, 19931989

self-reported migraineNational Health Interview SurveyN = 116,929 respondentsEstimated 825,916 restricted activity days per 2 weeks among employed persons or 3.465 restricted activity days per migraineur per year

Estimate that housewives lose 38.5 million days of activity per year

Based on wages lost, they calculated that the 6,196,378 employed migraineurs lost 1.4 billion dollars per year
Stewart, Lipton, and Liberman, 1996

Baltimore County Study

Telephone survey
IHS migraineHouseholds contacted through random digit dialing. Subjects were eligible if age 18–65. Respondents were included if they had at least one headache which was not attributable to injury, hangover, pregnancy, or cold or flu.N = 1,775 migraineWomen
missed work or school:never32.7%34.357.1
1/2 the time16.313.114.3
≥ 1/2 the time20.122.314.3
% reduced work efficiencynone7.314.616.7
≥ 75%16.917.616.7
missed work or school:never43.442.40.0
1/2 the time8.919.70.0
≥ 1/2 the time16.110.633.3
% reduced work efficiencynone9.217.70.0
≥ 75%15.821.00.0
No difference was seen by race in frequency of missed work or duration of attack

Black women reported more frequent attacks but were significantly less likely to report reduced efficiency at work

Black men were also less likely to report reduced efficiency
Stewart, Lipton, and Simon, 1996

Follow-up to American Migraine Study

Mail survey
IHS migraineThe first American Migraine Study survey was mailed to a representative sample of 15,000 households. A total of 20,468 individuals age 12–80 responded. Using IHS criteria and data from that survey, 2,355 people age 18 or over with one or more migraine attacks in the previous year were identified. A second survey, the "Headache Disability and Healthcare Questionnaire," was sent to these individuals during the 12 months covered by the original survey.N = 1,663Median number of missed workdays was 1 for men and 2 for women.

Average number of missed workdays was 3.8 for men and 8.3 for women.

At least one day of work was missed in the last year by 56.4% of men and 73.6% of women.

Men reported 42% effectiveness at work; women 34%.

Lost work day equivalents (LWDE):
van Roijen, Essink-Bot, Koopman schap, et al., 199510/92(interview) 6/93 (survey)

IHS migraine migraine + tension-typeRepresentative sample of the Dutch population age 12 years and older. Questioned 10,480 people in face-to-face interviews; of these, 992 met IHS criteria, had had a headache attack in the last 12 months, and agreed to oarticioate.N =436 headache sufferers responded to the survey

N = 585 non-headache controls
10% of women and 2% of men reported some absence from work due to headache

Based on a 2-week recall period, women reported 3.9 days/year and men 1.0 day/year absent from work due to headache

Women had 22.8 hours/year and men 18.7 hours/year of reduced productivity due to headache

Women reported having 73% efficiency at work with a headache and men 69% efficiency

Abbreviations: IHS = International Headache Society; Ltd. = Limited; mod = moderate; NHS = National Health Service; sev = severe; UK = United Kingdom; US = United States


Data collection on this study began prior to the release by the Ad Hoc Committee of its new definition of migraine. Study questions were not revised to reflect the new definition.

From: Evidence Tables

Cover of Resource Utilization and Costs of Care for Treatment of Chronic Headache
Resource Utilization and Costs of Care for Treatment of Chronic Headache.
Technical Reviews, No. 2.1.
Archibald N, Lipscomb J, McCrory DC.

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