Are migraines affecting a productive workplace?

Migraines are not just headaches. They are a complex neurological disorder that affects productivity, quality of life, and healthcare costs at both individual and societal levels. And like mental health, there's still a lot of stigma associated with having migraine.

Dr. William Kingston is a headache neurologist at Sunnybrook Hospital. He explains migraine is a complex brain disorder that includes not just disabling headaches but are often associated with neurological symptoms that can last for days. These include light sensitivity, nausea, and cognitive fog, all of which can significantly impair productivity. Despite being a leading cause of disability worldwide, migraines often remain misunderstood and under-treated in workplace settings.

“If you look at the World Health Organization data, it's the second most disabling condition that exists for years. It’s not nothing,” he says. “The only thing that causes more disability is lower back pain. We see more people living with [migraines and disability] than cancer and diabetes combined. Migraine is lifelong, and it affects people most when they're in their peak productive years, when they have to be at work.”

Kingston notes many employees hesitate to disclose their struggles with migraines for fear of being perceived as unemployable. Even those who push through the pain at work often experience presenteeism, a concept that means being physically present but unable to perform effectively. This phenomenon, coupled with the disabling nature of migraines, leads to reduced productivity and increased costs for employers.

He points to a Canadian study that found migraines costs Canadians anywhere between $15,000 to $30,000 annually per individual when factoring in both direct medical expenses and indirect costs like lost productivity. "When we have millions of people with migraines in Canada, that ends up being widespread, a very heavy cost," says Kingston.

As for what organizations can do to combat this hidden productivity killer, Kingston offers several recommendations. Employers must ensure their benefits plans adequately cover migraine treatments, including the newer, more effective medications, designed expressively for the purpose of treating migraine.

“For some people, these treatments are game changers. These can be the difference between someone being at work and not being at work, getting a promotion and not getting a promotion. Since I've started working with these newer classes of migraine medications, they have made the greatest impact on my career and on my patients,” he says. “Make sure that a benefits plan recognizes and gives access to these treatments, because unfortunately, some insurance providers are very difficult, even when they shouldn't be.”

Kingston highlights worldwide consensus statements from several global headache organizations, including the Canadian Headache Society that suggest “if we look at pharmacoeconomic as a whole, it makes more sense to pay for these medicines upfront, because it reduces disability, headache days and allows people to be more functional.”

For those working in-office, Kingston believes workplace accommodations can also make a difference. Simple changes like scent-free policies, access to dimly lit spaces, and screen filters that reduce harsh light can help employees manage their symptoms.

“All of those things can be helpful. Someone with a migraine who has an understanding provider, and an understanding workplace is far more likely to want to stay in their workplace, and far more likely to want to excel and participate and have that company be more successful if they feel seen,” says Kingston.

An update to migraine guidelines

Migraine guidelines for medical professionals were last published over a decade ago in 2012. This prompted Dr. Ioana Medrea, a headache specialist at the Women’s College Hospital, to revisit and update the Canadian Headache Society’s migraine treatment guidelines. She’s the first author of the guidelines.

She emphasizes the changes come at a time when new medications have emerged that offer more effective and better-tolerated options for the millions of Canadians suffering from this debilitating condition. Access to these newer therapies often remains a challenge, leading to prolonged suffering for many patients.

“It was very important for us to identify all of the new treatments and rank them and decide on the best treatment plans for our patients. A lot of them are disabled by their migraine disorder. They miss a lot of work, or they go into work, and they have difficulty working. We looked at the disability of migraine across our patients and have decided that it would be important to provide them access to the newer therapies earlier, because they’re waiting to see a headache specialist or neurologist and waiting three to six months to try each new therapy,” explains Medrea.

She emphasizes the inclusion of new medications, particularly anti-calcitonin gene-related peptide (CGRP) therapeutics, which include both monoclonal antibodies and oral therapies. Another treatment, Onabotulinumtoxin type A (Botox), has also been formally reviewed despite its clinical use for years. “They have been shown to be effective and well-tolerated for chronic migraine,” says Medrea.

The updated guidelines also reevaluated older medications. For instance, Candesartan now carries a strong recommendation due to new data, while the recommendation for Topiramate was downgraded. Gabapentin is now advised against due to insufficient supporting evidence. “There’s a lot of new medications, which is very exciting, and there are some updates to the older medications that are important for our patients as well,” she notes.

While most medications are covered in typical benefits plans, Medrea acknowledges there are a select few of the newer treatment options that won’t be available for sponsors. The out-of-pocket cost for a chronic sufferer can range from $400 to $500.

“We’re trying to make an advocacy push for equal access to all the different therapies. People who are very disabled by their migraine disorder should not be waiting months or years to access some of the newer therapies. These newer therapy medications really should be available first line,” says Medrea.