Two of three migraines occur on weekdays. Treating migraine within one hour of onset can improve patient outcomes, according to researchers.
PHILADELPHIA—Migraines occurring on a workday resulted in substantial lost work time due to both absenteeism and presenteeism with reduced effectiveness, researchers reported at the 14th Congress of the International Headache Society. Although presenteeism leads to more total lost work hours, the impact of absenteeism may be more costly to employers, according to Stephen H. Landy, MD, and colleagues.
In a prospective study of adults who experienced an average of two to eight migraines a month and were employed full-time, Dr. Landy’s group tracked 509 subjects through three consecutive migraine attacks, for a total of 1,527 episodes. On average, nearly one in three respondents’ migraines occurred during the morning hours (between 6 am and 9 am), and 23% began in the afternoons. Of migraines that occurred on a workday, 32% began prior to work (up to five hours), 40% began at work, and 28% occurred after work.
Two of three migraine attacks (68%) had the potential to affect work productivity of a typical 8 am to 5 pm worker, according to Dr. Landy, Clinical Professor of Medicine at the University of Tennessee Medical School in Memphis. Migraines beginning within two hours of the start of the workday did not affect productivity any more than attacks beginning several hours before the start of work.
The majority of migraines occurred on a workday (64%), and 28% resulted in lost work time in some form of absenteeism. Regarding the 970 workday migraine attacks, 11% of employees stayed home and did not go to work, 5% went to work late (mean, 2 hours and 38 minutes), and 12% left work early (mean, 1 hour and 52 minutes). The primary factors contributing to absenteeism included pain severity at onset, pain severity at peak, nausea, vomiting, sensitivity to light, and visual disturbances or dizziness.
Presenteeism accounted for 57% of lost work time, while absenteeism accounted for 43% of lost time. The mean work time lost per episode was 2 hours and 3 minutes for those who worked through their migraine and 1 hour and 23 minutes for those who were absent.
“Since approximately two of three migraines occur on a workday, they have tremendous impact on lost workplace productivity,” Dr. Landy told Neurology Reviews. “Even though 62% of workday migraines are associated with presenteeism and 28% are associated with absenteeism, the attacks associated with presenteeism resulted in an average of 75% effectiveness while at work, and most patients absent from work probably have 0% effectiveness or complete lost work productivity.”
Morning and Afternoon Peak Onset Times
Among the sample of 1,527 migraine episodes, subjects reported no correlations between onset times for each of their three migraines. For 12% of subjects, onset time for their three migraines occurred within two hours of each other and 28% reported times of onset within four hours.
A bimodal peak in time of onset was observed, as 29% of migraines started during the morning hours (between 6 am and 9 am) and 23% during the afternoon (between 2 pm and 5 pm). Morning migraines were significantly more likely to occur in subjects ages 50 to 59 (36%) than in adults younger than 30 (24%). They were also significantly more common in migraineurs with rotating schedules (28%) or regular daytime work schedules (30%).
Afternoon migraines were significantly more likely to occur in adults younger than 30 (32%) and older than 60 (34%), than in adults ages 50 to 59 (15%). Afternoon migraines were also more common in subjects who work evening shifts (40%) than in those who work daytime shifts (22%) and were also more likely to be accompanied with mild pain at onset (34%) than were morning migraines (23%).
Almost half of all migraines (47%) were deemed waking migraines, in which the patient woke with the headache. Severe pain at migraine onset was twice as likely to occur in waking migraines (22%) than in nonwaking migraines (11%), and waking migraines were significantly less likely than nonwaking migraines to occur on a workday (59% vs 68%). Among employees with waking migraines that occurred on a workday, decreased work productivity was significantly more common (67%) than in those with nonwaking migraines. Migraines also were more likely to occur on a Monday (17%) than on any other day.
“These findings show that it may be possible to predict the time of day when migraines most likely occur,” Dr. Landy and colleagues wrote. “This may help migraineurs prepare for episodes by having treatment on hand or by taking prophylactic therapy at the best time.”