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The Migraine Pain

Migraines exact a heavy toll on U.S. employers in health-care costs and lost productivity.

Thursday, November 1, 2007
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It's a scene that's dramatized daily in workplaces across the country: The telltale aura of an impending migraine sweeps over a poor desk-bound soul with its neon flashes and zigzag designs, dizziness, stiff neck and nausea.

Fluorescent lights magnify the pain. Unnoticeable noises intensify the throbbing.

For many employees, a migraine headache's excruciating agony means loss of focus and the ability to concentrate. And all too often, the urgency of whatever tasks are at hand precludes any opportunity to take steps to alleviate the symptoms.

Statistics show that working through migraines is commonplace. Though many employees take medications to keep migraines at bay, others suffer in silence or even fail to recognize their symptoms as those of migraines.

Women, studies show, are the most likely sufferers. According to the National Institute of Health, migraines affect about 28 million Americans, with the majority -- about 75 percent -- being female.

And painful as they are for employees, the impact on employers can be equally dramatic and destructive.

According to data presented at the recent meeting of the Boston-based American Academy of Neurology, up to $28.7 billion in annual direct and indirect health-care costs can be attributed to migraine-related losses in productivity.

Findings presented at that meeting by Titusville, N.J.-based Ortho-McNeil Neurologics Inc. indicate more than 50 percent of migraine sufferers surveyed experienced moderate to severe disability due to migraines, often affecting job performance and leading to missed workdays.

Some migraine sufferers have experienced these headaches over many years, but each attack or event is distinct and separate.

Regardless of the symptoms or combination thereof, migraines affect employees' abilities to function effectively, says Debra Lerner, senior scientist and associate professor at Boston's Tufts School of Medicine and Sackler School of Biomedical Sciences.

Chronic daily headache syndrome -- a form of migraine that occurs every day for a month or more -- not only keeps people from work but makes many who show up for work unable to follow through with simple tasks, also known as presenteeism, says Lerner.

People with CDHS, she says, "are impaired roughly on the order of 40 percent of the time in a two-week period.

"That's enormous," says Lerner. In terms of lost productivity, "it's on the order of having a major depressive episode or worse."

Specifically, she says, migraines interfere with two measurable aspects of employee productivity: time management and handling mental and interpersonal demands of the job.

To help alleviate sufferers' pain and keep better tabs on their overall productivity and absenteeism, she and other experts say, HR leaders would be wise to understand the impact these debilitating headaches have on workplaces and take steps to better manage employees' symptoms.

On the Radar Screen

To be sure, the problem is getting a lot of attention. When Patty Clark, senior occupational health nurse at Rochester, N.Y.-based Bausch & Lomb, recently coordinated with HR to invite employees to a lunch-and-learn to raise awareness about migraine headaches, she had no idea how widespread and troubling the problem was among employees.

Of all the lunch-and-learns she and HR had coordinated in the past, the recent program on migraines attracted a record crowd -- 80 altogether.

Employees wanted to know what triggers migraines, as well as ways to prevent and deal with them, according to Clark. Many wondered whether headaches they were experiencing qualified as migraines.

Clark believes most employees with migraines "literally suffer in silence." Luckily for those at Bausch & Lomb, they're among the slim minority whose companies provide on-site accommodations for what ails them.

The company offers intermittent family leave in increments as short as 15-minute spans. "If an employee wakes up with a headache and is going to be late, with approved FMLA, the occurrence is covered," Clark says, adding that employees do have to get a medical health certification prior to FMLA approval.

They also have to be recertified on a regular basis in order to use family leave. At B&L, employees must be recertified every 90 days.

For employees whose migraine symptoms appear after they've arrived, B&L's occupational health services offers a quiet darkened room where they can lie down or use an ice pack while waiting for medication to work. B&L also provides medication vending machines for those who "don't have their own," Clark says.

According to her, it's important to address migraine triggers in the workplace. For example, if fluorescent light bulbs are the culprits, HR can respond by softening the lights in the employee's work space.

Although she finds most migraine sufferers try to "work through" their headaches, Clark says, accommodations have been standard for more than two decades. "There has been a place for people to lie down or even to get over-the-counter medication for a very long time here."

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A Prevalent Problem

Helping workers manage their migraines is something Lerner would like to see more companies do, similar to steps Bausch & Lomb and a mere handful of others are taking. In some cases, health-risk-assessment screening, as part of a company's wellness program, might be the perfect first step to determining the scope of the problem.

Arlene Guindon, director of health-care analytics and outcomes reporting at Rochester, Minn.-based Mayo Clinic, says her clinic's questionnaires about migraines in the health-risk assessments for all commercial clients ask about chronic conditions for which there might be medication or intervention. In a quarter of a million individuals who have completed the HRA to date, "We've seen a [migraine headache] prevalence rate of about 7 percent," she says.

Research conducted by the Center for Health Economics and Policy at Bethesda, Md.-based United BioSource Corp. found more than 50 percent of respondents with migraines had experienced moderate to severe disability during the previous three months due to migraines.

Workers, on average, missed one workday per employee during those three months due to migraines, while the average number of days worked while suffering from migraines was 8.9 days. Direct medical costs were $200,410 per 1,000 migraine sufferers and indirect costs, including absenteeism and presenteeism were $404,660 per 1,000 migraine sufferers.

Other research shows migraine headaches are most prevalent among people 30 to 49 years of age, according to Jennifer Lofland, associate professor of health policy at Thomas Jefferson Medical College in Philadelphia. "That's a time when we have a lot of things going on in our lives," she says.

And, very often, staying home from work is just not an option. Frequently, work demands require employees to "manage migraines in the workplace," Lofland says. On the whole, she says, "medications work quickly." But that's not always the case. "Some people may need to lie down for a period and wait for medications to kick in."

To curtail losses in productivity, some companies with disease management programs or lifestyle coaching ask employees to keep a log of triggers that precede migraines, Guindon says. Triggers can include sunlight, foods, odors, insufficient sleep, skipping meals and even smoking cessation, she says.

The challenge for everyone -- HR and migraine sufferers -- "lies in identifying the triggers and causes [of migraines]," Guindon says.

There are aspects of migraine that are impairing, "that would pull you off the job," says Lerner. The throbbing headache, nausea and blurred vision make work nearly impossible for many migraine sufferers.

"These headaches," she says, are "part of a complex of painful conditions. It makes perfect sense that this is an incredibly impairing condition," she says. "It means that there are many people who are living with pain and trying to tough it out at work."

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