Even if you haven’t experienced a migraine headache yourself, you likely know or love someone who has. Migraines, reoccurring headaches that cause throbbing or pulsing pain and are often accompanied by nausea, vomiting, or a severe sensitivity to light and sound, are prevalent in nearly every demographic worldwide. Migraine symptoms can be so debilitating that they often affect the quality of life for those who suffer from them, impacting and disrupting both home life and work.
Migraine treatment, whether preventive or at the time of instance, is critical for patients’ relief. Treatments must be chosen carefully and methodically, based on official clinical recommendations and a range of personal and medical characteristics unique to each patient. Earlier this year, the American Headache Society (AHS) updated their guidelines regarding first-line migraine preventative therapies. While the update means overwhelmingly positive tangible differences in patient outcomes, it set in motion a cascade of consequences related to prescription drug utilization, healthcare costs and treatment approaches.
The landscape of migraines
Migraine headaches are more prevalent among women than among men (17% and 6%, respectively) and collectively affect around 2% of the world’s population. The type of migraines a person experiences — either chronic or episodic — depends on the frequency and duration of their symptoms. People who live with chronic migraines may experience 15 or more migraine days in a month, for at least three months More common, episodic migraines cause less-intense and shorter-lasting migraines, fewer than 15 days per month, though their impact is still significant.
In the U.S., chronic migraines affect nearly one in seven Americans each year, with an estimated 40 million people suffering from migraine headaches at any given time. Despite their high prevalence, migraines are often misdiagnosed or those suffering forgo seeking treatment. Data shows direct costs exceeding $2,500 per migraine patient. Many indirect financial burdens also exist, including lost work time and productivity. For employers, migraines can cost up to $13,000 per year for each migraine sufferer, at a total cost of $12 billion.
Treating migraines
Determining the route of medical treatment for a person who experiences migraines depends upon the duration, frequency and severity of their episodes. There are two types of migraine treatments: prophylactic (preventative) medication, taken daily to prevent migraines from occurring — or abortive medication, used to relieve or stop migraine symptoms as they occur.
Effective abortive medications include a variety of over-the-counter medications such as non-steroidal inflammatory drugs (NSAIDs), or a combination of aspirin, acetaminophen and caffeine (e.g., Excedrin Migraine). A drug class called triptans are the preferred first-line abortive treatment for moderate-to-severe migraines. Alternative medications work by inhibiting an overactive migraine-causing protein receptor called a calcitonin gene-related peptide (CGRP).
Effective preventative medications include beta-blockers, certain categories of antidepressants, and CGRP monoclonal antibodies.
In comparing prophylactic drugs to abortive medication, relying on the latter consistently (three or more times a week) can trigger “rebound” headaches from medication overuse. These usually happen at the time the medication wears off — which can worsen negative health effects if it happens frequently. Preventative treatment is the safest and most efficacious route, and should improve responsiveness to acute treatments, reduce overall treatment costs and improve quality of life, according to the AHS. Still, neither preventative nor abortive treatments promise to prevent migraine occurrences altogether; preventative medication should, however, decrease the number of migraine days per month a person experiences, decreasing the need for abortive medication.
In terms of treating migraines preventatively, comorbidities — or any underlying condition a patient might have — are critical to consider. Every medication causes its own independent symptoms. For patients with underlying conditions, many medications that indeed work prophylactically for migraines tend to either help with comorbidities or worsen them.
Workers’ compensation prescription trends
When the AHS updated their guidelines, it triggered the Official Disability Guidelines (ODG) to do the same. The update reflects a broad foundation of pre-clinical and clinical evidence that shows CGRP’s key role in migraine development. Although CGRP-targeting therapies have, in recent years, had a transformational impact on migraine management, none were widely considered as first-line approaches — until now. Evidence now shows that the efficacy, tolerability and safety of CGRP-targeting migraine preventive therapies is not only substantial, but also exceeds that for any other preventative treatment approach and should now be a first-line approach for migraine prevention along with other established first line agents.
Historically, legacy first-line treatment medications had been developed for conditions other than migraine. Which of these preventative treatments to implement is typically based upon a patient’s comorbidities, including insomnia, hypertension, depression or obesity. Studies now indicate that adherence to these therapies is overwhelmingly poor, in part due to unsatisfactory tolerability and a lack of efficacy.
Sedgwick has seen a 7% increase in CGRP use across our book of business in 2024, compared to 2023. The cost difference in comparison to previous first-line prophylactic medications (many of which are blood pressure medications or antidepressants) is enormous: while legacy medications cost around $100 per month maximum, CGRP-therapies cost a maximum of $2600 and are rarely covered by group health insurance plans. Consequently, though CGRP therapies are well-tolerated by patients — and would likely improve employee productivity — the shift places an enormous burden on healthcare costs.
Supporting employees with migraines
Certain industries — airlines and warehouse, for example — see a greater prevalence than others due to their workplace environments. Identifying a person’s unique triggers is integral to the non-pharmacological treatment of migraine prevention while at work.
This may mean avoiding overexertion, or bright lights and loud sounds. Employees should engage in an open and honest dialogue with their employer regarding their condition and any necessary workplace accommodations necessary to reduce migraine occurrences or migraine symptoms’ severity.
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