A Migraine Disease Management Program in the Primary Care Setting: Impact on Patient Quality of Life and Productivity Loss

Objective: To assess the impact of a migraine care program on patient health-related quality of life and productivity loss associated with migraine. • Design: Prospective observational study. • Patients and setting: 1126 consecutive consulting patients who screened positive for migraine in 27 primary care clinics. • Measurements: Patients completed questionnaires, including the Headache Impact Test (HIT-6), the Migraine-Specific Quality of Life Questionnaire (MSQ), and items related to migraine-associated time lost from work/school and nonwork activities at the beginning and end of the study. • Results: 258 migraine patients completed the study. Mean age of participants was 41 years; 85% were white and 77% were women. The percentage of patients whose HIT-6 total score reflected substantial or very severe headache impact was 75.3% at study entry compared with 68.8% at study end (P < 0.05). Mean changes from baseline also reflected improvement (P < 0.05) for the MSQ Role Function-Restrictive domain. Mean lost time equivalents from work/school and nonwork activities were lower in the 3 months after the migraine care program (5.7 ± 11.9 days ) than during the 3 months before study entry (8.7 ± 15.8 days; P < 0.05). • Conclusion: The migraine care program in primary care was associated with reductions in headache impact and lost work/school productivity and activity time in patients with migraine and improvements in certain aspects of health-related quality of life. Migraine is a highly prevalent and debilitating condition that exerts a substantial impact on indi­ viduals and society [1–11]. Migraine sufferers ex­ perience considerable disability and impairment of quality of life, and lost productivity due to migraine is estimated to be $5.6 to $17.2 billion per year in the United States. Despite the humanistic and economic burden of migraine, the con­ dition is underrecognized and undertreated [12–15]. To help improve awareness and recognition of migraine and to enhance the quality of headache care, the Migraine Care Program was developed. The Migraine Care Program is a disease management program developed by Glaxo­ SmithKline that contains educational materials and tools for patients and health care providers. Educational modules for health care providers cover migraine epidemiology, triggers, impact, pathophysiology, diagnosis, and treatment. The pro­ gram also introduces 2 brief patient surveys to assist health care providers in managing migraine in clinical practice. Patient tools include a headache diary and an action plan to be completed with a health care provider. In a prospective observational study in which patients with migraine received 12 weeks of care from primary care providers who had been introduced to the Migraine Care Program, the percentage of patients rating themselves as satisfied or very satisfied with the quality of migraine care increased from 32% at baseline to 48% at the end of the 12 weeks [16–18]. In addition, the proportion of providers who considered understanding of headache impact to be important or very important in treatment decisions and the proportion who considered themselves satisfied or very satisfied with patients’ descriptions of headache severity/ symptoms and impact increased. The current investigation was conducted to extend this assessment of the Migraine Care Program by evaluating its effects on patients’ headache­ related disability, health­related quality of life, and migraine­ associated time lost from work and nonwork activities.