Understanding the Economic Burden of Migraine: Q&A with Dr. Richard Lipton

Dr. Richard Lipton discusses how the burden of migraine impacts every aspect of a person’s life — including their bank account

Anyone with migraine can tell you it is a disease that truly affects every aspect of their life. Dr. Richard Lipton, Director of the Montefiore Headache Center, has dedicated his career to studying the epidemiology of migraine and the burden patients feel on a professional, social and personal level. We sat down with Dr. Lipton to discuss his research, the economic burden of migraine, and the one thing he wishes everyone knew about the disease.

Q&A with Richard Lipton, MD, FAHS

AMF: What is unique about your approach to migraine research?

RL: My research focuses on headache epidemiology and clinical trials. Epidemiology is the study of diseases in the population, so I focus on issues like how common migraine is, its economic burden, its natural history, and in recent years I’ve been doing a lot of work with factors that determine prognosis.

AMF: Economic burden is something that’s rarely discussed as a symptom of a health issue. How does your research quantify the economic burden of migraine?

RL: The economic burden of migraine has two big components. One is direct costs, which are primarily the cost of medical care; the other is indirect costs, things like productivity losses that people with migraine experience during different parts of their lives.

In terms of direct costs, better treatment is all about finding the highest value treatments that make it most efficient to release patients from headache-related disability. Indirect costs are all about relieving pain, restoring people’s ability to function, helping them manage their headaches—Addressing indirect costs is about taking people who are temporarily disabled and helping them function better.

AMF: Who is most impacted by migraine?

RL: Overall, migraine affects about 18% of American women and 6% of American men, making it by far the most common neurologic disorder. Women are three times more likely to have migraine than men, and it is most common between the ages of 18 and 55. These are the peak productive years in a person’s life, which is part of the reason why migraine has such an enormous economic burden—It disrupts your education, professional and personal life at a pivotal time.

AMF: What is something about migraine that you find most interesting as a doctor?

RL: Early in my career I was very struck by the fact that migraine really is a disabling condition. ‘Disability’ is a loaded word, so when you say migraine is disabling, it can conjure up images of people in wheelchairs, even though the nature of migraine disability for most people is temporary. Most people with migraine are able to function relatively normally between attacks, but there is a group of people who have chronic migraine, for whom attacks occur on more days than not. For that group, migraine headaches become a pervasive disorder that touches every aspect of their lives. That’s why measuring the burden of migraine, and then finding ways, clinically, to relieve that burden and help people get their lives back, is something I find infinitely fascinating and gratifying.

AMF: What would you say is the biggest obstacle migraine patients face?

RL: People with migraine encounter a number of obstacles: foremost, the burden of the illness itself. Headaches can strikeout of the blue—disrupting plans, shaking your confidence that you’ll be okay on a day when you’re teaching a course or facing an important life event like your daughter’s wedding—so part of the reason migraine is burdensome is because attacks are so unpredictable.

Another part of the burden is the stigma, and part of that stigma arises from the fact that migraine has a very broad spectrum. You have people with severe migraine, and then people with a milder form of the disease. A lot of the time the people with less severe migraine—instead of feeling fortunate—feel that they are strong and can ‘tough it out. Conversely, people with more severe migraine simply give in to their illness. This makes it difficult to objectively measure pain, and without a standardized measurement of intensity, people with the most disabling spectrum of migraine can be stigmatized as overreacting when in fact, their migraine symptoms may be utterly debilitating.

AMF: If you could share one piece of information about migraine based on your expertise, what would it be?

RL: The most important thing for people with migraine to remember is that the attacks can have multiple symptoms that can be managed in a variety of ways. I think of migraine as a chronic disorder with episodic attacks: of course, the most obvious manifestation of migraine is the attack itself. But even between attacks, migraine still has chronic effects at both the biological and social level. People with migraine might live with the ‘what if’ question—what if I get an attack today and can’t do what I need to do? What if I get an attack today and my boss doesn’t understand? What if I get an attack today and my child is ill and needs me?—That ‘what if’ question amplifies the burden of migraine, so it’s happening not only on days when people experience headache, but on other days as well.

We understand that the burden of migraine can feel insurmountable, but connecting with a community can provide support and help end the stigma associated with this disease. If you haven’t already, join our Move Against Migraine Facebook group, a community we created to show all migraine patients that you are not alone, and there are thousands of people who understand exactly how you feel. For more information about migraine, visit the American Migraine Foundation’s resource library.