The present study aimed to evaluate self-reported work-related parameters (i.e., weekly working hours, commuting time, absenteeism, presenteeism, and occupational burnout) among migraine sufferers and controls, and to assess their correlations with migraine severity (i.e., monthly migraine days, and MIDAS) in a sample of migraine sufferers.
Despite a systematic recruitment protocol, the study cohort cannot be considered a representative sample of migraine patients. The response rate of both migraine and control patients was 45% and the participating cohort is composed of relatively severe migraine patients (more than 50% of them with moderate to severe disability, 39% treated by preventive therapy).
In this cohort, half of the individuals with migraine reported migraine-related absenteeism of at least one day per month, and 25% missing at least 2 days per month. Migraine sufferers also reported an average of 4.5 days of migraine-related reduced productivity/month, and 25% of them reported 5 such days per month or more. Previous studies have reported lower rates of migraine-related productivity loss. A narrative review published in 2019 calculated that patients lost on average 4.4 workdays per year, and worked with reduced productivity for a further 11.4 days per year. (20) The findings in our cohort are approximately 4 to 5 times higher.
Commuting to work can be a challenge for individuals with migraine (21), with 50% of sufferers experiencing motion sickness (22), which may even trigger or exacerbate migraine attacks (23). Longer commuting time was associated with shorter sleep, which is a possible exacerbating factor for migraine patients. In our sample, commuting time was independently negatively correlated with migraine severity, indicating that individuals with more severe migraines tend to avoid longer daily travels to work. This correlation, not previously reported, may limit migraine patients' employment opportunities and income potential.
The most notable finding in our study is the correlation between occupational burnout and migraine. Migraine sufferers were found to have higher burnout than non-sufferers, and migraine severity was independently correlated with burnout even when controlling for well-known mental comorbidities of migraine, such as depression anxiety, and stress.
Notably, while meta-analyses studies on the relationship between gender and burnout either report no gender statistical differences or that women are more likely to experience burnout (24–26), in our study we found, among individuals with migraines, that men experience higher levels of occupational burnout across all levels of migraine severity. As gender role theory suggests (27), fulfilling the role of a breadwinner is an important motivation for men. Therefore, in comparison to women, the clash between the breadwinner role and their medical condition, makes them particularly vulnerable to the experience of high levels of burnout, and less likely to use coping strategies. This finding calls for further investigation, as gender is often confounded with many other factors, such as educational background and occupation.
The findings of this study are in line with previous research that has identified a higher risk of burnout among individuals with chronic illnesses, particularly those that cause pain and disability. Migraine, as a chronic neurological disorder, is a significant source of pain and can greatly impact an individual's ability to carry out daily activities. In addition to physical symptoms, individuals with migraine often experience high levels of stress, anxiety, and depression, which can contribute to burnout in the workplace. Work-related emotional symptoms (especially stress) have previously been correlated to migraine and migraine severity. (28) The association between migraine and occupational burnout, has also been studied before. (29) González-Quintanilla et al used the Maslach Burnout Inventory to study 94 migraine patients with correlations found between different sub-scales of burnout and migraine severity.
However, even after controlling for the psychological comorbidities, migraine severity remained an independent predictor of occupational burnout. A possible explanation for this association is migraine-related cognitive disturbances. Such disturbances can be disabling and cause avoidance (referred to by some as "cogniphobia") from a mental effort even interictally (30). Cognitive deficits before, during, or after migraine attacks may increase the cognitive overload of migraine sufferers and promote burnout (31–32). Although this study did not evaluate cognitive deficits, they may partially explain the association between burnout and migraine.
Working from home as an alternative to traditional work models was popularized during the COVID-19 pandemic. The participants of the study were asked to rank their preference to work from home. This preference was found to be correlated with migraine severity, possibly due to the higher burnout and the desire to avoid longer commuting time among high-severity migraine sufferers.
This study is the first to evaluate burnout and work commuting in a community sample of migraine patients. Despite a structured recruitment process, the sample still suffers from recruitment bias, causing underrepresentation of non-Jewish populations, and possibly overrepresentation of severe migraine patients, which may limit the generalizability of the results. However, the study evaluated the correlation of work-related factors with migraine severity, rather than a dichotomous comparison between migraine patients and controls allowing us to gain insights into less explored aspects of migraine in the workplace.
Given that migraine affects more than 10% of the workforce, avoidance of commuting and increased burnout among migraine sufferers may have significant impacts on individuals and economies. In light of new opportunities in migraine care, this impact could be, at least partially, mediated. Modern work models such as working from home or hybrid work models, may allow migraine patients higher, more productive ways to participate in the work market. Thus, interventional studies are needed to explore the efficacy of migraine therapies and new work models on workers and economies.
In conclusion, this study provides evidence that individuals with migraine are at higher risk of burnout in the workplace, particularly when their symptoms are more severe. Interventions aimed at reducing burnout among individuals with migraine should take into account factors such as work hours and commuting time, as well as the impact of psychological factors such as stress, anxiety, and depression. By addressing these factors, employers may be able to create a more supportive work environment for individuals with migraine, which could ultimately lead to improved work outcomes and better quality of life.
Table 1
Demographic and Self Rated Health Characteristics
|
Migraine
(N = 675)
|
Non - Migraine
(N = 232)
|
P-value
|
Demographic
|
|
Gender- Female, %
|
544 (80.6%)
|
186 (80.2%)
|
0.965
|
Age - Median [Q1, Q3]
|
43.0 [34.0, 54.0]
|
49.0 [39.0, 66.0]
|
< 0.001
|
Marital status, %
|
|
|
|
Married
|
405 (60.0%)
|
146 (62.9%)
|
0.176
|
Non- Married
|
270 (40.0%)
|
86 (37.1%)
|
|
Number of Children - Mean (SD)
|
2.87 (1.34)
|
3.31 (1.57)
|
0.004
|
Education Level, %
|
|
|
|
Higher Education
|
243 (36.0%)
|
103 (44.4%)
|
0.001
|
Self-Rated Health Status (1–10) - Mean (SD)
|
7.48 (2.05)
|
7.85 (1.81)
|
0.075
|
Comorbid Cardiovascular Diseases, %
|
71 (10.5%)
|
28 (12.1%)
|
0.126
|
Smoking %
|
173 (25.6%)
|
42 (18.1%)
|
0.391
|
DASS-21
|
|
Depression Symptoms Scale (0–3) - Mean (SD)
|
0.864 (0.811)
|
0.664 (0.712)
|
0.045
|
Anxiety Symptoms Scale (0–3) - Mean (SD)
|
0.776 (0.776)
|
0.693 (0.772)
|
0.265
|
Stress Symptoms Scale (0–3) - Mean (SD)
|
1.23 (0.876)
|
0.931 (0.819)
|
0.006
|
Table 2
Migraine patient-reported outcome measures (PROMs)
|
Female
(N = 544)
|
Male
(N = 131)
|
Overall
(N = 675)
|
P-value
|
Onset Age - Median [Q1, Q3]
|
19.0 [15.0, 27.0]
|
20.0 [16.0, 29.0]
|
20.0 [15.0, 27.0]
|
0.532
|
Diagnosis Age - Median [Q1, Q3]
|
24.0 [18.0, 30.0]
|
24.0 [18.5, 30.0]
|
24.0 [18.0, 30.0]
|
0.737
|
Treated by Migraine Preventive Drugs %
|
215 (39.5%)
|
48 (36.7%)
|
263 (39.0%)
|
0.953
|
MIDAS Score - Mean (SD)
|
54.8 (68.8)
|
45.3 (60.9)
|
53.1 (67.5)
|
0.15
|
Headache Days in Last Three Months (MIDAS A) -
|
Mean (SD)
|
17.7 (20.0)
|
16.9 (18.5)
|
17.6 (19.7)
|
0.978
|
Headache Intensity (1–10) (MIDAS B) - Mean (SD)
|
8.09 (1.68)
|
7.79 (2.10)
|
8.04 (1.76)
|
0.463
|
MIDAS Score groups
|
|
|
|
|
Little or No Disability (0–5)
|
55 (10.1%)
|
22 (16.8%)
|
77 (11.4%)
|
0.268
|
Mild Disability (6–10)
|
31 (5.7%)
|
9 (6.9%)
|
40 (6.0%)
|
|
Moderate Disability (11–20)
|
94 (17.3%)
|
25 (19.1%)
|
119 (17.6%)
|
|
Severe Disability (21+)
|
364 (66.9%)
|
75 (57.2%)
|
439 (65.0%)
|
|
Absenteeism Days per Month - Mean (SD)
|
2.13 (4.22)
|
1.82 (4.17)
|
2.07 (4.21)
|
0.268
|
Presenteeism Days per Month - Mean (SD)
|
4.72 (6.22)
|
3.88 (4.59)
|
4.57 (5.96)
|
0.675
|
Table 3
Employment and Burnout Characteristics
|
Migraine
(N = 675)
|
Non - Migraine
(N = 232)
|
P-value
|
Currently Working, %
|
607 (89.9%)
|
211 (90.9%)
|
0.363
|
Male
|
122 (93.1%)
|
40 (87.0%)
|
0.226
|
Female
|
485 (89.2%)
|
171 (91.9%)
|
0.385
|
Years of Experience in Current Workplace - Mean (SD)
|
10.0 (8.97)
|
13.8 (11.7)
|
0.694
|
Weekly Work Hours - Mean (SD)
|
35.1 (16.9)
|
32.7 (15.3)
|
0.054
|
Commuting Time to Workplace (Minutes) - Mean (SD)
|
29.6 (38.1)
|
25.7 (21.4)
|
0.811
|
MIDAS Score groups
|
Little or No Disability (0–5)
|
36.9 (24.4)
|
-
|
-
|
Mild Disability (6–10)
|
35.8 (28.8)
|
-
|
-
|
Moderate Disability (11–20)
|
33.6 (25.6)
|
-
|
-
|
Severe Disability (21+)
|
23.3 (17.0)
|
-
|
-
|
Desire to Work from Home (1–7) - Mean (SD)
|
3.78 (2.33)
|
3.56 (2.31)
|
0.45
|
Self-reported Efficiency in Work from Home (1–7) - Mean (SD)
|
4.69 (2.30)
|
3.47 (2.10)
|
0.001
|
COVID-19 Related Unpaid Leave, %
|
78 (11.6%)
|
18 (7.8%)
|
0.809
|
Male
|
10 (7.6%)
|
4 (8.7%)
|
0.115
|
Female
|
68 (12.5%)
|
14 (7.5%)
|
0.829
|
Burnout
|
Total Score (1–7) - Mean (SD)
|
3.46 (1.43)
|
2.82 (1.29)
|
0.004
|
Exhaustion (1–7) - Mean (SD)
|
3.72 (1.51)
|
3.01 (1.48)
|
< 0.001
|
Cynicism (1–7) - Mean (SD)
|
3.73 (1.79)
|
2.90 (1.65)
|
< 0.001
|
Professional efficacy (1–7) - Mean (SD)
|
3.13 (1.47)
|
2.54 (1.17)
|
0.009
|