Recognizing the Financial Pain of Migraines

August 30, 2006
Migraine headaches cost U.S. employers more than $24 billion annually, including direct health care costs and indirect expenses such as absenteeism, researchers reported at the American Headache Society meeting
in June. And that total doesn’t count "presenteeism"—when employees whose heads are pounding stay on the job but aren’t performing up to par.

Yet few companies address the problem—at least not yet—in the same way as they’ve learned to tackle heart disease, diabetes and obesity. The handful of companies and health care management firms on the cutting edge of migraine prevention and management programs say they cost very little to operate and promise to pay off in reduced costs and increased productivity.

The programs are so few and far between because many companies "don’t perceive it as a priority," says Michael Staufacker, director of program development for StayWell Health Management in St. Paul, Minnesota, which launched its first migraine program five years ago.

"Migraine headache programs will become more of a priority as the research becomes better in terms of direct and indirect costs savings and as programs such as ours show cost benefits," he says. "I would say it’s an emerging trend."

Migraines affect about 28 million Americans, with women more likely to suffer than men, according to the National Headache Foundation. Cardiovascular problems, including high blood pressure, affect more than 71 million, the American Heart Association reports, while diabetes affects 20 million, according to the American Diabetes Association. And 30 million Americans are obese, says the Centers for Disease Control and Prevention.

Two programs—one developed by StayWell for its clients, and a pilot project created by JPMorgan Chase for its employees—offer somewhat different approaches.

StayWell developed its migraine prevention program at the request of a specific client, Staufacker says, "because they had internally discovered through health claims that migraines were a large cost item." Now, six companies are using the NextSteps Migraine Headache Management Program.

NextSteps is the umbrella term for all of StayWell’s health coaching programs, which also include programs like weight management. Migraine participants keep a headache diary, noting when they occur and possible triggers. Then they get individual help through a phone-based coaching service staffed mostly by registered nurses.

"A lot of what we do is an adjunct to medical care," Staufacker says. "We help the participants establish a regular routine, with regular sleep patterns (known to improve migraines) and diet and exercise. It’s very individualized." Many lifestyle improvements to ease migraines, he says, are the same habits recommended to help workers with diabetes and weight problems.

"We always refer the participant to their physician when a question is related to medication, he says.

JPMorgan Chase’s Chicago offices launched the Mind Over Migraine program in February, and it will continue until December. It is tracking 23 workers with migraines. The program combines lectures—drawing from the nearby Diamond Headache Clinic in Chicago—educational material and advice geared to each person’s specific need, says Dr. Wayne Burton, senior vice president and medical executive for the company, which has 140,000 U.S. employees.

Nurse practitioner Jennifer Bouchard first met with each worker to get a history and then tailored the program for the employee. If workers have a weekend migraine, she tells them sleeping late might be triggering it. "I do a lot of research to find out if there are any new treatments," Bouchard says.

Burton says 15 percent to 20 percent of the company’s employees have a history of migraines.

"We’ve had noontime seminars for many years. We want to take it to the next level—a work-site disease management program," he says.

Costs are minimal, beyond Bouchard’s salary, he says. Burton takes advantage of educational materials provided by pharmaceutical companies, pre- viewing all material to ensure that it’s not intended to pitch a specific drug to employees. (Ortho-McNeil Neurologics, for instance, is piloting Headache Ease, a kit it provides to companies.) "We don’t accept any branded material," Burton says. "We don’t encourage the use of any particular product."

The program’s bottom-line value hasn’t been determined.

The StayWell migraine program "is part of a larger program, so employers aren’t measuring return on investment on migraines per se," Staufacker says. And, he adds, "when you do a true ROI looking at pharmacy claims, it’s not practical to do a true ROI on something this relatively small. You need larger numbers. You need to look at the ROI on the larger picture, (all the) lifestyle programs."

JPMorgan Chase hopes to have findings about its program by December.

Kathleen Doheny