Impact of migraine on productivity and efficiency among adult population in India: a scoping review

Abstract

Background

Migraine is a common neurological disorder that has a major negative influence on productivity loss and quality of life. Significant socioeconomic consequences are associated with the condition, such as decreased productivity at work and increased medical expenses. The frequency is higher in women, especially in reproductive age, and the burden varies globally. In India, the prevalence of migraine is 25%; this is higher than the global prevalence of 14.7%. The scoping review is undertaken with an aim to synthesize existing literature that summarizes the impact of migraine on productivity among working professionals, with a focus on its determinants in India.

Methods

A systematic scoping review, with a comprehensive search strategy, was conducted across major databases. Eligibility criteria for studies to be included focused on prevalence, economic and observational studies involving adults aged 18 and older diagnosed with migraines. Studies conducted from January 2014 to October 2024 in Low- and Middle-Income Countries (LMICs) were included. Data extraction was standardized, capturing key study characteristics. The methodological quality of included studies was assessed using the JBI score checklist for the assessment of cross-sectional and prevalence studies. The pooled estimates for productivity loss were collated from individual studies and adjusted per capita national income. This pooled productivity loss was used to estimate the per day economic loss based on per capita income.

Results

The systematic search identified 11 relevant articles for LMICs that provided insights into the impact of migraines on productivity and economic outcomes. The evidence highlighted that migraine-related productivity losses ranged from 3% to 4.3% of productive time, translating to significant financial implications. Evidence from India suggests one-year prevalence of migraines is approximately 14.12% to 28.99%, affecting around 213 million cases annually. The pooled analysis obtained from two studies shows that productivity loss due to migraine is 17.3 days per year. This was found to be INR 8731/- annually based on daily per capita income. Taking the prevalence of migraine in India, it leads to a total economic loss of about INR 18,674.35 crore (approximately USD 22.21 billion). This significant burden emphasizes the urgent need for effective healthcare interventions to address and manage migraine disorders in the population.

Conclusion

Migraines impose a significant threat to the economy and productivity in India, especially for working professionals and women in their prime working years. Addressing migraine as a public health priority through awareness, early diagnosis, and effective management will not only improve quality of life but also enhance national productivity and economic growth of the country.

Supplementary Information

The online version contains supplementary material available at 10.1186/s10194-025-02112-1.

Background

Headaches, particularly migraines, remain one of the most common and disruptive neurological disorders, significantly impacting the lives of millions worldwide [1]. Migraine is the second highest cause of global disability in the general population, but first among women aged 15 − 49 [2]. Recent estimates from the Global Burden of Disease (GBD) 2019 report indicate a significant increase in migraines, with cases rising from 62.5 million in 1990 to 87.6 million in 2019. This burden is unevenly distributed, with countries such as India, China, the United States, and Indonesia accounting for 43.6% of all cases. Notably, females aged 10–14 years reported the highest incidence rate, suggesting that hormonal or social triggers may contribute to migraine patterns [3]. The condition disproportionately affects women, showing a concerning female-to-male ratio of approximately 3:1. This is alarming, as migraines typically occur during individuals’ most productive year [4]. Evidence from various studies has reported a one-year prevalence of migraine in India as high as 25%, compared to the global prevalence of 14.7% [5, 6]. In India, the worse sufferers of migraine are women and individuals living in rural areas who struggle to afford basic medical care. There is socio-economic consequence of migraine including reduced productivity, economic burden, and loss of job opportunities leading decreased quality of life [7, 8].

Definition of migraine & types of migraine

According to the International Headache Society’s (IHS) Headache Classification Committee, migraine is a neurological disorder characterized by excruciating headaches [9]. There are two main forms of migraine. Migraine without aura is defined by a headache featuring specific characteristics and related symptoms [9]. In contrast, the primary characteristic of migraine with aura is the presence of transient, focal neurological symptoms that typically precede or occasionally accompany the headache. These auras, which are predominantly visual disturbances, serve as warning signs. Migraine with aura is significantly less common, occurring at least three times less frequently than migraine without aura. Additionally, some individuals experience a prodromal phase, occurring hours to days before the headache, and/or a post-dromal phase, which follows the resolution of the headache [9].

Determinants of migraine

One of the important features of the migraine pathophysiology is that it is hereditary by nature [10]. Further the pathophysiology of migraine comprises of vascular, neurogenic, neurotransmitter, and genetic molecular biological theories which have explained the multiple causes behind migraine [11, 12]. The intricacies involved in migraine causation are complex than the simple trigeminal stack cranial afferents and the central modulation of the afferent trafficker and subcortical structures of the brain [12, 13]. This requires a deeper understanding of the determinants of the migraine (Fig. 1).

Fig.1.

Classification of migraine, (Carmen M. Galvez-Sánchez et al., 2022) [14]

Socioeconomic burden and mental health

Migraines have a multifaceted socioeconomic impact on Lower-Middle Income Countries (LMICs), including India. Previous studies have shown that point prevalence of migraine is close to 25% [15]. This impacts the implications on the individual and the society since the economic cost impacts on health and productivity disrupt the social and economic growth of any society.

The National Mental Health Survey (NMHS) in India 2015–16 found an adult prevalence of 10.6% for a mental morbidity excluding tobacco use disorders for people above the age of 18 years pointing to the need for mental health services [16]. This rise in mental health morbidity may be linked to migraines in a way that each condition feeds the other– each condition leads to the other. According to Mario Fernando (2017) all anxiety and depression items were significantly related to migraine compared to non-headache controls [17].

Migraine impact on workplace productivity and economic consequences

Patients who suffer from migraines find that their productivity at work is significantly reduced. Hence, considering today’s competitive world and more especially in India where the prevalence is high, it becomes imperative to determine how the disease affects the productivity and efficiency of the working population. As per the American Headache Society Position Statement (2018), the migraine burden in India is significant, affecting nearly 13.1% of the total population, particularly within the 25 to 55-year age group, which corresponds to the most productive period of an individual’s career. The time spent in bed during migraine attack is 4.5 h. for men and 6.0 h. for women [18]; these figures reflect the important dysfunction triggered by this adverse health condition. Apart from productivity loss, Migraine also contribute significantly to a country’s economic burden due to associated costs. The productivity loss due to migraine in US is $27 billion annually [19]. However, in the context of the Indian healthcare scenario, which is more complex due to pressing economic and social challenges, the impact of migraine on productivity loss is more distressing [20–23].

The lack of evidence in Indian scenario about the debilitating condition of migraine, makes it essential that we do an evidence synthesis focusing on the substantial association between migraine and productivity losses. The diverse population classified by region and demographics make it more essential to undertake evidence synthesis. Although the review included LMICs, 7 of the 11 studies focus on India. Thus, the analysis primarily emphasizes Indian data with LMICs used for comparative context.

Objective of the study

This scoping review aims to synthesize existing literature on migraine’s impact on productivity and efficiency among adult population in India.

Methods

The current scoping review aimed to assess the burden and economic cost of migraine disorders in India and other LMICs following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [24].

Eligibility criteria for inclusion of studies

The inclusion criteria were established to ensure identification of the studies that could provide valuable information about migraine disorders in India. The scoping review focused on articles that included the subjects who were 18 years and older and, who had been diagnosed with migraines. To synthesize the findings, the review captured the data from observational studies (cross-sectional, cohort or case–control studies that reported the frequency of migraines, productivity loss or direct and indirect costs associated with migraine management were included. Additionally, the review also considered the grey literature to gather robust evidences on the impact of migraine. However, no grey sources met inclusion criteria after full-text review. The review focused on the articles published in English between January 2014 and October 2024. A PRISMA flow diagram was developed to outline the articles selection process, detailing the records identified as well as number included and excluded (Fig. 2).

Fig. 2.

Flowchart of the study selection process [24]

Search strategy

Peer reviewed articles from PubMed, Scopus, Google Scholar, and Web of Science were utilized to gather the publications as per the inclusion criteria. Search terms such as “Migraine” “Economic burden” “Headache disorders” “LMICs” and “India” were connected through Boolean operator AND and OR to ensure a broad range of articles was retrieved (Table 4 in Appendix).

Data extraction

To facilitate data extraction, we developed an extraction form that included standardized data fields such as study characteristics, author names, publication year, location, sample size, research design, and key findings related to migraine prevalence and its economic consequences. Two reviewers were assigned to extract the necessary data from the research articles, and any disagreements between them were resolved through consensus. Johanna Briggs Institute (JBI) scales were applied [25] to each type of study chosen in order to evaluate the studies’ quality and identify biases.

Data synthesis

The synthesis process involved both qualitative and quantitative data. Additionally, a narrative synthesis provided a comprehensive authoritative review of each study related to migraine prevalence, disability, and cost implications, wherein authors identified various emerging trends. The collected quantitative data were aggregated to present the overall migraine rates and associated losses, thereby illustrating the burden on the healthcare system. Our estimates of productivity loss were combined and adjusted using the per capita national income in Indian Rupees for economic standardization.

Quality assessment of included studies

The quality assessment of the included studies was undertaken with JBI checklist (Supplement Table S1–S3) depending upon the type of study [25]. Two authors—R.S. and M.W.—reviewed the quality evaluation independently. The interrater reliability was strong, and R.S. and M.W. discussed any disagreements until they were resolved.

Estimation of economic evaluation of migraine

Based on the findings from the scoping review, an economic evaluation was conducted to estimate the national economic loss resulting from migraine-related productivity loss. Productivity loss, measured in terms of lost hours or days, was converted into monetary terms using India’s per capita national income. The formula used for calculating the economic loss was [26]:

Results

Search results

The PRISMA flowchart illustrates the study selection process used to identify the literature related to the exploratory effects of migraines on working population in India. Initially, a total of 17,247 records were retrieved from the above-mentioned databases. After elimination of 16 duplicate records, 17,231 records were screened to exclude 17,000 studies found irrelevant to the focus of scoping review. From Google Scholar, we screened the first 25 pages sorted by relevance, as recommended in scoping review guidance for grey literature. Articles were excluded based on title/abstract relevance. Following a full-text analysis, 220 articles were found to be irrelevant and hence, excluded from the study because those studies focused on animal studies. Ultimately, a total of eleven studies [7, 8, 27–35] were deemed relevant to LMICs, ensuring the high standard of the findings. This review aims to provide key information about the burden and economic consequences of migraines affecting the workforce in India, and establish a foundation for further research and potential interventions.

Quality assessment of selected studies

The JBI checklist [25] were employed for each type of study chosen in order to evaluate the studies’ quality and identify biases. The nature of investigation determined the tool utilized. Each study’s scores are listed in the Supplementary Material. In particular, narrative reviews meet six of the six criteria (Table S2), prevalence studies meet eight of the nine criteria (Table S1), and cross-sectional studies meet the seven criteria (Table S3) that were assessed for quality.

Migraine prevalence, productivity loss and economic impact in LMICs

Table 1 below highlights a comprehensive overall evidence summary on migraine and headache disorders in LMIC and relevant findings emphasize on epidemiology, economic burden, and management difficulties. According to the study conducted by Zhang and his team in 2023, with regard to the burden of migraine, India seems to have a high number of 213 million cases of migraine and 17.9 million incidence cases in 2019 [27]. Additionally, the study examined the number of Disability-Adjusted Life Years (DALYs) caused by migraines and found that the incidence of migraines increased considerably in India, accounting for 7.68 million DALYs [27]. The findings emphasize a higher prevalence among women, especially those aged 40–44, suggesting that demographic and socioeconomic factors play crucial roles in the burden of these disorders.

Table 1.

Summary table for identified studies from LMICs

Author(s), year	Study Settings	Title	Objectives	Methodology	Key Findings	Factors for Migraine	Medication Use
Zhang, et al., 2023 [27]	Brazil, Russia, India, China, South Africa	Temporal trends of migraine and tension-type headache burden across the BRICS: implications from the Global Burden of Disease study 2019	To assess the prevalence and burden of migraine and tension-type headache across BRICS nations from 1990 to 2019	Data from Global Burden of Disease 2019 study; analyzed incidence, prevalence, and DALYs based on ICHD-3 criteria	Highest prevalence cases in India: 213,890,207 (18.96%) Incidence: India: 17,931,771 cases (20.45%);	Higher prevalence in women, especially aged 40–44. Socioeconomic and demographic factors influencing burden	Not mentioned
Kim, et al., 2023 [28]	Low- and lower-middle-income countries (LLMICs)	Vestibular migraine in low- and lower-middle-income countries: A scoping review	To evaluate the current state of research on vestibular migraine in LMICs, focusing on prevalence, diagnosis, and treatment	Scoping review; databases searched: PubMed, Embase, Web of Science; 26 studies included, primarily cross-sectional (57.7%) and case series (23.1%)	Prevalence of VMa: 0.3% to 33.3% among clinic patients. Most studies (92.3%) conducted in urban settings. Common symptoms: headache, nausea, photophobia	Geographic distribution skewed towards India (65.4%). Age, urban vs. rural setting, and healthcare level as factors influencing prevalence	Common pharmacotherapies include calcium channel blockers, beta-blockers, and antiepileptics. Ayurvedic medicine also discussed in case studies
Jawed, et al., 2019 [29]	Jinnah Postgraduate Medical Centre, Karachi, Pakistan	Effect of Migraine Headache on Productivity of Patients According to Migraine Disability Assessment Score: A Cross-Sectional Study	To determine the extent of disability among migraine patients, patterns of prophylaxis, and healthcare-seeking behaviors	Cross-sectional study; Sample size: 50 migraine patients diagnosed by a neurologist; Questionnaire used	Severe disability (Grade 4) in 40% of patients; Average MIDAS score: 22.42; 32% had regular follow-ups	Gender (higher prevalence in females); Age (most affected group: 20–40 years); Stress; Sleep disturbances; Family history of migraine	Acetaminophen (48% use); NSAIDs (40% use); Prophylaxis use: 54% (most commonly beta-blockers 20% and tricyclic antidepressants 18%)

^aVestibular migraine

Vestibular migraine (VM) is a disorder that combines vertigo and migraine, two clinical conditions. It is reported that approximately 30% of Indians who experience dizziness have VM [36]. Kim et al. [28] focused on LMICs and found vestibular migraines to range between 0.3% and 33.3% among clinic patients and most patients were from urban settings especially India (65.4% of the studies). This implies large urban–rural differences and shows that age, living in an urban area, and access to health care plays a crucial role in the diagnosis and treatment seeking behavior among the patients rates. The pharmacotherapeutic regimens included calcium channel blockers, beta-blockers and antiepilepticals with only few case references to Ayurvedic medications (Table 2).

Table 2.

Summary table for identified studies from India

Author(s), Year	Study Settings	Title	Objectives	Methodology	Key Findings	Economic Loss
Saylor & Steiner, 2018 [7]	Global level including India	Global Burden of Headache	Assess the prevalence and impact of headache disorders, and propose interventions	Sample: Not specified, but representative Methods: Cross-sectional survey using standardized questionnaires	1-Year Prevalence: 64% for all headache disorders Migraine 25% Headache on 15 days/month: 3% 1-Day Headache Prevalence: 5.9% Daily Productivity Loss: Estimated at 3% of overall productivity	Economic Loss: Estimated at 1.7% of GDP due to headache disorders Negative Impacts: 6–12% reported impaired educational attainment; similar percentages reported negative impacts on earning potential and careers
Thomas et al., 2021 [8]	Different countries (9) including India	The relationship between headache attributed disability and lost productivity: 2. Empirical evidence from population-based studies in nine disparate countries	Evaluate the link between headache disability and lost productivity, focusing on migraine and pMOH	Individuals from population-based studies across multiple countries, including India Sample: Not specified Methods: Regression analysis using individual participant data from Global Campaign studies	Migraine-attributed Disability: Mean Proportion of Time in Ictal State (pTIS): 4.5% (India) Lost Paid Work Time: 4.4 to 14.0 days/3 months (varies by country) Total Lost Productivity: 16–56% pro rata recovery in India	Economic Loss: Estimated productivity loss of approximately 4.4 days/3 months due to migraine, reflecting substantial economic burdens Policy Implication: Investment in structured headache services could yield significant economic returns by improving productivity
Rao et al., 2015 [30]	Karnataka State, India	The burden attributable to headache disorders in India: estimates from a community-based study in Karnataka State	Estimate the burden of headache disorders in India to inform health policy	Population: Adults (18–65 years) in urban and rural Karnataka Sample: 2,329 participants (92.6% participation rate) Methods: Door-to-door survey & questionnaire used	1-Year Prevalence: Migraine: 25.2%, TTH: 35.1% Productivity Loss: 4.3% of productive time lost due to headaches; 5.8% for migraine Disability Burden: 1.8% per person with migraine	Total Economic Loss: Estimated loss of 2.7% of the productive time of the entire adult population due to headaches Paid Work Loss: Accounted for 40% of productivity loss, directly impacting GDP Healthcare Access: Limited engagement with healthcare services (only 25% consulted)
Ray et al., 2017 [31]	Kolkata, Eastern India	Prevalence, burden, and risk factors of migraine: A community-based study	To study the prevalence of migraine, its burden (DALY), and associated risk factors	Cross-sectional, community-based study; Sample: 2421 individuals aged 20–50; 342 diagnosed with migraine; Controls: 684 age- and sex-matched individuals without headaches; Interventions: Assessment of risk factors and calculation of DALY using WHO standards	1-year prevalence of migraine: 14.12% (342 cases out of 2421); Higher prevalence in women: 81.87% (280 out of 342); Major risk factors: education, environmental exposure (e.g., sun exposure, travel), oral contraceptives; Maximum burden observed in women aged 30–34	Estimated 33,338 DALYs per 100,000 population due to migraines; Significant productivity loss due to the impact on individuals’ ability to work, especially in the productive age group (20–50); Economic burden necessitates public health interventions
Chowdhury et al., 2024 [32]	Delhi and National Capital Region, India	Headache prevalence and demographic associations in the Delhi and National Capital Region of India	To estimate the prevalence of headache disorders and explore demographic associations in a nationwide study	Cross-sectional study; Population: Indian nationals aged 18–65; Sample: 2,066 participants from 3,040 households (68.0% response rate); Methods: Structured HARDSHIP questionnaire; Interventions: Neutral headache screening; Comparator: None	1-year prevalence: Migraine: 26.3%, Predicted one-day prevalence: 10.5%	Estimated significant productivity loss due to migraines and TTH; Possible economic burden calculated from lost workdays and healthcare costs; Further detailed economic impact analysis pending
Gupta et al., 2021 [33]	Rajasthan, India	Clinical Characteristics of a Severe Headache and Its Impact on Personal Life of Patients	To identify characteristics of severe headache and its impact on personal life of patients	Cross-sectional hospital-based study; Population: 100 patients with headache; Methods: Structured questionnaire; Interventions: None; Comparator: None	Common migraine: 28.99% (n = 10); Vascular headache: 28.99% (n = 10); Tension headache: 6% (n = 2); Mean age: 32.66 years (SD ± 14.63); Age of onset: 26.05 years (SD ± 5.32); 82% married; Males: More fatigue and missed work (n = 89%)	Estimated productivity loss: 17 days/year absence due to headaches; Economic burden includes costs from reduced work effectiveness and absenteeism, particularly affecting males
Steiner et al., 2016 [34]	Karnataka State, India	Headache yesterday in Karnataka state, India: prevalence, impact and cost	To estimate the prevalence, impact, and economic burden of headaches in Karnataka using a “headache yesterday” approach	Cross-sectional survey; Population: 2,329 adults (aged 18–65); Methods: Structured questionnaire using ICHD-II criteria; No interventions or comparators	1-day prevalence of headache: 5.9%; Mean duration: 7.0 h; Intensity: 2.0/3; Lost productivity: 83.3% reported some loss; 37.7% did less than half of planned activities	Estimated daily productivity loss: 3.0% of the adult population attributed to headaches
Sastry et al., 2022 [35]	Uttar Pradesh, India	The Pattern of Primary Headache in the North India Population: A Hospital-Based Study	To investigate the clinical profile, disease burden, quality of life, and treatment patterns of various headache subtypes	Study Design: Prospective observational study Sample Size: 815 patients, Intervention: Detailed history, clinical examination, management over 6 months with reassessment	Migraine Prevalence: 67.7% (549 patients; 395 episodic, 144 chronic), Productivity Loss: Significant; poor quality of life in 72% of migraine patients	NA

Migraines, according to Jawed et al. (2019) have productivity consequences: Of 50 diagnosed patients, 40% reported severe disability [29]. Overall, patients’ Migraine Disability Assessment Score (MIDAS) average score was 22.42 showing considerable disability at work. Of the patient, it was found that 48% took acetaminophen whereas 40% involved NSAIDs; 54% took prophylactic therapies which included beta block and tricyclic antidepressants. According to the Duan et al. [37], anxiety and depression increase the risk of developing migraines and worsen their impact, highlighting the bidirectional relationship where depression can trigger migraines, and chronic migraines can worsen depression. Addressing both conditions together is key for better patient outcomes.

Migraines prevalence, productivity loss and economic impact in India

Migraines is a neurological condition which poses serious social and economic impacts on the affected people of India besides denying them their quality life. This scoping review observes prevalence of migraines, productivity losses, economic impact, demographic impact, and public health concerns through the analysis of numerous studies. The pattern of migraine distribution by gender with a higher prevalence among female especially during fertile age calls for gender-sensitive health cares. The overall economic impact of these disorders is severe, and reduced work output was noted in all the studies reviewed. For instance, cost of headache disorders in India was affected per capita gross domestic product (GDP) and individual studies was reported that 3 to 4.3 per cent productive time lost due to headaches.

Prevalence of migraines

The prevalence of migraines in India is alarmingly high, with various studies indicating significant rates across different populations. Saylor and Steiner, 2018 highlighted one-year prevalence of migraine disorders to be 25% meaning that a quarter of the general population is a victim of this terrible illness [7]. The credibility of this finding is supported by another study conducted Rao et al. (2015) on 1,057 adults in Karnataka, where they established migraine prevalence rates of 25.2 per cent among adults aged 18–65 years. Chowdhury et al. [32] also found a 26.3% prevalence of migraine in Delhi and the National Capital Region (NCR); the results pointed out that migraines are a common health issue in many geographic locations. Ray el al determine a similar finding in their 2017 cross-sectional study of migrants in Kolkata, India, which found that 14.12% of those between the ages of 20 and 50 had migraines, among 342 migraine patients, the mean age was 32.2 years (SD ± 7.85). Most were female (81.87%), with 47.08% from slum areas. A majority were housewives (59.65%), married (80.99%), and from nuclear families (76.02%) [31]. Therefore, these results suggest the need for more awareness and focused treatments to manage this common condition properly.

Productivity loss

Migraine does affect the economic productivity of an individual and society at large thus causing a lot of loss to the overall economy. Saylor and Steiner [7], stated that daily loss to productivity because of headache is approximately 3% of total productivity in India. This figure clearly brings out the economic implication of migraines within the workplace. Thomas et al. [8] revealed that employees in India are estimated to lose 4.4 days of paid work every three months because of migraines this means about 17.6 days in a year. Absenteeism of this degree is clearly likely to have a negative impact on personal and financial and organizational performance. Also found by Rao et al. [30], headaches decrease the productive time by 4.3%, and migraines by 5.8%. In addition, Gupta et al. [33] studied severity of headaches, and found that people with severe headaches lose an equivalent of 17 days of productivity in a year and that males are more affected because they are more prone to absenteeism. Altogether these avoidable productivity losses give the picture of the economic cost of migraines and the need for policymakers to pay attention to the condition.

Disability burden (YLD) & mental health

YLDs from GBD 2019 were disaggregated for migraine [27], estimating 7.68 million YLDs for India. YLD quantification complements economic burden and highlights chronic productivity loss. Mental health comorbidities, particularly depression and anxiety, affect 30–50% of migraine patients, NMHS 2015–16 data aligns with this trend [27]. Integrated mental health and migraine care should be prioritized.

Demographic insights

Demographic factors play a crucial role in shaping the prevalence and impact of migraines in India. Interestingly, it has observed that most of migraine patients are women, more specifically, those who are 30–34 years old. This makes it important to know about the problems that women largely experience concerning migraine disorder. The last determinant is the age, more so those in the 20 to 50-year age being most affected by migraines. The potential of migraine to have a greater economic impact is because of the majority of the age group affected by migraine. Further Ray et al. [31] have also observed various risk factors such as education level, sun exposure/travelling and hormonal contraceptive use. Sex and ethnicity also appear to play a role in migraine incidence and the ability to obtain care. People with low socioeconomic position (SEP) have higher migraine prevalence, and limited access to appropriate medical care only worsens their condition [38]. These demographic differences demonstrate why development of general public health policies requires assessment of the risk factors pertinent to each population group.

Economic impact

The cost of migraines is not just the loss of potential productivity but it includes other areas of costs which include health care costs and other indirect expenditures. Saylor & Steiner [7] projected that the cumulative direct cost for headache disorders is about 1.7% of India’s gross domestic product, indicating that there is an increased need for solution-based interventions. According to Rao et al. [30], the amount of the economic impact they estimated for headaches is 2.7% of the working age population’s productivity loss. This is worrisome given that 40% of such lost productivity affect paid work thus reduced household income and economic volatility. Further, the costs of seeking the treatment for migraine adds up on the out-of-pocket expenditure of a household. A large number of people spend a considerable amount on consultations and medication and on even treatments which is quite high, especially in families with low income and inadequate health care facilities. This would put financial pressure on the patients which in turn progresses the situation, thereby leading to attainment of a delayed treatment and worsening of the symptoms.

Other economic loss attributable to migraine such as presenteeism, health resource utilization, loss of career advancement opportunities, cost of co-morbid conditions such as depression, dropping out of the workforce. A cross-sectional study conducted in 2020 by Ong et al., based on an online survey of full-time employees in Singapore, revealed that lost productivity was responsible for 82.4% of costs. They found that absenteeism in the lower end episodic migraine (LEM) group was the main cause of lost productivity, accounting for 38.2% of costs, followed by presenteeism in the upper end episodic migraine (UEM) group (26.0%), absenteeism in the UEM group (18.8%), and presenteeism in the LEM group (17.1%) [39] According to this study, the average cost of healthcare was 17.6% of total expenses per capita, with diagnostic tests accounting for the largest share (33.6%), followed by consultations (17.1%), prescription drugs (16.7%), alternative treatments (16.6%), and hospital stays (14.8%) [39]. It has observed that in case of negative impact on loss of career advancement opportunities which reported 6–12% impaired educational attainment; similar percentages reported negative impacts on earning potential and careers [7].

Estimation of economic loss in India

The evidences highlighted that migraine-related productivity losses ranged from 3% to 4.3% of productive time, translating to significant economic implications. The pooled analysis obtained from two studies shows that productivity loss due to migraine is 17.3 days per year. This pooled productivity loss was used for estimating the economic loss based on daily per capita income. This was found to be INR 8731/- annually based on daily per capita income. Taking the prevalence of migraine in India, it leads to a total economic loss of about INR 18,674.35 crore (approximately USD 22.21 billion). Further, the economic loss attributable to migraines represents around 4.74% of the country’s per capita national income (Table 3). This significant burden emphasizes the urgent need for effective healthcare interventions to address and manage migraine disorders in the population. The evidence also highlighted that individuals suffering from migraine reported increased healthcare costs and a higher prevalence of comorbid mental health issues, exacerbating the economic burden and reinforcing the cyclical nature of migraine and mental health disorders.

Table 3.

Migraine-related economic losses in India

Prevalence of Migraine in India (from GBD 2019) [27]	21,38,90,207
Total Per capita national income (INR)/day [40]	504.7
Pooled Productivity Loss (days/year) [8, 33],	17.3 days
Economic Loss per Individual (INR/year)	₹8731
Total Economic Loss (INR)	₹18,674.35 crore (USD 22.21 billion)
Economic Loss as % of Per capita national income (among the migraine)	4.74%

Source: Authors’ estimation based on included studies [8, 27, 33, 40]

Discussion

Eleven studies [7, 8, 27–35] from different nations, including India, are included in this scoping review, which shows that there is a lack of research on migraine-related productivity loss and economic burden in LMICs. The economic impact of migraines on different workers in India is substantial, and they need attention. In India, a considerable number of people suffer from this neurological condition, although the incidence of disorder varies significantly. A significant amount of productive time is estimated to be lost due to migraines, amounting to several days lost per year per person.

Migraines significantly reduce productivity in Asian countries, such as Singapore, Malaysia, the Philippines, and India. Presenteeism, or decreased productivity at work, has a considerably greater economic impact than absenteeism, according to studies [39, 41, 42]. With per capita expenses ranging from Singapore Dollar (SGD) 4,925 (LEM group) to SGD 14,476 (UEM group), migraine-related productivity loss in Singapore accounted for 82.4% of the overall economic cost in case of episodic migraine in these groups. The total cost of episodic migraines in Singapore was around SGD 1 billion (USD 0.75 billion) in 2018 [39].

On the other hand, a cross-sectional study was carried out among employees in Philippines who were either suspected or confirmed cases to have migraines. Individuals with high migraine disability missed 17 workdays annually, resulting in an average productivity loss of USD 556 in Philippines [41]. Presenteeism in Malaysia costs USD 1,296 per person year, which is 20 times more than absenteeism [42].

On the basis of systematic scoping review literature, this study was able to estimate the socio-economic burden of migraine in India which is around 18,674 crore, or 22.21 billion USD, or 4.74% of its total national income per person. The financial burden on individuals and substantial economic pressure on the nation’s output negatively impact the country’s productivity. The impact of migraines on productivity are highlighted by Saylor & Steiner [7] and Rao et al. [30], who point out that a considerable number of missed workdays are caused by absenteeism caused on by this condition.

This scoping review effectively demonstrates not only the prevalence and economic impact as well productivity loss, but also demographic factors (e.g., gender disparities, age group consideration), workplace policies, awareness, and comparison with the global prevalence of migraine. According to Zhang et al., migraine disorder condition is more common among women at ages 40–44 [27]. Hence, there is a need for gender-sensitive healthcare and compensation practices in the workplace because migraines are more common in women throughout their most productive ages. Patients living in poverty along with rural areas often do not receive proper treatment, due to socio-economic factors. Limited access to healthcare services causes delays in identifying the migraine disorder and leads to harm, both for individuals and the economy.

In addition, there are direct productivity losses as well as financial losses in many other industries, as discussed below. Preventative care, prescription medications or drugs, and consultations are still another major issue of extra expense in the healthcare sector. There are significant out-of-pocket costs involved in treating migraines, especially for people who live in rural or remote locations. These repercussions are particularly severe in low-income communities where early-stage health conditions are neglected and worsened. In communities with low income, people often ignore minor health concerns, causing the results to be unequal. Evidence-based solutions include expanding access to specific medication for migraines, behavioral therapy, prophylactic regimens, insurance coverage for migraine therapy, and workplace adjustments like flexible work hours [43].

In addition to the major direct costs, individuals with migraines are frequently diagnosed with anxiety and depression, which increase the disability caused by the disease. The combined burden of migraines and mental illnesses has a major effect on medical facilities. Because migraines are a chronic condition its recurrence continuously affects quality of life and productivity at work, based on this review, the author highlights the significance of a multifaceted approach to migraine treatment in India. Despite the current focus on medicine and treatment costs, which is particularly related in LMICs settings, a similar tendency can be seen with relation to treatment efficacy. Measures that improve workable organizational policies, such as flexible work schedules or other arrangements that can assist impacted employees, are also likely to be successful.

Although the study concentrates on LMICs with a particular emphasis on the Indian setting it would be useful to compare these results with data from high-income nations in order to better understand global trends and possibly find effective intervention strategies that might be improved for the Indian setting. The study’s emphasis on LMICs prompts enquiries into the potential effects of socioeconomic factors on migraine prevalence and treatment accessibility. Interventions that are more focused and successful may result from more investigation on those factors.

Finally, there is a need for policy reform in workplaces and reimbursement sector to recognize migraine as a disorder which are essential for better support and workplace accommodation for individuals suffering from migraine. Impact of migraines on public health is not fully understood hence, primary research to understand health resource utilization due to migraine is required. Given the high economic burden, scalable interventions such as employer-sponsored migraine programs and inclusion of triptans in essential drug lists are relevant for India.

Limitation

While the methodology by Fuh et al. [26] from Taiwan was adapted for productivity loss estimation, it was adjusted for Indian per capita income. Most included studies were urban-centric, limiting generalizability to rural populations. This highlights the need for rural-focused primary research.

Conclusion

In India, migraines are a serious economic problem in addition to being a serious health condition. The influence on productivity should be considered in along with standard healthcare outcomes when assessing the efficacy of current migraine treatments. Our approach to managing migraines can be improved by researching the wider effects of successful drugs. Because of the prevalence of cases, gender bias, and decreased productivity, there is an increasing need for suitable treatments pertaining to workplace changes, health assistance, and insurance programs. To support female migraine sufferers at work, a strategy that incorporates more effective treatment, increased awareness, and suitable legislation must be implemented. It is obvious that local and specific treatment is required because migraines are treated differently and impact different people in different parts of the world. Strategies such as promoting disease awareness, specific migraine treatments, scaling up tele-neurology services, and migraine-focused workplace policies are urgently needed. Policy solutions like telemedicine, community health worker (ASHA) training, and public insurance coverage of migraine medication can improve rural access. Furthermore, future research can more clearly demonstrate if present treatment approaches are cost-effective because data on health care resource utilisation is not sufficiently detailed. We must have a thorough understanding of migraine and headache disorders in order to develop efficient management strategies.

Abbreviations

DALYs

Disability-Adjusted Life Years

GBD

Global Burden of Disease

GDP

Gross domestic product

HIS

International Headache Societ’s

JBI

Johanna Briggs Institute

LEM

Lower end episodic migraine

LMICs

Lower-Middle Income Countries

MIDAS

Migraine Disability Assessment Score

NCR

National Capital Region

NMHS

National Mental Health Survey

NSAIDs

Non-steroidal anti-inflammatory drugs

PRISMA

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

pTIS

Proportion of Time in Ictal State

SGD

Singapore Dollar

SEP

Socioeconomic position

TTH

Tension-type headache

UEM

Upper end episodic migraine

VM

Vestibular migraine

WHO

World Health Organization

Appendix

Table 4.

Full search strategy

Databases	Search strategy	Date & results	Time period
PubMed	((migraine prevalence) AND (productivity loss))	16/10/2024 32 results	2014–2024
Scopus	migraine prevalence AND productivity loss AND India	16/10/2024 52 results	2014–2024
Google Scholar	Impact of Migraine on productivity and efficiency in India among the working professionals	09/10/2024 17,100 results*	2014–2024
MDPI	Migraine AND economic burden AND India, Migraine AND economic loss AND workers	14/10/2024 63 results	2014–2024
Total		17, 247

From Google Scholar, we screened the first 25 pages sorted by relevance, as recommended in scoping review guidance for grey literature. Articles were excluded based on title/abstract relevance

Authors’ contributions

S.S., M.W., R.S., I.P., A.B., and V. M. were involved in study conception and design. R.S. and M.W. designed the search strategy. R.S. and D.R. were involved in data collection. R.S., M.W., and S.S. analyzed the data and were involved with manuscript preparation and critical revision. D.C., I.P., A.B., and V. M. reviewed the manuscript. All the authors approved the final version of the manuscript.

Funding

Pfizer limited, India.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

Not applicable.

Competing interests

Authors SS, MW, RS, and DR from the Indian Institute of Public Health Gandhinagar (IIPHG), and DC from the GB Pant Institute of Post Graduate Medical Education and Research, New Delhi, declare no conflict of interest. Authors IP, AB, and VM are full-time employees of Pfizer Limited, India, and own stocks in Pfizer.