Table 2.

Studies reporting economic burden of migraine

Citation	Country/ region	Study design Study dates	Migraine criteria	Migraine (n) Age, y % F	Main findings
Yu, 2012 [29]	China / Mainland	Population-based 2009	ICHD-II	469 respondents Mean 46.2 y 67.6 F	Over the past 3 mo, average (SD): • Days of missed work 2.7 (7.5) • Impaired work days 4.0 (8.1) • Missed housework days 3.3 (7.1) • Impaired housework days 4.7 (8.6) Indirect costs due to migraine-related lost productivity: CNY 273.7 billion (USD 39.4 billion) Direct costs (diagnosis / treatment out-of-pocket expenses) per person affected year: CNY 729 Direct costs per year CNY 58.0 billion (USD 8.4 billion) Total annual cost of migraine per year: CNY 331.7 billion (USD 47.8 billion)
Fuh, 2008 [33]	China / Taiwan	Population-based 1997–1998	IHS migraine and modified migraine (IHS and attacks 2- to 4-h duration)	1813 employees NR 43.2 F 1809 non-employees NR NR	Over the past 1 y: • Median no. of missed days/employee, 2 days • Estimated median cost due to missed workdays/person in subjects with migraine vs without migraine: NTD 1667 vs NTD 0, P < 0.001 Projected annual number of missed workdays and economic loss attributed to migraine in 2005: • 3.7 million missed workdays/y (3.06 million in women, 0.64 million in men) • Estimated annual cost of migraine was NTD 4873/person • Estimated cost of NTD 4.6 billion/y due to lost workdays • Women accounted for ~ 80% of total cost (~ 56% of total cost attributed to women aged 35–54 y)
Tang, 2013 [38]	China / Taiwan	Cross-sectional other: retrospective case-control analysis of NHIRD 1996–2009	Refractory migraine (ICD-9-CM)	936 patients with refractory migraine vs 3743 non-migraine controls Mean 42 y 76 F 673 patients with refractory migraine vs 2202 with other migraine Mean age 41–42 y 79–80 F	All analyses adjusted for age, gender, urbanization level, income, and comorbidities Refractory migraine vs non-migraine adjusted for sociodemographic factors/comorbidity, mean (SD) Frequency of care: • Outpatient visits: 35.5 (33.2) vs 16.5 (14.4), P < 0.0001 • Emergency visits: 1.2 (1.3) vs 0.3 (0.3), P < 0.0001 • Hospital admission: 0.7 (0.8) vs 0.3 (0.3), P < 0.0001 • Hospital days: 7.1 (11.5) vs 2.4 (4.7), P < 0.0001 Annual total drug costs per person: NTD 19,752 (USD 608) vs NTD 8660 (USD 266), P < 0.0001 Annual total medical costs per person: NTD 57,932 (USD 1783) vs NTD 26,817 (USD 825), P < 0.0001 Refractory migraine vs other migraine adjusted for sociodemographic factors/comorbidity, mean (SD) Frequency of care: • Outpatient visits: 36.3 (23.0) vs 26.2 (12.3), P < 0.0001 • Emergency visits: 1.4 (1.6) vs 0.5 (0.5), P < 0.0001 • Hospital admission: 0.6 (0.8) vs 0.3 (0.3), P < 0.0001 • Hospital days 7.0 (10.9) vs 2.7 (5.1), P < 0.0001 Annual total drug costs per person: NTD 17,623 (USD 542) vs NTD 10,088 (USD 310), P < 0.0001 Annual total medical costs per person: NTD 54,678 (USD 1682) vs NTD 38,397 (USD 1181), P < 0.0001
Takeshima, 2004 [53]	Japan	Population-based 1999	IHS	342 adults ≥20 y 81.6 F	Over the past 3 mo: • 20.3% had time off work due to headache • 25.8% with MWA had time off work (mean no. of days: 1.8) • 19.5% with MOA had time off work (mean no. of days: 3.8) • 27.3% with MWA were unable to do housework (mean no. of days: 2.0) • 28.0% with MOA were unable to do housework (mean no. of days: 2.8)
Suzuki, 2014 [52]	Japan	Community-based 2007–2008	ICHD-II	704 Tokyo employees ≥20 y 77.4 F	25.1% had to miss work because of headache 2.7% could not work once per mo
Choi, 2018 [54]	South Korea	Cross-sectional other: prospective disease registry 2016–2018	ICHD-IIIβ	38a adults Mean, 37.6 y 15.7 F	Employed patients with migraine compared with employed control patients without headache: • Experienced difficulty at work (63.9% vs 36.5%) • Had low productivity (33.3% vs 11.5%) • Greater sick leave (13.9% vs 3.8%) Migraine or TTH was significantly associated with difficulties at work after adjustment for health, anxiety, and stress (OR 3.05; 95% CI, 1.10–8.49; P = 0.032)

^a This study enrolled 143 patients with cluster headache, 38 age- and sex-matched patients with migraine or TTH, which included 5 patients had chronic migraine, 25 with episodic migraine, and 8 with TTH (4 chronic and 4 episodic), and 52 individuals without headache. Patients with cluster headache are not reported here

CI confidence interval; CNY Chinese yen; F female; ICHD-I/II/IIIβ International Classification of Headache Disorders; IHS International Headache Society; MOA migraine without aura; MWA migraine with aura; NHIRD Taiwan National National Health Insurance Database; NR not reported; NTD New Taiwanese dollar; OR odds ratio; SD standard deviation; TTH tension-type headache; USD United States dollar