Migraine's Economic Burden: USA and Europe

United States:

• 2019: A study estimated the total economic burden of rare diseases, including migraine, at $997 billion. Migraine's specific contribution isn't isolated in this figure. Another study estimated the cost of foodborne illness, not specific to migraine, at $75 billion.
• 2023: A study estimated the cost of foodborne illness, not specific to migraine, at $75 billion.
• 2019: Another study estimated the total economic burden of rare diseases, including migraine, at $997 billion. Migraine's specific contribution isn't isolated in this figure.
• 2019: A study focusing on brain disorders found that indirect costs (e.g., lost productivity) outweigh direct medical costs, even in high-income countries with advanced healthcare systems like those in Europe. This suggests a similar pattern likely exists for migraine in the US.
• Earlier estimates: A 2019 study using the Migraine Impact Model (MIM) estimated annual migraine-associated costs for US employers. Workforce sizes ranged from 18,800 to 250,000 employees. The model projected 60,000 to 686,000 lost workdays annually due to migraine, with indirect costs 6.2 to 8.5 times higher than direct costs. A 2017 study estimated socioeconomic losses due to migraine in Germany at 100.4 billion (including paid and unpaid work), averaging 6493 per patient. A 2008 study estimated the annual cost of pre-diabetes and diabetes at $218 billion, including $153 billion in medical costs and $65 billion in reduced productivity. A 2007 study estimated the cost of foodborne illness at $51.0 billion (basic model) and $77.7 billion (enhanced model). A 2006 study found that transformed migraine (migraine that increases in frequency over time) resulted in significantly higher costs ($7750 annually) compared to episodic migraine ($1757 annually). A much older study (1987) found children with asthma incurred 2.8 times higher healthcare expenditures than children without asthma.

Europe:

• 2021: A study estimated the annual cost of CVD across the 27 EU countries at 282 billion. Another study estimated the cost of hearing loss globally at $981 billion, with 57% of costs outside high-income countries (including some European nations).
• 2017: A study estimated the economic burden of stroke across 32 European countries at 60 billion. Another study examined the burden of migraine in five European countries (EU5), finding poorer health-related quality of life, increased work productivity loss, and higher healthcare resource utilization in migraineurs with 4 or more monthly headache days.
• 2015: A study estimated the cost of all cancers in the EU at 126 billion, with lung cancer having the highest cost (18.8 billion). Another study estimated the cost of colorectal cancer across 33 European countries at 19.1 billion.
• 2012: A study estimated the economic burden of malignant blood disorders across 31 European countries at 12 billion.
• 2010: A study estimated the cost of treating glioblastoma in the US and other healthcare systems, but did not provide specific European figures.
• 2009: A study estimated the cost of all cancers in the EU at 126 billion.
• 2008: A study estimated the economic burden of metabolic syndrome in patients with hypertension in Germany, Spain, and Italy.

Key Observations:

• Indirect costs are a major component: Lost productivity due to migraine significantly contributes to the overall economic burden in both the US and Europe.
• Chronic migraine is more costly: Individuals with chronic migraine experience higher healthcare resource utilization and costs compared to those with episodic migraine.
• Data limitations: Variations in methodology and the availability of data make direct comparisons between studies and across countries challenging. Many studies include migraine within broader categories (e.g., rare diseases, brain disorders), making it difficult to isolate migraine's specific economic impact. More research is needed to provide more precise and comparable estimates of the economic burden of migraine.
• Focus on specific cost drivers: Future research should focus on identifying specific cost drivers, such as medication use, emergency room visits, and lost productivity, to inform targeted interventions and resource allocation.

Dihydroergotamine (DHE), traditionally used for migraine, is being explored for other indications, although specific clinical trials for non-migraine indications are limited in the provided text. The available information suggests its potential use in other headache disorders and conditions involving nausea and vomiting, particularly in the context of migraine treatment.

Other Headache Disorders:

• Cluster Headache: DHE has shown benefit in treating cluster headache, particularly the intravenous form. One study found that patients with cluster headache benefit from IV DHE.
• Chronic Daily Headache: DHE is used in the management of chronic daily headache, often in an inpatient setting with intravenous infusions. One study included patients with chronic daily headache in a trial of IV DHE. Another study mentioned DHE's use for intractable transformed migraine, a type of chronic daily headache.
• New Daily Persistent Headache (NDPH): While DHE has been tried in NDPH, its effectiveness appears limited to those with migrainous features. One study found that only NDPH patients with migrainous symptoms responded to DHE, and the response was less robust than in chronic migraine patients.
• Status Migrainosus: DHE is a common treatment for status migrainosus, a severe and prolonged migraine attack. Several studies mentioned DHE's use in status migrainosus, often intravenously.
• Medication-Overuse Headache: DHE is considered useful in managing medication-overuse headache, particularly in transitioning patients away from overused medications. One study mentioned DHE's utility in migraineurs at risk of medication-overuse headache. Another discussed its use for bridging patients out of medication-overuse headache/chronic migraine.

Nausea and Vomiting:

• DHE-Induced Nausea: DHE itself can cause nausea, and studies have explored using other medications like domperidone and aprepitant to manage this side effect. One study found domperidone safe and effective for treating DHE-induced nausea, while another showed aprepitant reduced nausea scores and stopped vomiting in patients receiving IV DHE.

Intervention Models:

The primary intervention model in the provided texts for administering DHE is intravenous infusion, particularly for inpatient treatment of severe or refractory headaches. Other routes of administration mentioned include intramuscular injection, nasal spray, and oral inhalation. Specific trials mentioned include:

• Intravenous DHE infusion: Commonly used for chronic migraine, cluster headache, status migrainosus, and transformed migraine. Studies have explored different infusion durations and doses.
• Intramuscular DHE injection: Used for both acute migraine and self-administration at home.
• Nasal spray DHE: Studied for acute migraine treatment, offering a less invasive option than injections.
• Oral inhalation DHE (MAP0004): A newer formulation investigated in several clinical trials for acute migraine, aiming for rapid absorption and fewer systemic side effects than intravenous DHE.

It's important to note that while DHE has been used in various headache types and for managing nausea related to migraine treatment, the evidence base for these indications may not be as robust as for acute migraine. Further research and clinical trials are needed to fully establish DHE's efficacy and safety beyond its traditional use in migraine.