What can be done to lower the economic cost of migraine?

The annual economic cost of migraine is high — estimated to be €50–111 billion in Europe in 2011. This huge cost can be lowered by effective preventive medication and structured headache services, explained experts at a symposium at EAN 2022, but many patients receive inadequate treatment, even in wealthy European countries.

The annual cost of migraine

In Europe, the annual cost of migraine was estimated to be €50–111 billion in 2011,1 said Professor Massoud Ashina, Copenhagen, Denmark. Indirect costs resulting from work absenteeism and reduced work productivity accounted for 93%, while direct costs (ie, healthcare resource utilization) accounted for 7%.1

Healthcare resource utilization accounts for only 7% of the overall cost of migraine


The direct costs of migraine

The direct costs of migraine are medications, physician consulting services, emergency department visits, investigations, and management of treatment adverse events,1 explained Professor Paolo Martelletti, Rome, Italy.

32% of 420 Italians with at least 4 monthly migraine days and at least two preventive treatment failures had at least one emergency room visit in the previous 12 months

To investigate the healthcare resource utilization further, Professor Martelletti and his colleagues analysed data for 420 Italians attending a tertiary level headache center who had at least four monthly migraine days and at least two preventive treatment failures.2 They found that in the previous 6 months:

  • 58% of the patients had visited general practitioners (mean number of visits [MNV] 4.5)
  • 32% had visited neurologists (MNV 2.6)
  • 26% had visited headache specialists (MNV 2.8)

In the previous 12 months, 32% had at least one emergency room visit (MNV 2.8) and 15% had at least one hospitalization (MNV 2.9) because of migraine.2

Direct costs are higher in patients with chronic migraine than in those with episodic migraine

The direct costs have been further evaluated by a retrospective, noninterventional observational analysis of electronic medical records of patients with episodic migraine (EM) and chronic migraine (CM) undergoing continuous treatment for 2 years in Rome,3 said Professor Martelletti. They were found to be 4.8 times higher for patients with CM than for patients with EM, were significantly higher for women than for men, and increased with age.3


Effective preventive medication significantly lowers use of healthcare resources

Earlier use of effective treatments to prevent chronification lowers direct costs4

Use of healthcare resources is significantly lower for patients treated with effective preventive medication than for patients with stable or worsened migraine,4 said Professor Martelletti.

In addition, structured headache services based in primary care with provider training and consumer education have been shown to be cost-effective.5

Many patients are receiving inadequate treatment for migraine7

However, many patients with migraine are waiting years for referral to appropriate specialists,6 said Professor Raquel Gil-Gouveia, Lisbon, Portugal, and many patients with migraine are receiving inadequate treatment for migraine, even in wealthy European countries.7


This satellite symposium was supported by Novartis.

Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.


  1. Linde M, Gustavsson A, Stovner LJ, et al. The cost of headache disorders in Europe: the Eurolight project. Eur J Neurol. 2012;19(5):703–11.
  2. Martelletti P, Schwedt TJ, Vo P, et al. Healthcare resource use and indirect costs associated with migraine in Italy: results from the My Migraine Voice survey. J Med Econ. 2021;24(1):717–26.
  3. Negro A, Sciattella P, Rossi D, et al. Cost of chronic and episodic migraine patients in continuous treatment for two years in a tertiary level headache centre. J Headache Pain. 2019;20(1):120.
  4. Vo P, Swallow E, Wu E, et al. Real-world migraine-related healthcare resource utilization and costs associated with improved vs. worsened/stable migraine: a panel-based chart review in France, Germany, Italy, and Spain. J Med Econ. 2021;24(1):900–7.
  5. Tinelli M, Leonardi M, Paemeleire K, et al. Structured headache services as the solution to the ill-health burden of headache. 3. Modelling effectiveness and cost-effectiveness of implementation in Europe: findings and conclusions. J Headache Pain. 2021;22(1):90.
  6. Davies PTG, Lane RJM, Astbury T, et al. The long and winding road: the journey taken by headache sufferers in search of help. Prim Health Care Res Dev. 2019;20:e4.
  7. Katsarava Z, Mania M, Lampl C, et al. Poor medical care for people with migraine in Europe – evidence from the Eurolight study. J Headache Pain. 2018;19(1):10.