Sumatriptan Provides Headache Relief in the Workplace
abstract & commentary
Source: Schulman EA, et al. Effectiveness of sumatriptan in reducing productivity loss due to migraine: Results of a randomized, double-blind, placebo-controlled clinical trial. Mayo Clin Proc 2000;75:782-789.
Migraine affects roughly 24% of the population and is most prevalent in individuals during the most productive years of their life. In fact, estimated labor costs due to migraine range in the billions to tens of billions of dollars. The efficacy of the triptans as an acute migraine abortive treatment has been well established. The benefit of using these medications to prevent work-related morbidity has been less well studied. Schulman and associates report the results of a multicenter, randomized, placebo-controlled, parallel-group trial comparing the benefits of 6 mg subcutaneous sumatriptan to placebo. Several outcome measures were used including: time to headache relief, number of patients returning to normal work performance two hours after injection and across the work shift, and time to return to normal work performance.
One hundred sixteen patients comprised the final study group. Seventy-six received sumatriptan and 40 took placebo. Ages ranged from 18-65 and occupations ranged across the employment spectrum with subjects only needing to work outside the home for a minimum of eight hours. Sumatriptan demonstrated clear efficacy in one-hour headache relief after injection compared to controls (48/76, 63% vs 13/40, 33%; P = 0.004). Additionally, sumatriptan was superior to control by any number of work-related efficacy parameters. The sumatriptan-treated group showed significant reductions compared to controls in productivity loss over the entire work shift (36.8 vs 72.6 minutes; P = 0.001). The sumatriptan-treated group experienced shorter return to normal work performance at two hours (53/76, 70% vs 12/40, 30%; P < 0.001) and across the eight hour shift (64/76, 84% vs 23/40, 58%; P < 0.001). Adverse events were minimal and there was no loss of work related to the use of sumatriptan.
Commentary
The current study helps establish the relationship between the clinical efficacy of sumatriptan and work productivity. The study takes into account the importance of measuring the detrimental effect migraine can have in compromising work performance. Previous studies have looked at just absenteeism in migraine patients and have underestimated what Schulman et al call "presenteeism," or the impairment of work by migraineurs who continue to work at reduced capacity. Fiscally myopic insurers and employers ought to take notice that when it comes to migraine and the seemingly high cost of the triptan class of medications, effective treatment is money well spent. —Jeffrey Reich
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