So you suffer from a couple of headaches a year while at work, but it's no big deal ? right? Wrong, says one of the nation's leading medical experts. A large population-based telephone survey of more than 13,000 headache sufferers found that the average headache sufferer loses more than four workdays a year, either because of decreased productivity while on the job or because of actual sick days spent at home.
Q: Are headaches really a significant problem, or just a good excuse?
A: It's common to minimize the seriousness of headaches because they often don't require a physician's care and are usually self-treated. However, headaches are in fact among the 10 most common reasons people see a physician, accounting for 18.3 physician visits a year. Our study, by providing estimates of lost workdays and reduced effectiveness due to headaches, underscores the fact that this disorder can be costly to employers. Q: Do as many men as women get headaches or migraines?
A: It depends on what type of headache you consider. Tension-type headaches, the most common type, are equally prevalent in men and women. In contrast, women are three times more likely than men to experience migraine headaches, the second most common type. The prevalence of migraine is relatively high (over 20 percent) in women between ages 25 and 50, often years of peak productivity. Cluster headaches, although rare ? affecting fewer than one in 1,000 ? are more common in men than in women. Q: How do you determine the costs associated with headache on the job?
A: There are two types of costs, direct and indirect. Direct costs are straightforward and include such things as diagnostic testing, medical care and drug therapies. But the indirect costs of headaches on the job, which include wages paid for lost days and the costs of decreased quantity and quality of work, far outweigh the direct costs. And this study may even have underestimated indirect costs, because the researchers could not measure decreases in the quality of work or the impact that someone's headaches may have on the productivity of the whole group. Q: How serious a problem are headaches in the workplace?
A: The study looked not only at actual lost workdays, but also at lost productivity, what we call "reduced effectiveness workday equivalents" (REWEs) or losses due to decreased quality and quantity of work. It found that on average a person suffering from any type of headache ? migraine, tension-type or cluster ? is going to lose the equivalent of 4.2 days per year, with 70 percent of this loss taking the form of REWEs. Almost a third of the subjects reported that their headaches reduced their productivity more than just occasionally; 9 percent reported headaches severe enough to cut their productivity by more than 50 percent. Q: Are migraines more of a drain on workplace resources than nonmigraines?
A: It's a toss-up. Migraines are more disabling, so they account for a disproportionate share (57 percent) of days workers actually stay at home, but nonmigraine headaches are more prevalent, and thus are responsible for 63 percent of the REWEs. Q: Has the incidence of headaches gone up in this century?
A: Because the definitions of the different types of headaches have changed over time, we can't say whether a change in incidence is due to a real statistical difference or simply to changes in definition. Recent studies, however, suggest that the prevalence of migraine has increased 40 percent to 50 percent since the early 1980s, primarily in women 20 to 45 years of age. A number of explanations have been offered to explain this change in prevalence, including increasing family, social and work demands on women. Q: What can be done to relieve headaches and thus increase work productivity?
A: For the more common mild headaches, and depending on one's sensitivity to side effects (for example, stomach irritation from aspirin or ibuprofen), there is a wide array of over-the-counter medications. But one general concern about self-medication is that some individuals tend to develop what are known as rebound headaches, which can arise from continued frequent use of headache medications beyond what is recommended on the label. For the more severe headaches, like migraines, which are not helped by over-the-counter drugs, individuals should seek medical care. The clinician today has a number of consistently effective options that were not available even 10 years ago. Q: What are some of the common triggers of headaches?
A: We do not have firm evidence from scientific studies regarding what things trigger the different types of headaches. However, when headache sufferers are asked what they think causes their headaches, the most common triggers reported are stress and anxiety (tension and migraine headaches), fatigue, dietary factors (red wine, chocolate, certain cheeses), and hormones in women as triggers of migraine. In general, however, headache triggers are difficult to study because their effect may tend to vary over time in the same individual and may depend on interactions between more than one factor. So, a glass of red wine may only trigger a migraine headache when someone is under stress, fatigued or at a certain point in their hormonal cycle. This complex interplay between behavioral, mental and physical factors makes this question one of the more difficult areas of research regarding the causes of headaches. Q: Is there anything employers should be doing about headaches in the workplace?
A: If workers are educated about the different types of headaches, about when a headache is routine and when professional treatment should be sought, and about prevention strategies and headache triggers, they can learn how to manage headaches more effectively and avoid some of the risks associated with overuse of medications. Our results suggest that a small increase in an employer's direct costs (medical spending, workplace-based education) is likely to result in significant gains in productivity (by decreasing the large indirect costs of headaches). Finally, employers should expect better management of headache pain from health care providers, whom they help support with health insurance dollars
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