Migraine is a common and disabling primary headache disorder. It is a complex condition comprising a wide variety of symptoms. For many people, the main feature is a painful headache. However, other symptoms include disturbed vision; sensitivity to light, sound and smells; nausea and vomiting. The Global Burden of Disease study (GBD), when looking into the number of years lived with disability for the period 1990-2017, ranked headache disorders as the third cause of years lived with disability (YLDs) in Portugal both in 2007 and 2017.

The GBD study in 2017 estimates that 18.1% of the population globally experience migraine across both sexes and all age groups. There is a clear female preponderance, with 22.6% of women experiencing migraine compared to 13.5% of men. The data show that headache disorders (largely consisting of migraine) is now the second highest cause of total YLDs worldwide (causing 5.5%) for both men and women and all age groups, second only to low back pain (7.2%) which comprises a mixture of disorders. This illustrates the challenge posed by migraine prevalence for healthcare systems worldwide.

Figure 1 – Prevalence of migraine in Portugal, by age for both sexes, 2019¹⁷

Source: GBDx. GBD Results Tool Global Health Data Exchange; 2019

Migraine disproportionately affects people of working age, peaking at 30-40 years. This is generally when people are at their most productive, furthering their careers and starting families and, therefore, it has important implications for the career paths of people with migraine, but also employers and the Portuguese economy in general.

The substantial productivity losses associated with migraine could be reduced significantly through improvements in treatment and management of the condition. Our research indicates that to improve clinical and employment outcomes, further work is needed to improve understanding of migraine among patients, general doctors and employers in Portugal.

Our qualitative research aligned closely with findings reported on the literature on the impacts of migraine on the day to day lives of those who live with it. Participants report depression, anxiety and very frequent incapacitating and debilitating pain.

Although many also reported waking up with migraine and needing time in bed to let acute medication take effect, not all had of them were allowed the flexibility in their working hours needed to use this coping strategy in practice.

Stigma around this chronic ‘invisible’ condition was reported by all the groups interviewed. There was recognition among patients and stakeholders alike that the wider public do not understand the debilitating impact of migraine and see it as a ‘simple headache’, an excuse to arrive later or leave early from work.

Migraine has an impact at a personal level including, and extending beyond, individuals’ ability to perform their work. Light, noise, and working in shifts are some of the triggers most frequently identified through this research. Raising awareness of this among employers in Portugal and emphasising the simple adjustments that can be made to working practices and working environments, will be crucial. For example, the Work Foundation recently produced a guide for line managers on migraine, which outlines potential triggers, proposes workplace adjustments and facilitates conversations about migraine and wider workplace wellbeing. In addition, policies that have showed results in other countries to address these problems, like flexible working hours or targeted support for shift workers, should be promoted to ensure that work environments can accommodate people suffering from migraine, allowing them to be productive and to enjoy life.

Finally, investing in training for GPs and improving referral mechanisms between GP practices and NHS hospitals could contribute to reduce waiting times and improve the overall management of migraine in Portugal.

While a large number of studies that have attempted to estimate the prevalence and costs of migraine in many countries throughout the world, very few focus on Portugal, and national data is limited. To learn more about the particular barriers to optimal work and health related outcomes for people living in migraine in Portugal, we have delivered new qualitative research supported by Novartis.

This involved 10 semi-structured interviews with working age Portuguese adults with migraine as well as 9 interviews with key stakeholders including GPs, neurologists and employers. This has allowed us to develop a series of recommendations for employers, the Portuguese Health Service and policy makers to improve awareness of the condition and widen access to support.

Read the report in full here.

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