Socioeconomic impact of migraine in Italy: Results of a national survey

  • Mihaela Nica Novartis Farma S.p.A., Origgio (VA) - Italy
  • Delia Colombo Novartis Farma S.p.A., Origgio (VA) - Italy
  • Roberto Ravasio MA Provider, HEOR and RWE department, Milan - Italy
  • Carla Rognoni Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Milan - Italy
Keywords: Cost, Gender difference, Migraine, Out-of-pocket costs, Productivity losses, Quality of life


Background: Literature data indicate that migraine has a stronger impact on both healthcare consumption and quality of life (QoL) in women.

Objectives: The objective of this article is to evaluate out-of-pocket (OoP) costs, productivity losses and cost of informal care of migraine in Italy, with a special focus on the detection of potential differences between male and female subjects.

Methods: A cross-sectional study was conducted. Data were collected via a web-based survey platform, which included a socioeconomic questionnaire (five sections: clinical history; occupational status; informal assistance; visits, exams and treatments; and loss of productivity) and two questionnaires on QoL (EuroQol 5D 5L and Migraine-Specific Questionnaire, MSQ).

Results: Six hundred and seven participants took part in the survey (average age of 42 years; female 70%). The duration of the attack (4-72 hours) was significantly much longer in women than in men (71% vs. 49%; p < 0.001). Seventy per cent of the sample reported to be employed. Lower income was associated with women (p < 0.001). Men received more informal assistance days than women (5.2 vs. 3.9 days; p = 0.007). The quarterly cost including OoP costs, informal assistance and lost productivity averaged €1,088 and was higher for men compared to women (€1,515 vs. €908; p < 0.001). The MSQ reported a significantly worse QoL for women.

Conclusion: The results seemed to prove that migraine is a gender disease. Moreover, a potentially unequal access to informal assistance and healthcare resources not covered by the Italian National Health Service is highlighted for women because of their lower average income and purchasing power compared to men.


Dodick DW. Migraine. Lancet. 2018;391(10127):1315-1330. PMID:29523342

Marconi E, Pecchioli S, Nica M, et al. Epidemiology and determinants of chronic migraine: a real-world cohort study, with nested case-control analysis, in primary care in Italy. Cephalalgia. 2020;40(5):461-469. PMID:31744318

I.H.S. Classification criteria for migraine. [Cited March 2020];

Lipton RB, Serrano D, Pavlovic JM, et al. Improving the classification of migraine subtypes: an empirical approach based on factor mixture models in the American Migraine Prevalence and Prevention (AMPP) Study. Headache. 2014;54(5):830-849. PMID:24527745

GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1211-1259. PMID:28919117

Steiner TJ, Stovner LJ, Vos T, Jensen R, Katsarava Z. Migraine is first cause of disability in under 50s: will health politicians now take notice? J Headache Pain. 2018;19(1):17. PMID:29468450

Roncolato M, Fabbri L, Recchia G, et al. An epidemiological study to assess migraine prevalence in a sample of Italian population presenting to their GPs. Eur Neurol. 2000;43(2):102-106. PMID:10686468

Stovner Lj, Hagen K, Jensen R, et al. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia. 2007;27(3):193-210. PMID:17381554

Berg J. Economic evidence in migraine and other headaches: a review. Eur J Health Econ. 2004;5(1)(suppl 1):S43-S54. PMID:15754073

Andlin-Sobocki P, Jönsson B, Wittchen HU, Olesen J. Cost of disorders of the brain in Europe. Eur J Neurol. 2005;12(1)(suppl 1):1-27. PMID:15877774

Vetvik KG, MacGregor EA. Sex differences in the epidemiology, clinical features, and pathophysiology of migraine. Lancet Neurol. 2017;16(1):76-87. PMID:27836433

D’Amico D, Grazzi L, Curone M, Leonardi M, Raggi A. Cost of medication overuse headache in Italian patients at the time-point of withdrawal: a retrospective study based on real data. Neurol Sci. 2017;38(suppl 1):3-6. PMID:28527071

Bezov,D, Buse DC, Stewart WF, et al. Gender differences in headache-related disability and resource utilization in episodic and episodic probable migraine: results from the American migraine prevalence and prevention study (AMPP) Headache 2010. Abstract Conference: 52nd Annual Scientific Meeting of the American-Headache-Society, Volume: 50 (Online:

Burch RC, Loder S, Loder E, Smitherman TA. The prevalence and burden of migraine and severe headache in the United States: updated statistics from government health surveillance studies. Headache. 2015;55(1):21-34. PMID:25600719

Rhee TG, Harris IM. Gender differences in the use of complementary and alternative medicine and their association with moderate mental distress in U.S. adults with migraines/severe headaches. Headache. 2017;57(1):97-108. PMID:27885674

Wu J, Noxon V, Lu ZK. Patterns of use and health expenses associated with triptans among adults with migraines. Clin J Pain. 2015;31(8):673-679. PMID:25185875

Manack A, Buse DC, Serrano D, et al. Lost productive time and cost due to headache in chronic (CM) and episodic migraine (EM): results: from the AMPP study. J Headache Pain. 2010;11(suppl 1):S1-S64. (Online:

Rastenytė D, Mickevičienė D, Stovner LJ, Thomas H, Andrée C, Steiner TJ. Prevalence and burden of headache disorders in Lithuania and their public-health and policy implications: a population-based study within the Eurolight Project. J Headache Pain. 2017;18(1):53. PMID:28474253

Serrano D, Manack AN, Reed ML, Buse DC, Varon SF, Lipton RB. Cost and predictors of lost productive time in chronic migraine and episodic migraine: results from the American Migraine Prevalence and Prevention (AMPP) Study. Value Health. 2013;16(1):31-38. PMID:23337213

Steiner TJ, Stovner LJ, Katsarava Z, et al. The impact of headache in Europe: principal results of the Eurolight project. J Headache Pain. 2014;15(1):31. PMID:24884549

Baladón L, Rubio-Valera M, Serrano-Blanco A, Palao DJ, Fernández A. Gender differences in the impact of mental disorders and chronic physical conditions on health-related quality of life among non-demented primary care elderly patients. Qual Life Res. 2016;25(6):1461-1474. PMID:26590837

Rencz F, Brodszky V, Péntek M, Bereczki D, Gulácsi L. Health state utilities for migraine based on attack frequency: a time trade-off study. Neurol Sci. 2015;36(2):197-202. PMID:25108469

Sharma K, Remanan R, Singh S. Quality of life and psychiatric co morbidity in Indian migraine patients: a headache clinic sample. Neurol India. 2013;61(4):355-359. PMID:24005724

Talarska D, Zgorzalewicz-Stachowiak M. The influence of selected factors on the quality of life of children with headaches. Adv Med Sci. 2007;52(suppl 1):123-125. PMID:18229648

Zimmer T, Møller C, Westergaard M, et al. EHMTI-0209. Headache management is more than just managing pain. J Headache Pain. 2014;15:C28.

EQ-5D-5L. Online: [Cited March 2020].

Migraine-specific Quality-of-life questionnaire (MSQ Version 2.1) Online: [Cited March 2020].

Tarricone R. Cost-of-illness analysis. What room in health economics? Health Policy. 2006;77(1):51-63. PMID: 16139925

Report Banca d’Italia. Online:, [Cited March 2020].

Contratto Collettivo del Lavoro Domestico. Online: [Cited March 2020].

Degenza media per cefalea adulti, dati SDO Ministero 2016 (Online:].

van den Berg B, Brouwer WB, Koopmanschap MA. Economic valuation of informal care. An overview of methods and applications. Eur J Health Econ. 2004;5(1):36-45. PMID:15452763

Conto Annuale del Tesoro. Ministero dell’Economia e delle Finanze. Online: [Cited March 2020].

Stipendi minimi. Online: [Cited March 2020].

La vita delle donne e degli uomini in Europa. Un ritratto statistico. Online: [Cited March 2020].

Scalone L, Cortesi PA, Ciampichini R, et al. Health Related Quality of Life norm data of the general population in Italy: results using the EQ-5D-3L and EQ-5D-5L instruments. Epidemiol Biostat Public Health. 2015;12(3):e11457.

Wong ELY, Xu RH, Cheung AWL. Measurement of health-related quality of life in patients with diabetes mellitus using EQ-5D-5L in Hong Kong, China. Qual Life Res. 2020;29(7):1913-1921 PMID:32140920

Abedini MR, Bijari B, Miri Z, Shakhs Emampour F, Abbasi A. The quality of life of the patients with diabetes type 2 using EQ-5D-5 L in Birjand. Health Qual Life Outcomes. 2020;18(1):18. PMID:32000785

Hernandez G, Garin O, Dima AL, et al; ASTRO-LAB Group. EuroQol (EQ-5D-5L) validity in assessing the quality of life in adults with asthma: cross-sectional study. J Med Internet Res. 2019;21(1):e10178. PMID:30672744

Bethlehem J. Selection bias in web surveys. Int Stat Rev. 2010;78(2):161-188.

Berra E, Sances G, De Icco R, et al. Cost of chronic and episodic migraine. A pilot study from a tertiary headache centre in northern Italy. J Headache Pain. 2015;16(1):532. PMID:26018292

Johnson EB, Onwuegbuzie AJ. Mixed methods research: a research paradigm whose time has come. Educ Res. 2004;33(7):14-26.

How to Cite
NicaM., ColomboD., RavasioR., & RognoniC. (2020). Socioeconomic impact of migraine in Italy: Results of a national survey. AboutOpen, 7(1), 80-88.
Original research article