There are direct costs which include medication, visits to health care professionals, outpatient services, hospitalization, lab tests, and diagnostic examinations
Then there are indirect costs of absence from work and reduced productivity even if a person with headache can make it to work. Indirect costs make up the larger part of the financial burden of headache, upwards of 90% of the total.
These direct and indirect costs are shared in varying proportions among the person with headache, government, workplace, and insurance providers.
It is hard to quantify lost productivity when there is no salary involved. Lost household work or reduced family time should be counted as indirect cost. The problem is, there is no easy way to value this lost time. If we assume that household work should be valued as much as paid work, then lost household work make up a greater fraction of indirect costs compared to paid work.
There is no monetary equivalent for not being able to attend social activities, study for exams, or fulfill responsibilities to the family. A person who is anxious about triggering headaches might avoid sports, travel, educational opportunities, or job offers. These costs are arguably more important but there is no easy way to monetize quality of life.
Moving forward
For researchers
- Include cost estimates in quantifying the burden of headache.
- Include costs attributable to lost household productivity; these are often overlooked and might be higher than the cost of lost work.
- Measure the cost-effectiveness of interventions. An example is this study on how involving nurses in primary care for close follow-up of patients does not add to overall costs and possibly reduces the likelihood that patients have to be referred to specialists.
- Use the HARDSHIP questionnaire developed by Lifting The Burden to examine quality of life. The full paper can be found here and the questionnaire can be downloaded here. Another tool developed specifically for migraine is the MIDAS questionnaire.
For clinicians
- Encourage patients to comply with their treatment plan by looking at its cost benefit. Here is an example of reduction in direct costs with successful treatment of medication-overuse headache.
- Monitor disability caused by headache using the HURT questionnaire; or migraine using the MIDAS questionnaire.
For people with headache
- Consider the total cost of headache - not just payment for services and medications but also lost work time and productivity.
- In trying to avoid the indirect costs of headache, watch out for pain medication overuse. This study describes interviews of people with frequent headaches who coped by increasing their pain medications to the point where these became "indispensable". Medication-overuse headache, according to several estimates, is the most costly type of headache.
- Tell health care professionals about your level of disability - how headache affects work and daily life. Too often, the conversation about headache stops with standard questions on severity, location, duration, character, aggravating and relieving factors. These items are important for diagnosis, but they don't adequately describe burden.
