Lost productivity associated with headache and depression: a quality improvement project identifying a patient population at risk

Abstract

Objective: This quality improvement project was implemented in order to highlight the association between headache, mTBI and depression on lost productivity and resource utilization. Background: Mood disorders, environment and traumatic brain injury are common in patients with headache, and have been shown to influence clinical course, treatment response and outcome. Although widely recognized, the association of these factors on clinical outcomes, resource utilization and productivity is not well understood. Methods: All patients presenting to a military referral center for migraines are assessed for presence of traumatic brain injury, Headache Impact Score (HIT-6) and Patient Depression Questionnaire (PHQ-9). Based on screening, patients are offered referral to mental health and a multidisciplinary headache education course. Results: 237 patients were seen for headache or migraine. 180 patients had severely disabling headaches. These patients accounted for 146 emergency room visits over the course of one year. Of headache patients, 65% met criteria for depression and 15% of patients had severe depression. Only 37% of these patients carried a formal diagnosis of depression and 38% had been seen by mental health. Lost productivity and duty limitations were significantly associated with severity of depression. In service members screening positively for mild, moderate or severe depression, duty restrictions had been placed on 8.3%, 32.5% and 53.8%, respectively. Only 3.8% of patients who did not screen for depression had similar duty limitations. A history of mTBI strongly correlated with comorbid depression. Lost productivity and duty limitations were not impacted by other headache characteristics or HIT-6 scores. Conclusions: This quality improvement project identified a practice gap for treatment of comorbid depression in patients presenting to Neurology for headache. Depression strongly correlated with productivity loss, highlighting a possible target for the economic burden of headache.

Burden of migraine among Japanese patients: a cross-sectional National Health and Wellness Survey

“…Another US study discovered that depression was highly correlated with productivity loss in the headache population, and thus concluded that early recognition and treatment of comorbid depression could improve QoL and productivity as well as decrease healthcare resource use [46]. It highlighted the importance to understand the common comorbidities of migraine in Japan that is currently lacking, and how controlling these comorbidities might help to improve the overall health outcomes of patients with migraine.…”

Comorbidities of primary headache disorders: a literature review with meta-analysis

“…Indeed, non-pharmacological approaches, such as nutraceuticals, non-invasive neurostimulation, behavioral therapies and physical therapy, represent valid complementary options especially for patients with specific comorbidities, for those overusing medication, or for pregnant women [14][15][16][17]. A major awareness of the role of comorbidity in primary headache may therefore help clinicians in clinical management, improve headache sufferers' quality of life and reduce impact on societies, defined in terms of disability, cost or reduced work productivity [4,[18][19][20][21][22].…”

Potential Progression Mechanism and Key Genes in Early Stage of mTBI

“…[ 2 ] Mild TBI (mTBI) is the leading cause of death and disabilities in the United States and worldwide, with approximately 42 million cases annually [ 3 ]. Patients may present a complex array of symptoms, including cognitive disturbance, physical fatigue, decreased sleep quality [ 4 ], and depression or migraine [ 5 ]. Further insights into the underlying biological injury should be obtained, and the identification of key genes is essential for finding biomarkers and therapeutic targets for the mTBI.…”