“Doctor, I suffer from migraines.” Sorry, I may be a doctor, but I’m a doctor of economics, so I’m unable to treat you. However, I can pass on the message that there is a lack of research into your illness. And isn’t the economy interested in well-being and productivity, both of which are heavily affected by the high prevalence of migraine? It is one of the most disabling diseases, especially for young women. Finally, rest assured that you can continue reading because, contrary to popular belief, economic science does not give you a headache.
Knowing that a large number of people suffer from the same illness does not really bring any consolation, but at least it makes it easier to talk about your difficulties. In France, there are 11 million people suffering from migraines. If you are one of them, like Julius Caesar, St. Paul and Thomas Jefferson or Guy de Maupassant before you, you can contact the Voice of Migraine Sufferers, a patient health association that has recently been recognized as being of general interest.
We should instead be talking about migraine sufferers and patients, if the gender agreement in French applied according to the majority rule. Women are indeed three times more affected by this disease than men. If we stick to the vocabulary, let’s also point out that migraine should not be confused with headache (cephalalgia, in medical terms), an even more widespread symptom. While migraines are a type of headache, not all headaches are migraines. Migraines are characterized by attacks of varying frequency and severity, but the pain is often intense and sometimes unbearable. It is an infernal pain, as Raymond Devos put it, comparing a migraine attack to a subway train rushing through your head.
Migraine is generally associated with other symptoms, such as nausea and vomiting (in the case of a migraine without aura), or visual phenomena and other neurological signs (migraine with aura). The most common type of migraine (without aura) generally starts on one side of the head, then moves up and spreads more widely. Hence its name: migraine derives from hemicrania, its Latin name, with the first syllable missing (a form of aphesis, as a linguist would say).
Migraine is prevalent throughout the world, in rich and poor countries alike. It affects more than a billion people on Earth. We know this because it is listed in a global study of diseases, now funded by the Bill and Melinda Gates Foundation (not all American billionaires have become bad guys…).
It also quantifies the years lived with a disability (Years Lived with Disability). With 6 months of life without disability lost per 100 inhabitants, migraine is the second most common, behind low back pain. Migraines do not kill, but they are very debilitating. This is particularly the case for women, especially those under 50. Unlike most diseases, migraines begin when you are young and even improve with age.
As it mainly affects the working population, it is understandable that migraines lead to a drop in productivity. An Italian study recently estimated that a 10% increase in the migraine population leads to a 1.1% reduction in labor productivity. In fact, employees with migraines are unable to go to work during an intense attack and often have to stay in bed in the dark, without moving. Added to this absenteeism, for an even greater part, are the hours lost at work by people who, although less impaired and therefore less inefficient in their tasks, still go to their workshop or office. Human resources specialists refer to this as presenteeism.
By counting the days and hours lost due to migraines and based on the average salary, we can obtain an estimate of the cost of this loss of work for society. Such an estimate was made for Europe based on a large questionnaire survey, called Eurolight. The respondents had to state the number of days they stayed at home because of their migraine attacks and the number of days on which they were only able to carry out part of their usual tasks at work. In total, the loss of production was estimated at 111 billion euros per year. That is six thousandths of European GDP, a not inconsiderable amount for a headache.
But there’s more to life than GDP! Economists have known this for a long time. It may surprise you, but they have no fetishism towards this indicator, which reduces the well-being of society to material wealth.
They are also the first to suggest to policy makers that other dimensions such as health, education and the environment be incorporated to measure the economic and social progress made at the level of a country. They are also interested in assessing the subjective well-being of individuals and its determinants through standardized surveys. A branch of academic economic analysis, the economics of happiness, has made it its specialty.
Migraines obviously first of all reduce the quality of life in relation to health, in particular because of the pain they cause, the anxiety they create and the reduced mobility they cause for those who suffer from them. In Denmark, for example, this quality of life is estimated to be three times lower than that enjoyed on average by the population.
Migraine sufferers also experience difficulties in their personal and family life. In the Eurolight survey already mentioned, almost one in five sufferers said they had experienced relationship difficulties in the quarter preceding their interview and, if they were parents, that they had been unable to take proper care of their children. In another major survey, this time of the US population, the proportion rises to one in two sufferers. This increase is not due to cultural differences but to the question asked. Respondents were asked whether they would have had better romantic relationships and would have taken better care of their children in the absence of migraines. The disease also has an impact on the spouse.
According to a study in Spain and another in the UK, both of which are based on a small sample, the partner of the sufferer experiences an overload of domestic work and suffers more arguments.
Finally, there is a source of stress related to the invisible nature of this neurological disease. Migraine pain is not apparent. In the absence of external signs, it is therefore easier for some of those around them to minimize the disability of migraine sufferers. Moreover, a third of them say they are often or very often stigmatized. Either because they are suspected of exaggerating their suffering. “It’s just a headache, take some Doliprane,” for example. Or because they are suspected of trying to take advantage of their situation.
We are all familiar with the sexist joke, the pinnacle of gender stereotypes, “Not tonight darling, I have a migraine”. The woman would have to justify her non-consent. A justification interpreted by the man as a feint because it is not obvious and corresponds to the hackneyed image of the manipulative woman. It should be noted that this joke, which is meant to be funny, is nothing new. In his essay Physiologie du mariage (1829), Balzac states bluntly that migraine is “the most pleasant and the most terrible weapon used by women against their husbands”.
Stigmatization discourages many migraine sufferers from complaining. As well as from demanding that society provide better care for their illness, in particular by demanding more resources for research into the causes of migraine and new treatments. This is undoubtedly one of the factors explaining an anomaly observed on both sides of the Atlantic: public spending on research and development (R&D) is ridiculously low in relation to the cost and prevalence of migraine, and this in comparison with other diseases.
In Europe, these pathologies represent 0.025% of its social cost, compared with, for example, 0.5% for brain tumors or 0.3% for Parkinson’s disease. In the United States, they are almost 50 times lower per patient affected compared to asthma and more than 100 times lower compared to diabetes.
This weakness is reflected in the scant funding for public health policies, both in terms of awareness programs for employers and general practitioners and information campaigns for the public on the treatments available, on the triggers and on the risks of over-medication that perpetuates their headaches. The historian Katherine Foxhall even suggests that migraine was better regarded in medieval times. However, I would advise against following one of the treatments recommended at the time: mixing houseleek and earthworms with flour, wrapping it all in a cloth and placing it on your forehead.
Other factors may explain these shortcomings: migraines do not kill, they do not require hospitalization, they cannot be cured, their multifactorial origin remains poorly understood, their attacks cannot be seen and, finally, questioning the patient is the only means of diagnosis. In short, it is a disease that does not spontaneously trigger the interest of hospital and university doctors. Another factor is undoubtedly the fact that migraine mainly affects women, whereas medical research has long been the preserve of men.
Moreover, it was a female neurologist who broke the mold by choosing migraine as one of the specialties of her work and her teams. Keen to popularize her work, she published a book at the end of the 1980s solely devoted to this disease, as well as a nice little book Aspirin, for or against?, published by Le Pommier in 2006. After reading this, you shouldn’t need any aspirin! Or else, consult a doctor.
François Levêque, Professor at CERNA – Mines Paris – PSL, and Emile Quinet, École des Ponts ParisTech (ENPC), analyse the management of public spendin...