HEADWORK as innovative tool for monitoring MABs efficacy in migraine and their influence on work activity.

Abstract text (incl. figure legends and references)

QUESTION:Monoclonal antibodies (MABs) have been a game changer in the treatment of migraine since their approval. Their efficacy is generally assessed with disease related metrics, but there is an increasing need to evaluate the impact of disease treatment on the global burden on patients and society. HEADWORK (HW) is a new evaluation tool, developed specifically to assess the impact on work tasks and reduced productivity of migraineurs. The aim of this study was to test the performance of HW on migraine patients treated with MABs.

METHODS:We enrolled 56 patients receiving treatment with MABs at the Headache Centres of IRCCS "C. Besta" (Milan) or IRCCS "C. Mondino" (Pavia). They were assessed with the HW questionnaire at baseline and at the 3rd (M3) and 6th month (M6) of treatment. HW questionnaire consists of two sections: "Work-related difficulties" (HW1),11 items dealing with the degree of difficulty in general skills, problems solving or starting new task; "Factors contributing to work-related difficulties" (HW2), 6 items to address the degree to which some factors, such as noise and brightness of the workplace, negatively impact work-related tasks.

RESULTS:Population: 10M and 46F, mean age(49.5y±8.7), mean age at onset of disease(18y±8),mean duration of disease(34y±11.2). We observed a marked and consistent reduction in "classical" indicators: monthly migraine days(15±5.9 at baseline, 5±6.27 at M3, 7±6.8 at M6), medications per month(15±9.3 at baseline, 5±13.7 at M3, 6±7.4 at M6), MIDAS(48±36.8 at baseline, 8.5±17.4 at M3, 5±11 at M6), HIT-6(66±3 at baseline, 62±8.3 at M3, 59±8.2 at M6).HW scores paralleled the above parameters: HW1(20±8.3 at baseline, 10.5±5.8 at M3 , 7±8.5 at M6), HW2(10.5±5.8 at baseline,6±4.4 at M3, 4±4.1 at M6).

CONCLUSION:Our findings confirm the effectiveness of MABs. HW1 and HW2 also show an extremely positive impact on work related activities. HW appears a suitable tool to assess migraine-related work disability in these patients.