This analysis included CaMEO survey respondents who met modified criteria for migraine provided by the International Classification of Headache Disorders, 3^rd edition; were current users of acute prescription medications for migraine; were employed full-time (>35 h/wk); and completed both the Migraine Disability Assessment Scale (MIDAS) and the Migraine Treatment Optimization Questionnaire (MTOQ-5). Absenteeism was defined by MIDAS Question 1 (days missed work/school in the prior 3 months) and presenteeism by Question 2 (additional days with productivity reduced by ≥50% in the prior 3 months). LPT was the sum of absenteeism and presenteeism days. Acute treatment optimization scores based on the MTOQ-5 ranged from optimal to poor/very poor. Headache frequency groups included those with 0–3, 4–7, 8–14, or ≥15 MHDs.

Among 16,789 respondents with migraine, 2,455 (14.6%) met inclusion criteria. Mean LPT increased as treatment optimization score worsened. This relationship was statistically significant in all MHD groups (linear trend test: P≤0.001) except the 8–14 MHD category. For example, in the ≥15 MHD group, mean 3-month LPT increased from 7.1 to 30.5 days in the optimal to poor/very poor acute treatment groups, respectively. In the 0–3 MHD group, corresponding LPT values increased from 2.2 to 5.0 days in the optimal to poor/very poor acute treatment groups. Results were similar after controlling for sociodemographic and headache characteristics.

In people with migraine, poor acute treatment optimization was associated with greater LPT. Optimizing acute treatment may be associated with indirect cost savings.