Productivity losses attributable to headache, and their attempted recovery, in a heavy-manufacturing workforce in Turkey: implications for employers and politicians

BACKGROUND: Headache disorders cause substantial productivity losses through absenteeism and impaired effectiveness at work (presenteeism). We had previously found these losses to be high in a mostly male, heavy-manufacturing workforce at Ford Otomotiv Sanayi AŞ (FO), in north-western Turkey. Here we aimed to confirm this finding in a year-long study to eliminate any effect of seasonal variation. The question then was how much of this lost productivity could be recovered by the effective provision of headache care. METHODS: We used the HALT-30 Index to estimate productivity losses, surveying FO’s entire workforce (N = 7,200) during annual health-checks provided by the company’s on-site health clinic. Then we established, and widely advertised, a headache clinic within the same health clinic, providing specialist care free for 15 months. Outcome measures were HALT-30, company sickness records and the HURT questionnaire. RESULTS: Usable data were collected from 5,916 employees (82.2 %; 5,485 males [92.7 %], 431 females [7.3 %]; mean age 32.5 ± 5.4 years). One-month headache prevalence was 45.4 % (n = 2,688). Productivity losses were reported by 968 employees (16.4 %) and, per affected employee, increased from 0.23 to 7.56 days/month as headache frequency increased (P <0005). Employees reporting headache on ≥15 days/month (n = 64; 1.1 %) accounted for 21.1 % of productivity losses, those with headache on 10–14 days (n = 104; 1.8 %) another 18.5 %. With increasing headache frequency, absenteeism/presenteeism ratio (overall 1:16) declined from about 1:4 to about 1:25 in those with headache on ≥10 days/month. Headache frequency and lost productivity were higher in females than males (P <0.0005). Both absenteeism and presenteeism rates declined after age 34 years (P <0.0005). Only 344 employees with headache (12.8 %) requested appointments, and only 211 (7.8 %) actually consulted. Attendance was related to headache frequency (P <0.0005). Too few returned for follow-up to allow useful outcome assessment. CONCLUSION: The high productivity losses in this young mostly male workforce correlated with but were not wholly explained by headache frequency. A small minority of employees with high-frequency headache contributed highly disproportionately to the productivity losses. These should be the target of interventions aimed at productivity recovery. It is not clear what form such interventions should take: making headache care optimally available is not of itself sufficient.