Workplace mistreatment and migraine progression: a prospective cohort study

Abstract Objective To explore the predictive effect of workplace mistreatment on migraine progression among employed patients and provide evidence for occupational risk prevention of migraine. Methods This 2-year prospective cohort study enrolled 2217 employed migraine patients at baseline. Workplace mistreatment (past 12-month exposure) and clinical indicators were repeatedly measured. Migraine progression was defined based on standardized 4-week headache diary outcomes. Cox regression, stratified interaction analysis, and multiple sensitivity analyses were performed to verify the association and its robustness. Results A total of 2049 participants completed follow-up (loss rate: 7.58%), and 472 (23.04%) had workplace mistreatment exposure. After full confounder adjustment, workplace mistreatment independently increased the risk of migraine progression (HR = 1.74, 95%CI: 1.41–2.15, P < 0.001). Stratified analyses revealed stronger effects in patients aged < 45 years, without baseline anxiety and depression, without migraine family history, and with migraine without aura (all interaction P < 0.05). Time-varying exposure and sensitivity analyses confirmed stable results. Conclusion Workplace mistreatment is an independent modifiable risk factor for migraine progression in employed patients. Targeted screening and intervention for workplace mistreatment can effectively delay migraine deterioration and improve patient prognosis.