BACKGROUND: There are differences in perception and prioritisation of high morbidity diseases vs high mortality diseases. We hypothesise that the high mortality diseases receive disproportionate resources while ‘quieter’ high burden chronic diseases are neglected.

OBJECTIVES: to investigate the relative mismatch between the burden of a highly debilitating condition (migraine) and resource allocation focussing on European and North American markets.

METHODS: Earlier payer research highlighted a discrepancy in funding and prioritisation between migraine and other neurological conditions despite similar burdens, often referencing multiple sclerosis. A targeted literature review exploring disease burden, sales data, and research pipelines in migraine and multiple sclerosis was conducted to further explore this relationship.

RESULTS: Migraine affects 90,000,000 people in the US and EU and is the leading cause of years lived disabled for people under 50. It is also the leading neurological cause of years lived disabled in the US. 2,500,000 individuals have multiple sclerosis, with the largest group being 50–59-year-olds. Multiple sclerosis is also the 7^th leading non-communicable neurological cause of years lived with disability in the US, and causes ~19,000 deaths per year globally.

The cost of burden of migraine in the EU is between €18,000,000,000 – €27,000,000,000, mostly in work productivity losses, while we estimate the EU cost burden of multiple sclerosis to be ~€19,500,000,000.

64 pipeline assets were identified for migraine, and 285 for multiple sclerosis. Total 2021 USA market sizes were $3,220,000,000 and $6,260,000,000 for migraine and multiple sclerosis, respectively.

CONCLUSIONS: Despite having a comparable burden and significantly higher prevalence, migraine is chronically under-researched and underfunded compared to multiple sclerosis and is continually under prioritised in healthcare systems. This research highlights the opportunities available in ‘quiet’ high morbidity diseases, and the strategic importance of early market research and pipeline analysis.