OBJECTIVES: Determine impact of a worksite disease management program (DMP) on work productivity loss among employees with migraines. METHODS: A total of 712 health risk assessment questionnaires were distributed to employees of a medical group (64% response rate), with 180 identified as migraineurs using IHS criteria from respondent self-report. Migraineurs were given a DMP which included: 1) tailored behavioral print material; 2) headache diary; 3) access to worksite presentations (“Lunch & Learns”) by a physician on triggers, diagnosis and treatment options, Q&A, and instruction on completion of the MIDAS (Migraine Disability Assessment); 4) headache tipsheets and suggestions for web-based resources; and 5) access to worksite physicians for same-day treatment. A follow-up questionnaire distributed 12 months post-launch revealed no nonresponse bias between respondents (n=73) and nonrespondents (n=107). The primary dependent measure of the evaluation was work productivity loss (WPL), which combined absenteeism (full and partial days missed due to headache) and presenteeism (days worked with headache and self-reported productivity) during the past four weeks. RESULTS: Only 52% of migraineurs recalled reading the provided tailored educational print materials on managing their headaches, 28% reported attending Lunch & Learn sessions, and 7-13% used other program components. Mean lost productivity dropped only slightly from baseline to follow-up (8.3 v 7.3 hours, NS). However, subgroup analyses revealed the program was effective in significantly (p<0.05) reducing WPL for employees who 1) increased their level of confidence to control their headaches after program exposure (6.7 v. 2.3 hours), and 2) sought medical care for headaches and used migraine prescription medications (13.4 v. 4.1 hours). CONCLUSIONS: Overall, the DMP failed to reduce productivity loss among employees with migraines; however promising findings were observed for selected groups. Future programs need to identify effective strategies to improve self-confidence in headache management and to engage more migraineurs in seeking medication attention.