OBJECTIVES: This study aimed to describe the incremental burden of migraine on work productivity and healthcare resource utilization (HRU) in those suffering from ≥4 monthly headache days (HDs) in Europe. METHODS: A retrospective, cross-sectional analysis of 2017 National Health and Wellness Survey (NHWS) data from the EU5 was conducted. Outcomes from respondents who self-reported a doctor diagnosis of migraine, experienced at least one migraine during the prior month and overall ≥4 HDs during the prior month, were stratified by HD frequency (4-7, 8-14 and ≥15 HDs) and matched by propensity scores within each subgroup and country using sociodemographic characteristics to respondents without migraine (controls). Work and activity impairment were assessed via the Work Productivity and Activity Impairment Questionnaire (WPAI) and HRU via healthcare provider (HCP) visits, emergency room (ER) visits and hospitalizations during the prior 6 months of survey completion. Mann-Whitney U tests were used for continuous variables and Chi-square tests for categorical variables to determine significant differences between subgroups. RESULTS: Compared with matched controls (N = 1,569), a significantly higher proportion of individuals with migraine (N = 783 with 4 -7 HDs; N = 429 with 8-14 HDs; and N = 357 with ≥15 HDs) reported at least one visit to a HCP (85.1% controls vs 96.0% 4-7HDs, 95.6% 8-14HDs and 94.1% ≥15HDs), ER visit (11.9% controls vs 23.0% 4-7HDs, 21.7% 8-14HDs and 27.7% ≥15HDs), or hospitalization (7.8% controls vs 11.9% 4-7HDs, 14.9% 8-14HDs and 15.4% ≥15HDs). Among employed respondents, overall work impairment was also significantly higher across all migraine subgroups (34.8% 4-7HDs, 37.0% 8-14HDs and 47.2% ≥15HDs) compared with matched non-migraine controls (22.6%). CONCLUSIONS: Migraine patients across all migraine frequency subgroups reported significantly higher HRU and work impairment compared with matched non-migraine controls, highlighting the economic implications of migraine to the healthcare system and society.