Migraine - a headache for employees and employers alike

Migraine is hardly a modern phenomenon. People have suffered from mysterious, chronic head pain since doctors first started to note down medical conditions. The earliest records of migraine date back to Hipocrates Trusted source Journal of Neurology, Neurosurgery & Psychiatry Peer-reviewed Journals Neurology and Neuropsychiatry Go to source who was born in 460 BC.

Thankfully, we’re closer to understanding the cause of migraines than the Ancient Greeks were, though still a long way off a definitive cause. Today, it is believed that migraines with aura are the result of abnormal activity and inactivity in the brain, specifically, an electrical wave that affects nerve signals. Referred to as cortical spreading depressions (CSD), the intensity of this “wave” activates neurons before suppressing them. The charge and subsequent electrical silence is what neurologists Trusted source ScienceDirect Peer-reviewed Journals Multidisciplinary Research Go to source argue causes migraine symptoms.

What about aura?

A migraine aura is a sensory disturbance that precedes the headache stage of a migraine. Not all migraine sufferers will experience this, just how not all migraine sufferers will experience a headache.

Although sensory disturbances include changes to speech, touch and sound, by far and large (∼98%) Trusted source The Journal of Headache and Pain Peer-reviewed Journals Headache and Pain Research Go to source , aura sufferers experience visual symptoms; for example, strange lights and flashes, flickering, zig-zig lines and blurred and foggy sight. Other less common aura symptoms include numbness, speech problems and dizziness. In extreme cases, individuals may experience blindness and loss of consciousness.

The condition is exceptionally common; around 15% Trusted source National Center for Biotechnology Information (NCBI) Government Source Biomedical Research and Literature Go to source of the international population will experience migraines in their working life. The global burden of disease is massive. Despite this, the general public’s understanding of a migraine is often limited, leading to scepticism and stigma. This is no surprise when the cause of migraines remains debated. Unfortunately, the stigma migraine sufferers endure puts them at a professional disadvantage. Employers, in particular, should be conscious that if migraines are serious and chronic, the condition is classed as a disability under the Equality Act 2010 as it can cause genuine impairment.

For the employer, the cost is financial. Reports have shown that the condition costs the US market $19.3 billion Trusted source American Journal of Managed Care (AJMC) Peer-reviewed Journals Health Economics and Outcome Research Go to source annually. Similarly, the EU market suffers a loss of roughly $27 billion . Some of that is the direct result of absenteeism; if an employee is bedridden, they will of course be unable to work. However, the vast majority is lost through presenteeism, due to the extended recovery period a migraine attack requires.

“the EU market suffers a loss of roughly $27 billion”

For the employee, migraines are both personally and professionally damaging. According to a 2019 study Trusted source National Center for Biotechnology Information (NCBI) Government Source Biomedical Research and Literature Go to source on the wider impact of chronic migraines, of 1,120 of participants with chronic migraines surveyed, 58.4% reported their condition negatively impacting their career. Depending on a country's healthcare system and costs, the financial burden to the employee is also massive.

In short, yes.

As an employer, you might not have any control over whether an employee experiences migraines, but there are various ways you can help prevent attacks and aid recovery.

Most importantly, take your employees' condition seriously. As tempting as it might be, don’t presume they’re exaggerating. One study Trusted source The Journal of Headache and Pain Peer-reviewed Journals Headache and Pain Research Go to source found that a scary 72% of employees with migraines were afraid to report them to their boss, despite it impacting their work.

Screen time

How many hours do you think you spend in front of a screen on average per year?

1,700.

It’s a scary figure, especially when you learn that 17% of workers report attributing screen-time to the prevalence of headaches. For migraine sufferers, the link between head pain and artificial light is exaggerated.

It is recommended to take regular breaks from the screen throughout the working day and seek out natural lighting. Unfortunately, for migraine sufferers, a twenty-minute coffee break outside might not be enough to rest the eyes. If you or one of your colleagues finds they’re particularly sensitive to bright lights and computer screens, it’s not a bad idea to spend some of the day working “traditionally” with a pen and paper. Where that isn’t realistic, the employer should explore ways to reduce screen time so as not to trigger light sensitivity.

Stress

It’s easy to underestimate the health impacts of stress. However, for those with migraines, there are very obvious physical and psychological symptoms that show its significance. Almost 70% Trusted source National Center for Biotechnology Information (NCBI) Government Source Biomedical Research and Literature Go to source of individuals report stress as a major cause of their attacks. It is believed that a stressful environment actually alters brain structure and function, leading to migraines.

It goes without saying, work can be exceptionally stressful. As an employer, reducing overworking should be a priority, for the sake of employee retention and productivity. If a member of a team is struggling with their workload, it is in everyone's interest to share the burden, transparently and with fair compensation. This is even more the case if one of your employees reports migraines or any other stress-related condition. Interestingly, migraines are linked to the chronic conditions depression, anxiety and high blood pressure - all impacted by, and producers of, stress.

If you suffer from migraines and believe them to be work-related, you must communicate this to your line manager or boss. Other than this, good techniques to alleviate stress include prioritisation of tasks, asserting your position to co-workers and taking frequent breaks.

Flexible working

If the ongoing COVID-19 pandemic has taught us anything, it is that there are many upsides to flexible working schedules. We can all benefit from a more trusting and progressive employer.

One common trigger of migraines that goes hand-in-hand with stress is sleep deprivation. The article’s author isn’t advocating we sleep through the working day (as appealing as that might sound), rather a flexible working-day allows for the same volume and quality of work to be produced over an extended period, allowing for frequent breaks. The ability to grab an extra couple of hours of sleep in the morning, in exchange for a later log-off time, might just be enough to postpone or prevent a migraine attack.

Alongside improved sleep, through reduced commuter times and pressure to make an appearance at your workplace, another advantage of flexible working is the ability to customize a workspace. The employee will have the opportunity to reduce common migraine triggers such as fluorescent lighting and loud noises.

Education

Perhaps the most effective way that an employer can deal with the prevalence of migraines is to institute educational programmes. Programmes may include lecturettes, distributing materials like pamphlets and informational emails, and training managerial staff about how to better respond to reports of migraines in and outside the office.

Though it may seem counterproductive to dedicate resources to an issue that already costs an organisation, studies show that providing employees with information about migraines greatly reduces absenteeism and increases productivity. One survey, investigating the impact of migraine education on three American corporations, found that after six months of an educational programme being in place there was a 25% reduction in missed workdays and a 10% increase in employees productivity.

More so, initiatives that allow for employees to make medical appointments show great promise if implemented across businesses. A doctor may diagnose employees with the condition and prescribe treatment, or they may advise on the various tools and techniques that can be employed to reduce the severity of attacks. Adopting this referral method, a Spanish study of the national postal service, reported a 53% decrease in migraine-induced absenteeism, and a 41.8% increase in productivity on days when workers experienced attacks.

Thankfully, there are many practical steps you can take as a business to mitigate the loss of productivity you may experience as a result of chronic health concerns. If you’re reading this for a colleague or employee who suffers migraines with aura, the key takeaway should be that the condition isn’t something to be dismissed or overlooked. Though symptoms may at first sound far-fetched or exaggerated, migraine and associated aura is very real and is best thought of as a mental warning sign of potentially excruciating symptoms to come. You should support employees and improve their work environment, workstations and quality of life, as their occupational health directly impacts the health of your business.

If you’re reading because you suffer from migraines and worry they’re impacting your work, it is best to contact your doctor to make sure you’re receiving proper treatment. You should also communicate openly with your employer to educate them about your condition and receive the allowances you need - and don’t take no for an answer. It is in both of your interests to maximise your productivity and minimise your pain.