Returning to work with migraine

Understanding migraine

Migraine is a common neurological disorder characterised by moderate to severe headache and can be accompanied with nausea for some people (1). Other symptoms can include sensitivity to light or sound, visual disturbances, sensitivity to smell and touch, and more.2 It is estimated to affect over 4.9 million Australians (1).

Unfortunately, migraine is highly stigmatised, under-diagnosed, and under-treated.1 It can affect a person’s life at home, socially, and at work, and attacks can sometimes be debilitating (2). Migraine is much more than ‘just a headache’ and it’s important to speak to your doctor about any headache that interferes with your daily routine.

There is no absolute cure for migraine, but there are treatments and lifestyle changes that can help patients manage their migraine and enjoy a normal life (2).

The impact of migraine at work

Migraine can impact people at work in a number of ways, such as (1,3):

• Reduced workforce participation. Many people are unable to work either due to disadvantages in job-seeking or disability.
• Absenteeism. People living with migraine often need to take more time off work than the average person.
• Presenteeism. ‘Presenteeism’ refers to when someone is at work but is less productive than usual due to illness. 
• Limited career prospects. Many people feel they are less likely to receive promotions or bonuses due to their migraine.

The workplace can also be a source of migraine triggers, which are factors that increase your likelihood of having a migraine attack (4). Common migraine triggers that can be encountered at work include stress, odours/perfume, bright lights, and neck pain (i.e. due to an uncomfortable desk setup) (5).

Survey results: the impact of migraine on women

While people of any age or gender can have migraine, middle-aged women are disproportionately affected. In fact, 71% of migraine sufferers are women of which majority are of working age (1).

A survey commissioned by women’s healthcare company, Organon, has investigated the social, economic and physical impacts of episodic migraine on women. The Australian Women and Migraine Survey was conducted in December 2022, and surveyed 1048 women aged 21-50 years.

The survey revealed that a number of women are being seriously impacted by migraine at work (3).

• 3 in 5 women (62%) experience migraine at work.
• Over a third (37%) admit to losing concentration.
• A third (30%) feel comfortable speaking to their manager about their migraine.
• 1 in 4 (25%) say that living with migraine has negatively impacted their career prospects including promotions and bonuses.

These results show that we need to do much more to support women with migraine in the workplace, for example by making workplaces more migraine-friendly and improving access to treatments.

Preparing for return to work after holidays

Managing migraine at work can be challenging at the best of times, but returning from holidays can make things slightly more complicated. The festive season can be disruptive to your routine and can involve migraine triggers such as (4,5):

• Disruptions to your sleep schedule
• Increased stress
• Changes to your exercise routine
• Dietary changes
• Travel

Unfortunately, the effect of these triggers can persist beyond the holiday season. It may take you some time to readjust to a regular routine (4). Depending on your job, the return to work might also be stressful if you have lots to catch up on after the holiday.

As a result, it is helpful to set realistic expectations for the first days back at work. Consider how much the holiday season affected your routine and your migraine attacks. Depending on the extent of the impact, you could:

• Ask if you’re able to work from home for the first few days back.
• If you take medication, ensure it is with you.
• Gradually readjust to your regular sleep patterns and routines.
• Find time to relax, meditate, or practice mindfulness if you are concerned about stress levels.
• If possible, start readjusting to your regular routine early. For example, if you have two weeks of leave, try to minimise triggers in the week before returning to work.  

You can consult with your doctor or pharmacist to discuss other management strategies depending on your personal triggers and symptoms.

Managing migraine at work

Returning to work after the holidays might require specific migraine management strategies, however it’s important to make sure you have an ongoing workplace management plan. If you don’t have an active plan for managing migraine in the workplace, the new year could be a great time to create new routines to help you thrive at work.

Discussing migraine with your employer

There are benefits and risks when it comes to discussing migraine with your supervisor or HR department. According to The Australian Women and Migraine Survey results of women with episodic migraine aged 21-50, of the women who experience migraine at work (62%), less than half (48%) feel comfortable speaking to their manager about their migraine (3). Unfortunately, there is still a risk of stigma and discrimination in some situations. On the other hand, if your employer doesn’t know you have migraine, it’s more difficult for them to provide accommodations.

Consider whether it’s right for you to have this conversation with your employer. This might depend on the extent to which migraine affects you at work, the potential benefits, the relationship you have with your employer, and other factors. 

If you decide to speak to your manager or a HR representative, plan ahead and know what your goals are for this conversation. You could bring a letter from your doctor which explains the impact of migraine, or details your management plan. This conversation is also an opportunity to remind your employer of your value to the company. Supporting migraine health is supporting brain health which is not just good for the individual, but for the entire organisation in improving overall productivity. 

Creating a migraine-friendly workplace

Whether or not you choose to speak to your employer about your migraine, there are ways to make your workplace more migraine-friendly. Some changes include (6):

• Anti-glare accessories. Blue light glasses or anti-glare shields can reduce eye strain from looking at a computer.
• Regular breaks. Take short breaks throughout the day if possible. Even a few minutes away from your desk can help reduce neck and eye strain.
• Access to water. Keep a water bottle on your desk to reduce the risk of dehydration (which can be a migraine or headache trigger).
• Ergonomic desk set up. Check that your chair, desk and monitor are set up in a way that minimises tension in your neck and shoulders. 
• Lighting changes. This might involve swapping out fluorescent lights for warmer or more natural light bulbs. Alternatively, ask to move desks to be near natural light. 
• Noise reduction. Noise-cancelling headphones, lowering the volume on the office radio, or establishing quiet spaces can help with noise-related migraine triggers.
• Fragrance-free workplace. This is harder to manage individually, but you can ask your manager to consider implementing a fragrance-free workplace policy (or fragrance-free areas).

Some of these changes can be implemented by yourself while others may require a conversation with your employer. This could also be a helpful stepping stone towards a broader conversation about migraine at work. 

Workplace triggers

A migraine trigger is any factor that reliably increases your likelihood of having a migraine attack (4). Some common workplace triggers are addressed in the previous paragraph, such as bright lights, odours/scents, neck or eye strain, and dehydration (4).

However, migraine triggers are quite personal, and you might find that your personal triggers are not listed above. For example, stress management will vary from person to person depending on the nature of your work and your strengths. Some stress management techniques are outlined in the next section.

In order to identify workplace triggers you can keep a migraine diary which tracks potential triggers and the frequency/severity of your migraine attacks. Once you have an idea of which triggers affect you the most, you can come up with a management plan. 

Time management and stress reduction

Stress is one of the most common migraine triggers (5). Finding effective methods to manage stress at work can improve your migraine attacks as well as your overall mental health and wellbeing. 

A big part of stress reduction is planning ahead in order to avoid stressful situations. This might sound simple, and you probably already have some planning or time management techniques in place. An important tip is to ensure your schedule is realistic. Consider allowing extra time in case you have a bad migraine day, or an unexpected task comes up that takes priority. This can help you avoid overcommitment and set your workload more realistically.

Stress isn’t always avoidable. You can prepare for this by incorporating stress-reduction techniques into your daily routines, such as meditation or mindfulness. Research shows that daily mindfulness practice improves your ability to cope with stressful situations (7). You can also use these relaxation exercises throughout the work day when necessary.

Communicating with co-workers

Just like discussing migraine with your manager, there are pros and cons to talking about it with your co-workers. There’s the potential benefit of feeling more supported and being able to be honest about your health, but also the risk of facing stigma or discrimination. However, there are a few key differences.

Depending on the structure and culture of your workplace, your colleagues aren’t typically measuring your performance. They are on the same ‘level’ as you so it might be less intimidating to share your experience with a trusted work friend rather than your manager. Also, if you work in a tight-knit team, the benefits of explaining migraine to these colleagues could make a significant difference to your wellbeing at work. Many people do not understand how debilitating a migraine attack can be, and instead think it is ‘just a headache’. Educating colleagues about migraine and its impact can help you feel supported and understood in the workplace.

At the end of the day, it is entirely your choice to tell anyone at work about living with migraine. Whether you want to only tell your manager, or just your closest colleagues, or the entire team, it’s important to make sure you’re comfortable with that decision. 

Elizabeth’s story: case study

Migraine is a complicated and debilitating disease, and sometimes you may feel isolated or like no one understands you. However, over 4.9 million Australians are living with migraine, and while each story is unique there are many others who may have experienced similar struggles (1).

One of these people is Elizabeth Reid, a 35-year-old beauty therapist trainer from the Central Coast of NSW. She was diagnosed as a child after her parents noted frequent complaints about her headaches. Currently, she takes prescription medication to treat her attacks, but the goal now is to prevent attacks rather than treating them. She will actively avoid triggers if she can and take note of how different things affect her.

Her current work gives her a lot of flexibility if she needs to take days off, but her previous experiences haven’t always been positive. She used to work in a day spa, but one of her major triggers is artificial fragrances. This was almost impossible to avoid and triggered a lot of migraine attacks.

While her new workplace isn’t completely free of triggers, she ensures that her medication is always on hand. She feels that being able to access treatments quickly has taken off a lot of stress as it’s one less thing she needs to plan ahead, and believes this could help other people living with migraine as well. Other strategies she uses to cope with an attack include taking generic painkillers, staying in a dark room, using an ice pack, or sleeping it off. 

Managing migraine at work will be different for everyone, but there are parts of Elizabeth’s story that will resonate with many.

Conclusion

Overall, managing migraine in the workplace is complicated, but it is possible. Your doctor or pharmacist can help you develop a migraine management plan, and hopefully this is supported by your employer. There will probably be disruptions to this routine – such as returning to work after the holidays – but knowing the principles of migraine management at work can give you the best chance of thriving in your workplace. 

References:

1. Deloitte Access Economics, 2018, Migraine in Australia Whitepaper. Retrieved from: https://www2.deloitte.com/au/en/pages/economics/articles/migraine-australia-whitepaper.html. Accessed December 2023. 
2. Vic.gov.au, 2012, Headache – migraine. Retrieved from: https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/headache-migraine. Accessed January 2024.
3. Organon and Fiftyfive5, 2022, Women & Migraines. Data on File.
4. The Migraine Trust, 2021, Migraine attack triggers. Retrieved from: https://migrainetrust.org/live-with-migraine/self-management/common-triggers/. Accessed December 2023.
5. L Kelman, 2007, The Triggers or Precipitants of the Acute Migraine Attack. DOI: 10.1111/j.1468-2982.2007.01303.x
6. O Begasse de Dhaem & F Sakai, 2022, Migraine in the workplace. DOI: 10.1016/j.ensci.2022.100408
7. K Micklitz, G Wong, J Howick, 2021, Mindfulness-based programmes to reduce stress and enhance well-being at work: a realist review. DOI: 10.1136/bmjopen-2020-043525