Migraine pain: from auras to absenteeism

‘Sorry, I can’t come in today: I’ve got a migraine.” Bosses don’t often hear those words from their employees. That’s because migraine is still not properly recognised as a real, debilitating condition.

When a person is hit by a migraine attack, they’re probably unable to function properly, but are often reluctant to call in sick because their colleagues might not take them seriously. After all, it’s only a headache, isn’t it? So they’ll come in to work anyway and suffer in silence, even though their productivity will be seriously affected.

“Migraneurs try to battle through it rather than call in sick,” says Esther Tomkins, migraine specialist nurse at Beaumont Hospital. “I’ve a lot of people asking me to write letters for them to bring to work, because they feel that’s the only way their boss will believe them.”

Almost half a million Irish people suffer with migraine, and it’s a huge cause of absenteeism. But the sufferer may give another reason for calling in sick, saying they have flu or a tummy bug, because that may be taken more seriously by their boss.

Invisible condition

Tomkins works with migraine specialist Dr Martin Ruttledge at the headache clinic in Beaumont, and has advised many sufferers about how to manage their condition in the workplace.

One of migraineurs’ biggest concerns, she says, is because migraine is so invisible, when they call in sick, their bosses and colleagues might write them off as work-shy or as malingerers.

Another concern is that migraine may curtail career progression. Some chronic sufferers could be affected by migraine for up to 15 days a month; that’s half of your working life trying to battle your way through a sickness that is often so severe, sufferers need to go to bed.

But now, migraine is gaining recognition as a serious workplace issue. Employers are realising that it’s not just a headache; it’s a neurological condition with a range of symptoms, including nausea, dizziness, vomiting, sensitivity to light and sound, and temporary visual impairment.

These symptoms can make it almost impossible to perform basic functions, let alone concentrate on the complexities and demands of work. A migraine attack can last up to four hours, which is basically half your working day.

Even in non-headache forms of migraine, where the sufferer experiences visual disturbances such as blind spots, flashing lights and zig-zag patterns [known as “aura”], their ability to function efficiently is seriously curtailed.

“Some of the people we see in the headache clinic in Beaumont could be getting headaches every day for years,” says Tomkins. “And they’re thinking about their condition every day, worrying about the impact it’s having on their lives. Patients tell me it affects their work.

“The number of migraineurs is similar to the number of asthma sufferers, so it’s about managing the condition and reducing the frequency and severity of attacks. It’s three times more common in women than in men.

“Some may be lucky – their migraine may be episodic and may never change to chronic, so they’ll be able to manage it at work more easily. But when you’re dealing with weekly migraines, it starts to affect work.”

The World Health Organisation has classified migraine as the world's seventh most debilitating illness, but among women the statistic is closer to fourth, says Tomkins. So there's no point ignoring it and hoping it'll go away: it needs to be addressed in the workplace, both from a productivity and employee rights perspective.

Adjustments in the workplace

Under EU law, employers are obliged to make reasonable accommodation for employees affected by a disability. In the case of migraine, this could mean making small changes to the workplace to reduce potential triggers for migraine, or adjustments to working hours to minimise the impact of a migraine attack.

The Migraine Association of Ireland has been active in raising awareness of the condition in the workplace, and in helping people manage their migraine at work. The first thing you need to do, says Tomkins, is to get a diagnosis from a specialist.

“Seek help, look to a professional and get a diagnosis, so that if you have to go to your employer, you’ve got something concrete. Early intervention with the right treatment can reduce the severity of your migraine. Learn to recognise the triggers so you can start preventative measures. Eating regularly, exercising, keeping hydrated and managing stress will all help alleviate attacks. Working long hours or dealing with extra workloads can lead to migraine attacks, so you need to make sure you’re not being overstretched.

“The migraine brain likes routine, so try to keep to a regular work schedule and avoid chopping and changing your working hours.

“Get support from your workmates. Some people build up credit with their colleagues, in case they have to leave work early. So they’d fill in for other employees and help with backlogs. That way, if they have to leave the office suddenly, they can rely on colleagues to cover for them.”

“People are more aware of the condition these days, and everyone knows someone with migraine. There’s a heightened awareness of migraine in the public arena, and that can only be a good thing.”

For support with migraine, call the Migraine Association of Ireland 1850-200-378/01-8941280/01-8941281.

email info@migraine.ie or see migraine.ie