Migraine in the Workplace – for Employers

Migraine in the Workplace for Employers

An Overview of Migraine

Migraine is a complex neurological disorder classified by the WHO as the second greatest cause of disability worldwide in people aged under 50 years[1], and the first for young women[2]. Severe migraine attacks are classified by the World Health Organization as among the most disabling illnesses, comparable to dementia, quadriplegia, and active psychosis.^[3]

Migraine affects 12 – 15% of the population, which means a staggering 600,000 people in Ireland alone suffer from migraine. 5 – 10% (30,000 – 60,000) of those have chronic migraine; which means that they suffer severe pain and debilitating symptoms for at least 15 days per month! On any given day, at least 13,000 people in Ireland experience a migraine attack[4]. Chances are, some of them work with you or for you.

Migraine in the workplace is a huge issue! People living with migraine find that many of their colleagues or employers do not understand that it is a complex neurological condition and a real medical condition, just like diabetes, epilepsy, or asthma. In fact, it is more prevalent than all three of these conditions put together.[5]

Migraine is particularly hard to understand for people who have no experience of it because it is invisible, with no obvious signs of discomfort, and those with migraine can appear perfectly fine between attacks.

Some Symptoms

Migraine generally features a one-sided throbbing headache which is episodic and lasts hours or even days. The headache is normally worsened by movement or routine physical activity. Migraine has been likened to a power cut, as the whole body seems to shut down until the attack is over. The headache is of course just one of the symptoms, albeit the most well-known.

An attack of migraine can be very frightening. The onset of classical migraine (Migraine with Aura) may be signalled by visual disturbances in what is called the “aura” stage. This affects about 20% of migraineurs.

Common migraine (or Migraine without aura) and classical migraine may be accompanied by nausea, vomiting, diarrhoea, confusion and, in rare cases, temporary paralysis and loss of speech. Sensitivity to light, noise and strong smells is also frequently reported.

Triggers

A migraine attack can be ‘triggered’ by a combination of factors which are specific to the individual but most commonly include stress, certain types of food and alcohol, dehydration, hormonal changes, an excess or lack of sleep, weather factors, changes of routine, poor posture, and flicker from televisions, phone or computer screens and certain types of lighting.

Migraine is three times more common in women than men. This is largely due to the hormonal changes through a woman’s life from puberty to menopause.

Diagnosis

There is no test for migraine – rather an extended consultation which considers family history and pattern of symptoms. The doctor may then decide that further evaluation is necessary to rule out sinister underlying causes.

Migraine is inherited in up to 60% of all cases which suggests that there is a strong genetic component.

Stigma – https://migraineagain.com/what-is-stigma/

Many people with migraine act as though everything is fine to cover up the fact that they are in the middle of a nightmare to avoid being classed as lazy, skiving, or weak employees. Or much worse, unable to do their job properly. This is down to the perception that migraine is a headache and that’s all, and it can be cured by simply taking a paracetamol or some other form of pain killer. This could not be further than the truth

Migraine has real, debilitating and sometimes devastating effects on a person’s life. This in turn affects their working life, can have a significant effect on business, with repercussions for employers, and in the long-term, can even affect the national economy.

Migraine in the Workplace

The workplace can be a minefield for a migraineur, especially in an office environment, where everywhere they turn there is a potential trigger, be it fluorescent lights, overpowering perfume/cologne, long periods in front of a computer screen, loud noises from machinery, air conditioning, or lack thereof. It can be overwhelming.

For a person with migraine to ask colleagues to help by not doing something or changing something in the office is a daunting prospect as they first need to tell them that they have migraine, then must try to explain that it is not just a headache, they are not taking the mick, and they’re not looking for time off. Then they might have to go through all the other symptoms to explain it better, after which, they must wait and see if their colleagues accept it, understand it and are willing to help, or if they will just brush them off and tell them to get on with it!

It is a bit easier if the person works in a small office with a few close colleagues who know them well and understand, but if they work in a large office with a high volume of staff then it could be easily overlooked with less compassion shown especially as they may need to stop doing something that they like, such as wearing their favourite perfume/cologne every day or having the radio on during work.

Corporate Outreach

This is where the Migraine Association of Ireland can help. As part of our Corporate Outreach Programme, we try to educate people in workplaces about this disorder. The programme is aimed at those who work with migraineurs and those who employ them by showing that although migraine is a very real complex neurological condition which can have lasting and devastating effects on a person’s life, a person with migraine is just as capable a worker as a person without migraine but may require some small adjustments to enable them and their employer to get the best out of the employment.

Considering that 12-15% of the population gets migraine, then chances are if your workforce is big, you will have several people with migraine in your workplace. Recognising this, you can begin to work to improve their work environment to improve production overall.

Opening the conversation

You might be surprised by how many people will be willing to make small changes to help their colleagues. You might also be surprised at how many others in the office might be hiding that they too have migraine. Inevitably, once the discussion is opened up, you may find many people will have at least one relative with migraine. This is when you can begin to change things and help your colleagues or the staff you manage….

When people learn more about migraine and associated symptoms, and realise the effect on a migraineur, their family and friends, they begin to appreciate that something as small as not wearing their favourite perfume/cologne to the office is not a big deal but might save one or more of their colleagues from needless stress and pain.

For further information, contact us on 1850 200 378 or email info@migraine.ie

Statistics

The ‘My Migraine Voice’ study was carried out by Novartis and the MAI in Ireland to discover how migraine affects sufferers in everyday life;

• At home,
• In their workplace,
• At school/college, etc
• How much support is needed?

The study covers the social, economic, and emotional aspects of migraine and explores the real-life experiences of people living with migraine, including going through the healthcare system and employment environment. For a copy of the study, please click the links below…

My Migraine Voice Report

Work Statistics

Should an employee disclose or not?

Due to the stigma attached to having migraine, most migraineurs will be reluctant to disclose their disease to their employer, or indeed their colleagues.  The law does not require a person to disclose any disability to their employer.  However, it can be difficult for employers to provide help if they do not know what they need to do.

Disclosure is a difficult choice and many people, particularly those who have a hidden disability will fear discrimination or disciplinary action in the workplace if they do disclose their disorder. “Disclosing a disability to an employer can be of greater concern for people with ‘non-evident’ or hidden disabilities (Wilton, 2006:26, Goldberg et al, 2005, Equality Forward, 2007). It is considered by some as a ‘high risk strategy’ (Equality Forward, 2007: 12)” http://nda.ie/nda-files/disclosing-disability-in-the-workplace1.pdf

What are my Obligations?

Summary of Legal Rights of Migraineurs*

Chronic migraine is a debilitating disorder that can affect a person’s ability to work properly. Legal obligations exist to ensure that the effects of this impediment on the employer and on the employee is minimised. These include:

• Under the Employment Equality Acts, 1998 to 2007, an employer has a duty to do all that is reasonable to accommodate the needs of a person with a disability. Reasonable adjustments or accommodations can take many forms, some with a cost and others costing nothing. The level of accommodation in making a job or workplace accessible varies greatly and can include adaptation of premises and equipment, patterns of working time, distribution of tasks or the provision of training. Although, the obligation does not extend to the provision of reasonable accommodation which would cost more than a nominal amount. Reasonable accommodation must be made by employers to the working environment of the migraineur to minimise the potential for attacks to be ‘triggered’ or to relieve the symptoms as they arise.
• Failure to make such adjustments may be deemed discriminatory – it is up to the employer to show that it is not.
• Employers should facilitate dialogue with employees and other parties, such as non-governmental organisations, to ensure that reasonable and suitable adjustments are made.
• Employees cannot be dismissed or adversely treated in any way because they have made a complaint or taken legal proceedings against an employer about their working conditions.
• Migraineurs cannot be disadvantaged as regards access to employment or promotion because of their condition.
• Employers can apply for a workplace adaptation grant if they are employing somebody with a disability, including migraine. More details at: http://www.welfare.ie/en/Pages/Workplace-Equipment-Adaptation-Grant.aspx

*Adapted from MacMaoláin, C. (2016) ‘Protecting Chronic Migraine Sufferers in their Employment: The Role of Law’, in Murray M., Little, P. and Craven, A. (eds.) Migraine: Not Just Another Headache, Dublin: Currach Press, 115-124.

Supports for employers

There are several support schemes available to you if a member of your staff has a disability. These supports are provided by the Department of Social Protection.

• Workplace/Equipment Adaptation Scheme: As mentioned above, if you must make changes, you may be able to get this grant towards costs
• Employee Retention Grant Scheme can help you to retain an employee who has acquired an illness, condition or impairment that affects their ability to work.
• Disability Awareness Training Scheme For the private sector, disability awareness training can help businesses provide service to customers with disabilities as well as developing good working relationships with colleagues with disabilities.
• Wage Subsidy Scheme is an incentive to employ certain people with disabilities to work between 21 and 39 hours a week.

For further information see https://www.citizensinformation.ie/en/employment/employment_and_disability/working_with_a_disability.html

MAI Tips for Employers

Here are some simple tips for Employers

Facts first…

• Migraine is responsible for the loss of over half a million working days each year in Ireland
• It costs the Irish economy on average €252 million per annum!
• The unemployment rate in individuals with severe migraine is four to five times greater than the average rate[6]
• The average migraineur takes 2 sick days per year and loses another 4 in reduced productivity

With a few small changes and a bit of understanding, the above can be avoided. With the right information, support, treatment and understanding, the majority of migraineurs can bring their condition under control, reducing the frequency and severity of attacks, thereby reducing the effect on their work, boss, and colleagues.

Tips that Require No Cost

• Educate yourself and your staff.
• Let your staff know that you are open to them coming to you about health problems they may suffer from.
• Be supportive to those who do.
• Learn the signs and symptoms of migraine, be aware of who suffers.
• Contact the MAI for help and information.
• Direct sufferers to MAI for the same
• Come to any of our free Migraine Events to find tips from medical experts, complementary therapists, sufferers, etc.
• Be tolerant of someone who seems to have slowed down, don’t assume that because someone looks well, they feel fine.
• Encourage a healthy work/life balance culture.
• Consider having a perfume/aftershave-free office.
• Allow breaks as often as necessary for food and medication.
• Moving desk location to accommodate an employee with a disability.

Tips that Require Some Cost

• In the office, install and maintain a good lighting system which is as near to natural daylight as possible. This can be as easy as swapping out eye straining old fluorescent lamps for LED energy efficient lamps that are glare free and will save you money on your lighting bill too.
• If strong fumes or smells are produced make sure that efficient extractor fans are maintained.
• Try to keep machinery noise levels to a minimum. Supply equipment to help employees against it such as noise-cancelling headphones.
• Provide computer screens with a low flicker rate, or non-flickering screens.
• Provide special screen guards if you can’t afford to change screens.
• Design or install ergonomic workstations.
• Organise outreach/wellness days for your staff.
• Provide stress management training.
• Be aware of patterns in carpeting or decor you might be having done. Believe it or not some patterns can badly affect a migraineur, e.g., zigzag lines, houndstooth and other patterns that are very busy and colourful.
• Allow time off for medical appointments or flexitime to accommodate an individual.
• Allow Job Sharing
• Have a water fountain or readily available drinking water.
• Consider allowing flexible working hours.
• Provide a darkened area or rest room for staff.
• Let people know that if they are unwell and are not expected to show up for work – The practice of going to work despite illness and not being able to do anything while there, is called ‘presenteeism’. One of the aims of MAI is to reduce this by asking employers for fairer sick-leave policies which do not penalise sufferers but instead reflect understanding.

Some of the tips above are more practical and practicable than others. Obviously, a lot depends on the size of your business and how much you can afford to spend. A little understanding and implementation of small changes that will not cost anything will go a long way towards having a more content and productive workforce.

Have a look at the Health and Safety Authority website for tips on ‘Ergonomics in the Workplace’

For all other information, visit migraine.ie

References

[1] GBD (2019) Diseases and injuries collaborators (2020) global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the global burden of disease study 2019. Lancet 396:1204–1222

[2] Migraine remains second among the world’s causes of disability, and first among young women: findings from GBD2019 T. J. Steiner, L. J. Stovner, R. Jensen, D. Uluduz & Z. Katsarava on behalf of Lifting The Burden: the Global Campaign against Headache

[3] Goadsby PJ, Lipton RB, Ferrari MD. Migraine – current understanding and treatment. N Engl J Med. 2002;346:257–270.

[4] Natoli JL et al. Global prevalence of chronic migraine: a systematic review. Cephalalgia. 2010 May;30(5):599-609

[5] www.migrainetrust.org Headache Disorders – not respected, not resourced. All-Party Parliamentary Group on Primary Headache Disorders. 2010

[6] Grading the severity of chronic pain Michael Von Korff ¹, Johan Ormel, Francis J Keefe, Samuel F Dworkin