Last reviewed 20 June 2018
Migraine is the most common neurological disorder in the UK. Understanding of the problem is generally poor and yet, writes Vicky Powell, there is much that proactive employers can — and indeed should — do to support sufferers and address the key work-related issues around this debilitating health issue.
A painfully common disorder
New figures have confirmed that 86 million working days are lost to migraine headaches each year, costing the UK’s economy a massive £8.8 billion annually in lost productivity.
According to the charity the Migraine Trust, migraine is the most common and disabling neurological disorder in the UK, more prevalent than diabetes, epilepsy and asthma combined.
New research contained in a recent report on the subject by the Work Foundation indicates that migraine affects more than 23% of adults with almost 200,000 attacks happening every day in the UK.
However, the condition is far more than just a headache. Migraine is a complex condition with a wide variety of symptoms. Certainly, for many people the main feature is a painful headache, but other symptoms include disturbed vision, sensitivity to light, sound and smells, feeling sick and vomiting. Migraine attacks can be very frightening and may result in sufferers feeling physically unable to do anything other than lie still for several hours.
The symptoms will vary from person to person and individuals may have different symptoms during different migraine attacks. Attacks may differ in length and frequency, but they usually last from 4 to 72 hours and most people are free from symptoms between attacks.
The impact of migraine
Migraine can have an enormous impact on work, family and social lives. The equivalent of 86 million workdays are lost to migraine each year due to migraine-related absenteeism and presenteeism, while close to £1 billion is spent on healthcare costs associated with the condition.
So prevalent is the condition that migraine is the most common neurological reason for accident and emergency attendance.
It is estimated that 10 million adults aged between 15 and 69 are estimated to suffer from migraine, with the condition being the second highest cause of years lived with disability worldwide and the highest among those aged 15–49.
Migraine in the workplace
The Work Foundation’s new report asserts that, “Everyone — including people with migraine — has the right to a ‘good’ job. Employers should — and increasingly do — provide healthy work environments which support a happy, healthy and engaged workforce.”
It also warns that migraine disproportionately affects people of working age, peaking at between 30 and 40 years of age, which is generally when people are at their most productive. It is therefore no surprise that, as experts told the Work Foundation’s researchers, working life is where migraine seems to have the biggest impact.
The Foundation adds that there is a consensus among migraine sufferers and the experts interviewed for the research report that understanding of migraine is poor in the workplace. For example, one female interviewee with episodic migraine was asked by her line manager why she had not “cured” her migraine yet. Migraine experts add that employers do not see migraine as “genuine”; indeed, there is stigma surrounding the condition, with market research findings suggesting migraine as one of the most common reasons for “pulling a sickie”.
Best practice advice for employers
The Migraine Trust points out in its recently updated workplace guidance that employers have legal obligations for the health and safety of their staff under the Health and Safety at Work, etc Act 1974. Other legislation and guidance which might be relevant for staff who suffer from migraine headaches will include the Health and Safety (Display Screen Equipment) Regulations 1992 and the Stress Management Standards produced by the Health and Safety Executive (HSE).
The Work Foundation report warns that aspects of the physical work environment can present problems for people with migraine. Experts told the Foundation’s researchers that people are often forced to work in “hot, stuffy environments,” with low quality lighting, computer screens, poor ventilation, loud noises and the presence of strong odours.
All of the people with migraine interviewed for the research complained of sensitivity to light and in some cases loud noises and strong smells. These aspects of the work environment were therefore perceived as triggers for migraine and as such workers were at pains to avoid them.
In its guidance, the Migraine Trust offers a number of highly practical suggestions for employers, ranging from strategies for flexible working practices to ensuring adequate access to drinking water (since dehydration is a major trigger for migraine) as well as implementing adjustments for the physical work environment.
For example, key areas to consider in terms of workstations are the organisation of the workspace or office, individual posture and furniture. Correct posture is important if an employee is sitting at a desk: a stiff back and neck can trigger migraine.
Many problems with lighting relate to glare and the Migraine Trust points out that anti-glare screens are available for most sizes of screens and can also help with DSE flicker. Limiting screen flickering can also help — the Trust advises that a figure of between 75–85Hz is best, but is not always possible on older machines. (The newer flat panel screens do not have this problem as they do not contain cathode ray tubes which cause the flickering.) Other aspects to consider include the ergonomics of the keyboard, mouse and wrist rests, as well as the size of text displays.
Best practice in tackling the occupational health implications of migraine will demand strong emphasis on psychosocial factors. In its report, the Work Foundation highlights the “vast body of evidence” which shows the positive effect of the following psychosocial components on employee health and wellbeing, highlighted in the context of migraines.
Increased autonomy and control — allow migraine sufferers to manage their workload and perceived “triggers”.
Manageable demands — reduce the risk of stress, which is a known trigger for migraines.
Good social support from colleagues and managers — to help them manage their condition.
Workplace flexibility — enabling staff who suffer from migraines to manage their hours, work from home if necessary, and to fit their work around their migraine.
Other stress management strategies set out by the Migraine Trust include the following.
Stress risk assessments: by working with their manager to identify and manage stress factors, an employee may be able to reduce stress levels which can be a trigger for migraine.
Stress management training: workshops on time and stress management strategies can be beneficial for all staff, not only migraine suffers.
Regular supervision: regular one-to-one meetings with a manager can help identify work triggers or stress factors and lead to discussions about support for an employee.
Health buddies: a colleague or representative who has an understanding of or training about migraine can provide support to an employee, which can go a long way to easing anxieties about attacks happening at work.
The Migraine Trust relates the case of Christina, a migraine sufferer, who explains her experiences of migraines at work as follows, “I can’t ever thank my employers enough… I was always supported, always believed even though they didn’t really understand… I returned to work to have a health and safety assessment where I was bought a screen glare overlay for my monitor and given other suggestions. I still struggle with my migraines as I’ve never been able to find an obvious trigger. I try my hardest to not let it make too much of an effect on my life.”
Indeed, a supportive — and educated — employer can make all the difference between losing and retaining valuable members of staff who face this highly common and incapacitating health issue.
Advice from David Price, Wellbeing Expert and CEO at Health Assured
In order to ensure appropriate support is offered to staff who suffer from migraines, employers would be wise to steer clear of the perception that migraines are the same as everyday headaches. Although migraines will often cause intense and prolonged head pain, symptoms will vary from person to person and can also include nausea, dizziness, muscle pain in the neck and shoulder area and loss of vision, so it would be wise for employers to hold discussions with an employee to identify the specific effects on them to ensure a bespoke approach to support is adopted.
Although employers may not initially be minded to consider migraines as a “condition”, further investigation into individual circumstances may reveal that those who suffer are considered to have a disability under the Equality Act 2010 and so it is important to bear in mind the extra obligations that apply to employers in this circumstance. Reasonable adjustments must be made the employee’s working arrangements to reduce the barrier that the condition creates to the employee’s performance of their role. Additionally, disciplinary sanctions or dismissals due to migraine-related absences may need to be avoided.
An important step in supporting employees with migraines is to investigate whether the working environment is causing or exacerbating their condition. Exposure to excessive lighting and noise have been proven to play a role in increasing the occurrence of migraines.
Migraines also commonly occur when individuals spend a large part of their working day using computer monitors. To address this, employers could consider a change in working duties to reduce the time spent on a computer or introduce computer software to ease the symptoms.
From a more general perspective, employers may consider taking other measures such as implementing a flexible working hours system, increasing the amount of breaks that the employee has or, as a minimum, ensuring that work is arranged so that it does not prevent the employee from taking their allocated breaks. Other simple but effective ways of supporting employees with migraines include allowing access to a rest room or access to drinking water to prevent hydration, which is often a key trigger of migraines.
To sum up
Migraine affects more than 23% of adults with almost 200,000 attacks happening every day in the UK.
Migraine can have an enormous impact on work, family and social lives. Some people cannot function properly for several days after an attack.
Best practice in migraine-related occupational health and wellbeing focuses on the following aspects.
Psychosocial factors including autonomy, stress management, and ensuring support from colleagues and managers.
Flexibility to enable staff to manage their work around their migraine.
Stress risk assessments, training, regular supportive meetings and health buddies.
The physical work environment: ie drinking water, temperature, workstations, lighting, computer screens, ventilation, noise and odours.