Working with Migraines
Migraine Awareness Week 2019 is running from 1st to 7th September. According to the Migraine Trust it is “an annual campaign to draw attention to migraine, educate the public and reduce stigma.” A lot of that stigma comes from a lack of understanding about what migraines are and how they differ to headaches. In a workplace, it is (usually) possible to work at the same time as having a headache; so if your workload has increased because a colleague is off with a migraine, it’s not unusual for resentment to settle in if you think that a migraine is just a bad headache.
It wasn’t until I experienced a migraine myself that I learnt migraines are a neurological disease, that there are many different subtypes of migraine and that they aren’t all associated with head pain.
In 2011 I was doing some university work at home when I realised I’d been reading the same sentence over and over but it wasn’t making any sense, I switched screens and went to message someone but it didn’t matter what I typed the words didn’t make any sense. I thought I was typing correctly but the words looked like nonsense. Slowly I started to notice that everywhere I looked I could see a big black line across my left eye vision and even though it was quite a cloudy day, the left side of the room seemed very bright and sparkly. Then I noticed the fingers in my left hand tingling, then they started to go numb and within a few minutes my left arm and left side of my face was numb and my lips were drooping so I went to see my flatmate and when I spoke, instead of words, I sounded like a baby burbling. I could think the words but only garbling came out and I honestly thought I was having a stroke! My housemate took me to A&E and by the time I got there I could speak and the feeling was returning in my face so a couple of hours, and a few tests later, the doctors were confident it wasn’t a stroke but a Hemiplegic Migraine and that’s where my journey of migraine discovery started.
Hemiplegic migraines don’t usually come with head pain but the list of different symptoms that can be experienced is quite varied and can feel very different to different people. There are different types of migraine so a migraine attack might come with all or some of the following symptoms:
- Feeling sick
- Being sick
- Moderate to severe throbbing sensation in head
- Pain in face and neck
- Poor concentration
- Dramatic temperature changes
- Abdominal pain
- Slurred or garbled speech
- Lack of energy
- Sensitivity to what would otherwise be normal levels of light and sound
- Feeling dizzy
Aura’s are an interesting symptom that can develop with a migraine; they are like a temporary warning sign that a migraine will follow and can be very alarming to experience. They include symptoms such as:
- Numbness or tingling
- Other visual problems such as seeing flashing lights, dark spots or colourful zigzags across field of vision
- Dizziness or vertigo
- Loss of speech or hearing
- Memory changes
The Mayo Clinic has made a video of what having an aura can look like, from the person who is having its point of view here.
My aura started with the visual problems and tingling which became paralysis and garbled speech – hallmarks of a Hemiplegic Migraine. Other people might get a headache and start to feel sick which will signal to them that a migraine attack will be starting soon. Others might not get any warning at all and will suddenly become overwhelmed with extreme head pain.
The Migraine Trust explain the stages of migraine really well here but to sum up, a migraine can be broken down into 5 stages:
In the hours or days before a migraine attack, experiencing a change in your physical or mental state might occur, such as feeling tired, hungry, thirsty or getting a stiff neck.
Someone who gets auras could experience a wide range of the neurological symptoms mentioned above and usually the aura comes before the migraine but with children they can sometimes happen at the same time. Usually the aura stage can last from a few minutes to a few hours, but they can be much longer and come without the migraine following.
The head pain can be found on both sides of the head, or just one, and has been described as tightening or pressing pain, with nausea and/or vomiting taking place about this time too. Sometimes the pain is exacerbated by movement or light and sound.
Migraine attacks will usually subside gradually but sometimes they will end suddenly after the person has cried a lot or been sick, and some people find trying to fall asleep will help them, especially children.
Recovery or Postdrome stage
This stage can last for a different amount of time, varying from person to person but can take hours or days. It might include a feeling of being hungover or mirror symptoms to the ones in premonitory stage e.g. if you were tired, you now might be full of energy.
Now you know a bit more about what a migraine entails, let’s think about how that kind of condition can affect your work. If you’re like me, my attacks are few and far between (the last ones were 4 years apart) but some people will have them several times a week, which will affect them driving, managing a household or holding down a job.
Most workplaces aim to reduce short term sickness through policies such as not having more than 3 instances of sickness in six months. This kind of policy favours someone who might take 3 days off for a cold or stomach bug once or twice a year, but not someone who can feel a migraine coming on in the morning and doesn’t feel safe to drive to work, or who knows they will have to leave work soon after arriving.
In 2012 The Migraine Trust conducted a Migraines in Employment survey of over 350 people who get migraines and 46% of them thought that their absence management policies do not treat them fairly.
Some further stats to give you an insight into how migraine sufferers feel:
- 85% report migraine has a substantial and adverse effect on ability to perform normal activities
- 61% consider themselves to have a disability or be disabled by migraine
- 45% report that migraine impacts on their employment either often, most of the time or always
- 55% have been absent for more than seven days in the last 12 months
- 15% have been absent for more than 31 days in the last 12 months
- 46% say their manager does not understand
- 47% say their colleagues do not understand
- 40% feel unsupported by their employer
- 32% feel unsupported by their colleagues
- 32% report that when adjustments have been made there is improvement
So, what can we do as employers?
- Take time to understand what triggers and symptoms your employee has
- Validate them and let them know you want to support them
- Try and dispel the misunderstanding about migraines in the workplace
- Point your employee to the Migraine Trusts advocacy service
- Download and utilise the ‘Migraine: Help at work toolkit’
- Understand their rights and what guidance they will get
- If you are concerned about whether an employee’s migraines are genuine, sitting down and talking about migraines seriously might dispel any confusion or dishonesty