Migraine affects more than 10% of people, and it’s most common between the ages of 20 and 50. So, it affects a large proportion of the workforce.
“Migraine is very common, but it’s most common during the time of our lives when we’re expected to be the most productive,” says Rashmi Halker Singh, MD, professor of neurology at Mayo Clinic.
“It’s really heartbreaking when people say they have turned down opportunities because they’re afraid of what would happen if they have a migraine attack,” or they’re afraid of disappointing their colleagues, Halker Singh says. “That really speaks to the stigma of the condition.”
But there are ways to manage migraine. Sometimes, you can take time off work when you have an attack, but other times, you may need to deal with it at work.
Chrisi West, who works in communications and lives in Alexandria, Virginia, has been dealing with migraine since she was a teen. In her early 20s, she experienced her first bad attack at work, at a university dean’s office. “All of a sudden, I had this awful migraine and had to run to the public restroom,” she says. “I was on my hands and knees dry heaving, and I couldn’t see.”
A coworker offered to drive West home, but she didn’t think she could get in a car. One of the deans was out of the office, so the coworkers “put me with a couple sweatshirts and things under the dean’s desk and closed the blinds, because it was the only remotely dark place,” she says. “I had to sleep for four hours before I finally felt like I could drive myself home.”
Modifications at Work
Migraine symptoms and triggers vary from person to person. Triggers can range from strong smells to bright lights to stress to certain foods. Avoiding your triggers may be more challenging at work than it is at home or in other areas of your life.
Here are some common workplace modifications:
- Turning off or avoiding fluorescent lights or bright overhead lights
- Having a dark, quiet room available
- Adjusting the brightness of your computer screen or using a cover
- Having a scent-free space
- Being able to work from home or have a flexible schedule
One of Larissa Lavrov’s triggers is strong chemical smells. Once, her workplace was installing new carpet, and as soon as she got to work and smelled the carpet glue, she knew she couldn’t stay there. “This was before the era of working from home. It was hard for me to say, ‘Hey, I either take a sick day, a vacation day, or I find a different place on campus or in the office to work, because if I’m around this, I’m going to be sick for five days.’”
Lavrov, a higher education professional in Minneapolis, now has her own office, and when she has an aura at work, she turns off the lights. But she knows if she were working in a bunch of cubicles, she couldn’t just say, “Hey, can we turn the fluorescent lights off? This is really bad for me.”
In previous jobs, where Lavrov didn’t have her own office, she was able to sign out a private conference room or office when she needed a quieter, darker space.
Dany Cook-Sisson, who lives in Los Angeles, is a video producer for a marketing agency, so she spends a lot of time in front of her computer. She wears computer glasses that are different from her regular glasses and limit UV, after a recommendation from her nurse practitioner neurologist.
Asking for Accommodations
Some modifications might be easy enough to do on your own or without going through a formal process. But you might need to ask your employer for accommodations. If you do, a doctor can help establish what you need.
Your health care provider can be your advocate. “I’m a big advocate for my patients, as are my colleagues, and if they need FMLA or if they need letters written for accommodations at work, that’s something that we could always provide for patients,” Halker Singh says.
When people with migraine are able to modify their work environment, “that makes such a big difference for those individuals in order to be fully functional at work. And it can allow them to really thrive in their work environment,” she says.
Because migraine is invisible, people in the workplace might not understand migraine or what you need to deal with it at work.
“We need to make sure that the workplace is just as accommodating for the person who has migraine as it is for someone who has a condition that is more visible or obvious to other people. Everyone needs to have that sense of belonging at work and have an equal ability to thrive,” Halker Singh says.
Deciding Whether to Push Through
Ideally, you might always want to take time off work when you’re dealing with migraine symptoms. But if you have limited sick time, you might need to keep working. And you’re not alone.
In 2022, Cook-Sisson says, she was averaging 18 headache days per month, but she couldn’t miss more than two days per month from work. So she had to ask herself: “How severe are the symptoms? Can I get away with staying at home?” She’s thankful that her company is supportive, and she doesn’t have to deal with the stigma of: “Is she faking it? Is she not?”
For Lavrov, deciding when to go home and when to keep working became a game of numbers. “I would do 5-, 10-, 15-minute increments. Like, let me just do this one thing. I’ll answer this email, see how I feel. Let me make it to lunch,” she says. Then, “if it gets to the point where the pain becomes so noisy that I can’t think, I can’t function, then I call it.”
Lavrov says she has pushed herself to keep working because she has felt: “I have to do this because if I stop, then I’m perceived as weak or incapable. Because it’s an invisible illness. Nobody’s going to believe me that I’m in pain and I can’t function.”
Dealing With Symptoms at Work
The first medication Lavrov took for migraine had severe sedative properties. “I knew if I was going to have to take them, I was going to be a little bit slower in doing things,” she says. “It kind of forced me to lock in a little bit harder, which oftentimes made the pain after work harder.”
Lavrov has also learned to work around some of her symptoms. She sometimes loses vision in her left eye. “The pain in that portion of my head is so bad that my eye just closes and I can’t see, and so I can only do small tasks. I’ve created my work life around that so I’m able to do things to accommodate when I’m not feeling 100%,” she says.
West had always been a distance runner, but in her late 20s, she started getting sick in the middle of her runs, and she was diagnosed with exercise-induced migraine. She didn’t want to be on a lot of medication, so she stopped running. “I kind of just suffered with random migraines for a while,” but she didn’t do anything about it because she thought it was normal.
When West worked from home and had an attack during the workday, she would take Excedrin and tell her boss, “I need an hour to just lay in the dark with like a cool rag on my head until the Excedrin kicks in…and then I would sign back on and keep working.”
Migraine can be unpredictable, but it helps to be as prepared as possible. “I have a go bag. I have meds everywhere — in my desk drawer, in my office, in my purse, in my work bag, in my coat pocket,” Lavrov says.
Caffeine helps her attacks, so Lavrov keeps soda in her desk drawer. She also keeps plastic bags so she can make ice packs to put on her head as she works at her desk.
Along with her meds, West always keeps a small snack with her. Her rescue meds make her stomach feel upset, so she needs to eat something when she takes them.
What to Say About Migraine
Deciding whether to tell people you have migraine — and whom to tell — is a personal decision.
“Sometimes, I’ve had supervisors where I know I didn’t feel supported, so it was none of their business, and I tried to keep it pretty close to the chest,” Lavrov says. But she has told her supervisor in other instances. In a supportive environment, “it’s a lot easier to say, ‘Hey, I’m really not feeling great today. Is there something else I can work on? Or, you know what, I need the lights out. Or can we make this meeting a Zoom call?”
Migraine is about three times more common in women than in men. One review found that the prevalence of migraine ranged from 17.1% to 19.2% in women and 5.6% to 7.2% in men.
“I work in communications, which has a lot of women. My bosses have always been female, and most of them have also dealt with migraines,” West says. “They can see it on my face when I’m getting one.”
Usually, West needs time to take meds and be in a cool, dark room before she can return to work — and her bosses have been understanding. “They know how awful [migraine attacks] are, and they kind of know what you need to do to pull yourself together,” she says. But without this understanding, “it really could have hurt my career,” she says.
It takes patience to figure out who is safe to talk to, Cook-Sisson says. “What a safe person really looks like is someone who actively listens and does care,” she says. With some of her colleagues, she’s comfortable saying, “Hey, I am having a little bit of a headache today. If I start slurring or if I kind of lose my train of thought, I apologize.”
At Cook-Sisson’s daily team meeting, she will say up front, “My effort today — I’m going to give my 100%, but my 100% right now is like 25 or 30.”
If Lavrov is in a meeting, she will say, “I’m going to be camera off. I have a really bad migraine today. I have my lights out. I’m here participating. I’m fully present.” She adds, “If I am in a position where I don’t feel like I can be physically 100%, I advocate for myself a lot more, which I did not do in my early career.”
For Cook-Sisson, migraine causes issues when she’s on calls with clients or leading meetings. About three times a week, migraine causes speech impairment. “I’ll stutter, or I will completely lose my train of thought,” or have brain fog. So, she figured out how to get back on track when it happens. If she’s stuttering or slurring, she will pause and say “excuse me.”
People who don’t have experience with migraine might think it’s “just a headache.”
“There’s a big campaign within the headache community to educate employers about migraine,” Halker Singh says. The organization Migraine at Work offers resources for employers as well as employees.
Cook-Sisson is conscious about the language she uses to talk about migraine, in line with guidance from the American Migraine Foundation. “Instead of saying ‘I get migraines,’ we kind of reword that: ‘I have chronic migraine, I have migraine.’
Dialing in Your Treatment
It’s important to see a health care professional to get treatment that works for you and allows you to manage your symptoms at work.
You may need medication that you can take in the moment to stop an attack and possibly preventive medication as well. With the first, you should consider: “Does it work quickly? Does it get rid of their pain and associated symptoms completely? Does it not have any side effects? Does it make sure that the symptoms do not come back? Is it reliable? Is it consistent?” Halker Singh says. If it’s not meeting those criteria, “maybe they should be talking to their clinician about finding another option.”
Cook-Sisson says she takes a newer medication that has limited side effects, but it takes two hours to kick in. So, if she wakes up with a migraine, she can text her boss that she needs to take her meds, sleep for two hours, and then start her workday.
Lavrov and West have specialists who recommended new treatments in recent years that have made a significant difference. For Lavrov, it’s Botox. For West, it’s a beta blocker, which stopped her headaches. “The beta blockers were life changing,” she says.
Your health care provider also may recommend lifestyle changes that can help, such as adjusting your sleeping and eating habits, avoiding stress, and keeping a migraine journal.
“I would suggest not waiting as long as I did to finally see someone and get help with it, because you don’t need to suffer, and you shouldn’t suffer,” West says.
