The writing and publication of this article was supported by Novartis Pharma Canada.


References

¹. Steiner TJ, Stovner LJ, Vos T. GBD 2015: migraine is the third cause of disability in under 50s. J Headache Pain. 2016;17:104.

². Steiner TJ, Stovner LJ, Vos T, Jensen R, Katsarava Z. Migraine is first cause of disability in under 50s: will health politicians now take notice? J Headache Pain. 2018;19:17.

³. Buse DC, Scher AI, Dodick DW, et al. Impact of Migraine on the Family: Perspectives of People With Migraine and Their Spouse/Domestic Partner in the CaMEO Study. Mayo Clin Proc. 2016.

⁴. CBI, Pfizer. Healthy returns: Absence and workplace health survey, 2011: 20.

⁵. Zhang W, McLeod C, Koehoorn M. The relationship between chronic conditions and absenteeism and associated costs in Canada. Scandinavian journal of work, environment & health. 2016;42:413-422.

⁶. Migraine Trust [UK]. Migraine help at work.2018.

7. Young WB, Park JE, Tian IX, Kempner J. The stigma of migraine. PLoS One. 2013;8:e54074.

“… workplace accommodations [are]… effective in preventing long-term sick leave.”

Employers need to know more about migraines. Migraines are difficult to understand and treat because they are complex and multifaceted. They are challenging in the workplace because they are often unpredictable and are unique to each sufferer or “migraineur.” Another challenge is the lack of imaging or lab test proof of disease. Migraine is a chemical and electrical phenomenon, and at present time there is no clinically available test to demonstrate it to a third party.

Extent of disability

In all its forms, migraine is a chronic disease, meaning that it affects an individual over many years. Chronic migraine also designates a subtype of migraine with frequent attacks (>15 days per month). The World Health Organization (WHO) estimates that migraine is the second cause of years lost to disability, because it affects so many people during their productive years.¹, ². Migraine affects all aspect of a person’s life, from planning holidays to taking care of family and being productive in the workplace. For example, 70% of chronic migraine patients report that they would be better parents if they did not have migraine, and 70% also have financial insecurity caused by their migraines.³

Costs for the workplace

While direct costs related to migraine are not high compared to diseases associated with expensive procedures and more costly medications, the indirect costs, including absenteeism and most of all presenteeism, are huge. A recent survey by the Confederation of British Industry (CBI) found that migraine/chronic headache was the second most frequently identified cause of short-term absence (47%) for non-manual employees.⁴ Canadian researchers have found that migraine is significantly associated with absent work days and have estimated the productivity loss for migraine at CAD $245 million in just three months.⁵ At the same time, they have found workplace accommodations to be effective and even cost effective in preventing long-term sick leave.

Help in the workplace

It is important for employers to recognize that migraineurs must manage unpredictable and debilitating attacks, with very imperfect treatments and, often, without much social support. Workplace accommodations that can help, as identified by the Migraine Trust UK,⁶ include:

• Flexible working hours.
• Flexible breaks.
• Rotation of tasks.
• Access to drinking water.
• Rest room.
• Time off for medical appointments.
• Re-deployment.
• Optimal desk placement.
• Lighting and glare adaptation.
• Ventilation.

Employers can also be reasonable. For example, in the case of a severe attack leading to absenteeism, asking the patient to get a physician’s note or go to the local emergency department is not ideal. Since many migraine attacks are best managed at home, going out for a note is not helpful, especially since providing notes is not the best use of health care resources.

Finally, employers can help by promoting positive collaboration among all involved in the work situation, including the patient, the employer, the physician, and other allied health care professionals such as occupational therapists, psychologists and physiotherapists.

Long-term disability and migraine

Employers need to remember that migraine attacks cannot always be prevented or controlled. They should consider whether benefit plans include coverage for migraine medication and adopt appropriate sick time and leave policies. When people suffer from chronic migraine, a severe and disabling form of the disease, they may not be able to work full-time. Some must even accept long-term disability. In the study by Young, 45% of chronic migraineurs were not able to work full time.⁷

In summary

• When employees experience migraines, employers can take three steps:
• Recognize: be aware of what migraine is, reduce stigma, create an environment where sufferers can talk about their condition
• Accommodate: find out what you can reasonably do and take steps to ease the situation
• Support: consider adopting benefit plans that have flexibility to meet the needs of migraineurs and make it possible for employees to take extended disability leave when necessary. bh