The link between mental health and invisible illness becomes particularly sensitive within a work setting: sadly, it remains all too common for workers with legitimate health conditions to be judged on their apparent lack of physical symptoms. Perhaps the most common and debilitating of all such ‘invisible illnesses’ is migraine, affecting a staggering number of the working population.
Here, during Migraine Awareness Week, David Bloomfield - Chief Executive of the National Migraine Centre and Dr Nazeli Manukyan - consider the effects of migraine on sufferers in the workplace and why it’s so much more than ‘just a headache’…
Migraine is probably costing your company serious money. Migraine is a neurological condition that affects 1 in 5 of the adult population, runs in families and can be completely debilitating. If not dealt with appropriately it could land you in court.
Diagnosis and treatment are often sub-optimal. The challenge is that symptoms can vary from one to another, and headache is not necessarily present. Disabling symptoms - apart from severe headache - may include cognitive dysfunction, nausea, vomiting, dizziness, visual disturbances, speech disturbance and sensitivity to light, noise, motion and odour. Sufferers commonly need to lie down in a dark quiet room during a bad attack.
A migraine attack can last from a few hours to many days. Even if the pain responds to medication, the attack can be followed by a phase akin to a hangover, rendering the individual foggy headed and unable to concentrate. There is frequently an anticipatory anxiety between the attacks, further adding to an individual’s ability to function normally. For some particularly unlucky sufferers, a more disabling variant is chronic migraine: when sufferers have almost no symptom-free days throughout a month, which is often accompanied by depression and anxiety.
There is no diagnostic test for migraine and there is no complete cure. However, approaches such as preventative drugs, lifestyle strategies and avoidance of common triggers can minimise the impact and help to gain control. Triggers include changes in routine, such as too little or too much sleep, missed meals, jet lag, alcohol and motion intolerance. They are a bit like a ladder with each rung a stressor and migraine activates as you reach a certain high point on the ladder.
In the unpredictable world of business, it’s safe to assume that leaders and senior management are likely to encounter many triggers on any given week of the year. Recognising them is the first step to managing them and can make a significant difference. Sometimes it is impossible to control migraines through trigger management alone. Knowing what to do when an attack starts can significantly reduce the absolute severity and duration of an attack.
Perhaps unsurprisingly, there is a strong correlation between mental health and migraine. In some instances, headaches can be presenting symptoms of anxiety and depression. Migraineurs frequently experience co-existing mental health disorders such as major depression, general anxiety disorder, bipolar disorder and PTSD. Indeed, in a recent 2019 survey conducted by the National Migraine Centre (1734 respondents) 65% of respondents reported that they have experienced depression linked to their migraines and/or headaches, with 24% having had suicidal thoughts and/or self-harmed as a direct result of their migraine condition.
Migraine is a hidden condition much like mental health, and migraineurs can feel stigmatised, isolated and are often reluctant to reveal all to employers for fear of the consequences.
As a business leader, perhaps you’re thinking ‘how much is migraine costing me?’ The easy bit is working out absences. However, most of the costs are hidden and difficult to calculate. Imagine your productivity and the quality of your work the last time you tried working with a hangover. The chances are that much of what you did required reworking and the costs of fixing problems escalates dramatically once these impact customers. At the very least you risk losing credibility, perhaps jeopardising the next contract.
This doesn’t mean you should not employ migraineurs. Aside from obvious legalities, it would in fact eliminate a large proportion of the working population. What it does mean is that you need to make some reasonable adjustments.
So, what can you do to assist those that might be suffering in your organisation? The following tips are a good starting point.
- Listen: Don’t assume staff are swinging the lead - a little understanding goes a long way.
- Be flexible: allow sufferers the time they need to rest and recuperate during and after an attack, offer the chance to work from home where possible and aim to show flexibility when it comes to working patterns.
- Environment is key: try to provide a quiet space onsite for recuperation.
- Consult Occupational Health guidelines: ensure workstations are set up properly, decrease screen intensity or consider anti-glare filters. Try to provide natural light; sadly many eco-friendly lights are not migraine-friendly.
- Knowledge is power: encourage people to identify, understand andmanage their triggers.
- Plan to prevent: migraine thrives on stress and change – push against this by establishing and maintaining a routine as much as possible.
- Think laterally: a ‘one-size-fits-all’ approach generally won’t work when it comes to heath / sickness policies. Try to accommodate individual sufferers’ needs when it comes to managing their (potentially chronic) condition.
David Bloomfield is an IoD Member and Chief Executive of the National Migraine Centre.
Return to the IoD Mental Health hub