The Migraine Brain

by Bernstein, Carolyn; McArdle, Elaine

  In any job, it’s probably inevitable that at some point you’ll get a migraine. It’s just the odds. In this chapter, we’ll discuss how to minimize that chance and what to do when you get a migraine at work.

  Tell Your Boss and Co-workers

  “My boss knows now that when I get them I can’t function at all and have to leave immediately.”

  —Hank, 37, photographer

  Unless you have a truly difficult boss or co-worker, it’s really helpful to let people know what your problem is. If you’re throwing up in the bathroom or need to lay your head down on your desk, someone may think you’re hungover and have a drinking problem. It’s better to be up front about your illness. Telling the truth not only helps you, it educates people about migraine.

  Both you and your employer have the same goal: for you to stay healthy so you can do the best job possible. As the Pfizer study showed, migraineurs are often overly responsible employees, to the detriment of their health. The accommodations you need in order to reduce migraines at work are not only reasonable, they’re beneficial for your employer because they improve your productivity. But you will probably have to explain why you need these accommodations: why you may need to take a break to get some water during a meeting or have shades on the windows in your office, for example.

  Be open and honest. Make sure your boss and co-workers understand that migraine is a neurological disease, not a type of headache, and isn’t fatal but makes you sick and often disabled. Emphasize that you want to have as few sick days from migraine as possible, and with a few simple accommodations can reduce them. There’s a very good chance your boss and co-workers already know a migraine sufferer—and may even get migraines themselves.

  Telling Your Employer. You may want to bring a note from your physician to explain your migraine illness. I usually write one saying that this patient has severe, disabling migraines, that he or she is under my care, and asking the employer to please afford this person all due consideration at work. If you encounter resistance, talk to the Human Resources department.

  Since you want to minimize the effect your illness has on your employer, have a plan on how you can get work done despite your illness; for example, by taking work home or coming in on the weekend if you’re working on an important project. It works best to voice your willingness to get your work done despite your disability. You don’t want to be seen as a slacker but you do want to take care of your headaches.

  How to Reduce Migraine Triggers in Your Workplace

  You can take many practical steps at work to minimize migraine triggers and keep you as healthy as possible just as you do at home. Most are simple and unobtrusive, and should not bother your co-workers in any way. But if someone says something negative about your requests, stick to your guns. You have a right to be healthy at work. If your migraine is a disability (more on this below), your employer is required by law to make reasonable accommodations that enable you to do your job.

  How can you make your office as migraine-free as possible?

  Keep an eye on stress—It will be nearly impossible to eliminate stress from your work life, even if you work in a relaxing place, but you can learn to manage your own response to it through relaxation techniques, exercise, and good health habits. If your job is stressing you out terribly, so that despite your efforts at reduction, you are really feeling unhappy, you should consider whether the job is worth it. Stress can kill you. If you are getting chronic headaches related to work, your body is sending you a signal that you should listen to.

  Set up your office to minimize strain on your body. Larger corporations often have ergonomic specialists to help with this, and many employers use only ergonomic equipment and furniture since this results in fewer employee injuries and sick days. For more on ergonomics, see the federal Occupational Safety and Health Administration (OSHA) website: www.osha.gov/SLTC/ergonomics/index.html

  Use an ergonomic chair that places you in the correct, healthy posture so that you don’t get muscle strain in your back or neck, since muscle strain may be a migraine trigger for you (and because many other health benefits stem from correct posture).

  Make sure your computer workstation and keyboard are ergonomically positioned so that you avoid back and neck strain, as well as carpal tunnel syndrome or other problems.

  Get a computer glare screen. If eyestrain or flickering lights are a migraine trigger for you—and even if they aren’t—get a glare screen for your computer monitor.

  Check your office lighting. If your office has fluorescent lights, a problem for many migraineurs, get a fluorescent light filter or change to nonfluorescent lights. Energy-efficient fluorescent bulbs, the compact kind with a twisted shape, may be excellent for saving energy but have been connected to migraine attacks.

  Wear sunglasses in the office, if you need to. Don’t worry if your co-workers find it odd. Your goal is to stay migraine-free and healthy. If you wear sunglasses, it’s important that you tell your boss and co-workers that you have migraines; otherwise, they may suspect you have a drug problem.

  Ask that your desk or office be in a quiet area away from loud traffic outside, foot traffic inside, and loud machines such as the photocopy machine. The photocopy machine may also annoy you because of its bright light.

  Use a white-noise machine if your office is loud and noises trigger migraines. You can also wear noise-cancelling headphones.

  Ask for a fragrance-free office policy if strong smells are a problem for you. If your office has a policy, you won’t be forced to ask individual co-workers to go easy on their perfume or aftershave.

  Use an air-filter system to purify the air around your workspace, if odors, dust or other pollutants are a problem.

  Drink lots of water at work, at least eight eight-ounce glasses during the day, or one eight-ounce glass each hour, to avoid dehydration, a top migraine trigger. Your office probably has a water cooler or a refrigerator for you to keep water. If not, keep water at your desk.

  Keep your migraine medications handy in your purse, or in a safe and locked place in your desk. Keep your prescription up to date.

  Keep a protein bar or other healthy snack in your purse at all times or in your desk. Don’t hesitate to take a break and eat a snack when you need it.

  Eat regular meals during the workday. Keep your blood-sugar levels on an even keel. Take a lunch break when you need to. This alone staves off migraines for many people.

  Telecommute. Perhaps your boss will let you telecommute so that you can work from home on days that you need to take a nap or are feeling particularly bad.

  Work Emergency Plan

  Migraines can strike at any time. Since they’re more likely when you’re under stress, they may suddenly appear while you’re at work. What should you do? Here is an attack plan:

  Immediately notify a sympathetic co-worker or your boss that you are in the middle of a migraine attack and need to attend to your health immediately to stop it from getting worse.

  Take a break from whatever you are doing, and make your Migraine Brain your priority.

  Put your phone on voice mail and turn away from your computer.

  Take your abortive medications right away—don’t wait.

  Try an ice pack on your head or face, especially if your trigeminal nerve is throbbing. Ice really helps many migraineurs.

  If you’ve taken biofeedback training, now is the time to use it.

  Try slow, deep breathing.

  If massage helps you, try using self-massage techniques. Massage your head, neck, and temples, if this feels good.

  Put your head down on your desk and turn off the lights in your office, or dim the lights at your desk. (I lie down on the floor in my office during a migraine attack.)

  Get outdoors and take a short walk around the block, if your migraine isn’t too severe. The fresh air may help. Try slow, deep breathing as you walk.

  Drink a caffeine drink such as a cola (not a diet cola, unless it’s free of aspartame) o
r coffee, if caffeine helps you stave off an attack.

  Go home! If you try all of these techniques but it becomes clear you aren’t feeling better, it may be time to go home. Try not to feel guilty. You’ve done everything you could to avoid getting sick. You may need to call a cab or have a co-worker or family member drive you home if you’re too sick to drive yourself. When you get home, turn off the lights, unplug the phone, and try to sleep.

  When you start to feel better, think about what might have triggered this particular migraine. Which triggers were present? If you can put your finger on them, you may be able to avoid them in the future or at least try to sidestep a particular confluence of triggers. When you can’t avoid work-related stress, avoid other triggers like getting dehydrated or not getting enough fresh air and exercise.

  Planning for a Possible Migraine at Work

  “I felt a migraine coming one morning when I really did not want to go back home because there was an important meeting that afternoon. Sort of in desperation, I put my head down on my desk with the lights out in the office. I woke up half an hour later and I was much better. My boss never even knew. But if anyone had complained, they’d just be wrong. Because that quick nap meant I didn’t miss a full day of work.”

  —Fiona, 49, writer

  Let’s say you have a big project coming up at work and you know your sleep schedule is going to suffer as a result. When you don’t get enough sleep, you get terrible migraines. The stress of the project is also enormous. It looks like a migraine may be on the horizon just when you can least afford it. What can you do?

  Be prepared, and put your Migraine Brain first. Try not to feel like you’re coddling yourself with these steps. You’re working hard to prevent migraine and keep yourself healthy, which benefits you and your employer.

  Refill your meds. If you take medication for migraine, refill any prescriptions to make sure you have enough. Always carry your abortive medication with you wherever you go.

  Make a schedule. On the difficult days, block out fifteen-minute chunks of time for exercise. Even a brisk walk around the block will help.

  Nap. A ten-or fifteen-minute nap can allow your brain to recharge itself and avoid a headache. Close your door or find another quiet place to sit or lie down. You may be able to completely avoid migraines triggered by stress and sleep deprivation.

  Have snacks with you at all times. Protein bars and fruit are excellent. Eat at regular intervals to keep your blood-sugar levels even.

  Have water with you at all times. Stay hydrated throughout the day by drinking at least eight ounces of water every hour.

  Don’t forget your daily dose of coffee if your brain is used to it.

  Consider taking rescue meds. If you’re not someone who normally needs a rescue medication, this might be the time to ask your doctor to prescribe one, just in case. A major work project is not the time to get the migraine of your life—and rescue meds can save you from heading home in agony.

  Stay home the next day. If you get a severe migraine and can’t move the next day, it may be better to take that day off and return to work feeling healthy as opposed to dragging yourself in and prolonging the headache.

  Is Migraine a Disability Under the Law?

  Many of my patients are embarrassed when a migraine lays them low at work. Some are afraid they’ll be penalized if they ask for time off, however unfair this may be. Others are concerned about getting behind on their projects.

  You are entitled to take care of your health, and migraine is a true disability. If you are really sick from migraine, and your treatment plan hasn’t helped, you shouldn’t be embarrassed or worried about going home.

  Fortunately, the law protects people with disabilities. The Americans with Disabilities Act (ADA) requires employers to employ people with disabilities as long as they can do the job with “reasonable accommodations.”

  While the ADA doesn’t list particular illnesses that constitute a disability under the law, the federal Equal Employment Opportunity Commission has found that migraine headaches are an impairment under the ADA. That’s good news for migraineurs in the workplace. If your migraines substantially limit a major life activity, you have a disability under the ADA and are protected in your job, so long as you can get your work done with “reasonable accommodations.”

  As you can imagine, there is plenty of litigation over the definition of various aspects of this law including what “reasonable accommodation” means. In general, however, the types of workplace accommodations that migraineurs might need in order to do their job—filters on the lights, a noise machine, the opportunity to wear sunglasses if needed, and the others we listed earlier in the chapter—are the sorts of things that the ADA allows. These accommodations are so reasonable and unobtrusive that your employer should be willing to make them. But it’s good to know that the law will back you up, too.

  On the other hand, your boss may disagree with your requests. If this happens, you should talk to the HR department. You also may want to consider contacting an employment lawyer to find out what your rights are under the ADA.

  For more information on whether you as a migraineur have a disability as defined under the Americans with Disabilities Act, go to www.jan.wvu.edu/corner/vol02iss04.htm

  Can You Get Unpaid Leave for Migraine?

  Depending on where you work, if you have migraines you may be entitled to unpaid time off from work while you are sick without fear of losing your job.

  Under the federal Family and Medical Leave Act (FMLA), certain employers must provide up to twelve weeks of unpaid family and medical leave to eligible employees, including those who need to take care of their own health problems. The law also provides part-day leave for doctor’s appointments. (The law does not apply under certain circumstances, including if your company has fewer than fifty employees, you’ve worked in your job for less than a year and for less than 1,250 hours in that year, or if you’ve already used up your FMLA leave in the calendar year or your company’s fiscal year.)

  If you need to take time off to cope with your migraine, are you eligible for unpaid leave under FMLA? The answer is: Yes, probably.

  Under the regulations, migraine is specifically named as an illness that may qualify for family leave (other headaches, however, are excluded). But the law is complicated and has numerous requirements. And, in recent years, it has come under attack from business groups who complain it is being abused by employees.

  If your employer generally is sympathetic to your illness, you can approach your HR person or your boss to ask for unpaid leave under FMLA. If you run into opposition, you should contact an employment lawyer in your area to see what your rights are and how you can protect yourself.

  Travel

  “My flight this past weekend was a night flight. At a certain point, the cabin was dark, unless you had turned on your overhead light. The plane was preparing to descend, and the crew decided that a great way to wake people up in order to get them to put their tray tables back into place was to suddenly flip on the fluorescent lighting. It was cruel punishment because it instantly triggered a headache.”

  —Abigail, 31, sales representative

  A middle-aged mom I know planned for months to take her eleven-year-old daughter from their home in Boston to Washington, D.C., to stay with friends, visit historical sites, and see a Washington Nationals baseball game. Strong and athletic, this woman gets terrible migraines, but she was determined that this visit would be a rousing success. She knew she had to make her health a priority: She refilled her Imitrex prescription so she wouldn’t run out while on the road, carried a healthy, substantial lunch for their train trip, and had protein bars and bottles of water with her. She packed her running shoes and planned on a run every morning before they went out for the day’s activities. She thought she’d covered all the bases.

  But when she tried to go to sleep in her friends’ home, her high-maintenance Migraine Brain rebelled against the air mattress and the not-exactl
y-like-home pillow. The red light on a power strip near the bed aggrieved her head further. The change in atmospheric pressure—from New England to the mid-Atlantic coast—also unsettled her brain, and the streetlight shining through the window kept the room too light. She pulled the power strip out of the wall plug, which ended that problem, removed a pillow case from her pillow to cover her eyes, and tried sleeping on the floor. When she finally felt herself drifting off, someone banged shut the bathroom door and woke her up. As a post-college traveler, this woman had traveled the world staying in youth hostels and spent more than a few nights in airport waiting areas without getting sick, but this time, she was so irritated by her inability to adapt that the ensuing stress contributed to a perfect storm of triggers. By 6 a.m., she had a throbbing migraine that her medicine couldn’t touch. She spent the first day of their vacation sick in bed while her daughter went off with their friends to see the White House.

  “Next time, I’ll stay in a hotel,” she said wearily, then added, “although I don’t know if I can control my sleep any better there.”

  Another of my patients has terrible migraine trouble whenever she travels, something her job requires. She needs eight hours of good sleep but hotel rooms are often noisy. Even when she gets a quiet room away from the elevators, as she always requests, she can’t fall into a deep sleep. Because she’s concerned about being a woman traveling alone, she wakes at the slightest sound. (Once she awoke to the sound of something in her room and lay motionless in the dark for an hour before she realized it was only the morning’s newspaper being shoved under her door.) On every trip, she’s so sick she misses breakfast meetings, feels terrible during other meetings, and can’t join her colleagues for dinner afterward because she needs to return to her room to try to nap.