Factsheet – Migraine

This resource is part of our Disability Essentials range. You can find the other free resources that are included in this range by clicking here.

Introduction

The World Health Organisation places migraine within its top ten most disabling conditions.

Migraine is also ranked as the most common cause of neurological disability.

A 2018 report calculated that migraine costs the UK £8.8 billion a year, with migraines affecting 23.3% of the UK adult population.

What is migraine?

Migraine is a complex neurological condition causing temporary changes to the nerve signals, chemicals and blood vessels in the brain. The cause of migraines is still unknown, but there is increasing evidence that genes play a significant role.

Migraines affect approximately one in seven people, and women are three times more likely to experience migraines than men.

Each person’s experience of migraine is unique. Some people may have gaps of several years between attacks, whereas others have several a month. The symptoms and severity also differ between people and often between migraines.

In between migraines, the person is symptom-free, but they may worry about when the next one will arrive.

There is currently no cure for migraines, but there are effective treatments for many of the symptoms. In addition to relevant adjustments, these treatments can allow many people to manage their condition very successfully with minimal impact on their daily lives.

It is likely that the Equality Act 2010 will be applicable for most people who experience migraines. This is a legal decision, though and is made on a case-by-case basis.

How do migraines affect an individual?

Symptoms

There are many different types of migraine and many symptoms. The main symptoms usually include:

• An intense one-sided headache. Sometimes both sides and face and neck are affected.
• The pain is often described as ‘throbbing’ and is worse on movement. The pain is usually moderate to severe.
• Nausea, vomiting, tummy pain and diarrhoea.
• Poor temperature control; they may feel very hot and be sweating or feel very cold.
• They may have an increased sensitivity to light and sound. These stimuli can also be triggers for a migraine.
• Some people have warning symptoms which are known as an ‘aura’. These can include visual disturbances such as seeing ‘floaters’ and flashing lights. Some people may experience problems with their speech, feel dizzy, or have neurological symptoms such as tingling or numbness. An aura can last for up to an hour.

Triggers

Many people will be aware of triggers for their migraines. The triggers will be different for each person, but the most common triggers include:

• certain foods – such as chocolate and caffeine
• dehydration and hunger
• tiredness
• emotions – such as stress
• hormonal – usually linked to a woman’s menstrual cycle
• physical – such as over-exercise and muscle tension
• environmental – sensory overload from light and noise.

Potential impact on the individual at work

Migraines typically last between four and 72 hours. Some people may need time in a quiet place to rest and let their medication work. Others may need to go home and not be able to attend work during a migraine.

Many people who experience migraines regularly can successfully manage their condition well with little impact on their work.

Legal Duties

The Equality Act 2010

In the UK, employers have legal duties to:

• prevent discrimination, and
• provide reasonable adjustments

for their disabled employees. This means it is unlawful for employers to treat applicants, job candidates and employees unfavourably because of their disability.

The Equality Act also requires employers to make ‘reasonable adjustments’ for their disabled employees.

For more information, see our ‘Briefing – Adjustments in employment’.

Suggested adjustments

One of the main aims of implementing adjustments is to reduce any work-related triggers that might cause a migraine.

The person may well also need adjustments to allow them to recuperate when a migraine occurs.

The first step should always be to discuss any potential adjustments with the person. They are the expert in their migraine management. They will know their triggers, what helps them, and what they need to reduce the likelihood of them having an attack.

Workstation and desk-based assessment (DSE)

A well-set up workstation and following DSE best-practice should significantly reduce the likelihood of work-related migraines for many people.

An assessment should provide training, identify areas that need intervention, and suggest solutions. For example, if a person has started having more migraines since moving desks, the assessment may identify that their desk is in a very bright, drafty and noisy area. Portable noise-reducing baffle boards in a light-absorbing colour may be the most practical solution.

Workstation assessments should also be carried out to identify any actual or potential issues for those workers who are not desk-based. For example, a worker on a production line may be affected by the noise, light, and posture they need to adopt. The issues may be resolved with tinted safety glasses (if worn), more robust hearing protection, and more frequent task rotation to avoid muscle strain and tension.

• Ensure that you have a good adjustable lighting system that is well maintained with any issues fixed promptly. For example, flickering lights can cause migraines.
• If upgrading lighting, test the lux levels at various desks and at different times of day to ensure that lighting levels remain comfortable. Different bulb types and natural lighting level changes throughout a day can alter lux and glare levels dramatically.
• Reducing the wattage of light bulbs over a person’s desk can also help. They may also need a desk lamp.
• If the building has natural lighting, ensure that there are blinds to reduce any glare.
• Keep walls a matt pastel colour to help reduce glare. Posters and other artwork can help this too. The colours should be relaxing. Acoustic panels will absorb light and noise levels.
• Choose office furniture carefully. White desks can create more glare than darker ones. Anti-glare desk coverings may be a good alternative.
• Ensure adequate ventilation and extraction systems will prevent stuffiness and smells, which can both trigger migraines
• Keep the workplace at a comfortable temperature that is suitable for the work being carried out. Drafts from doors and poorly fitted windows should be fixed.

Work practices

• Reduce stress. A stress risk assessment can be a valuable tool for measuring this and identifying key areas such as heavy workloads, training needs, control, provision of adequate tools, and clarity of required tasks. The risk assessment can be carried out for an individual or team proactively as well as reactively.
• Flexible working can help reduce stress, and so all requests should be considered.
• Offer any training that may help with the causes and self-management of stress, such as stress awareness and time management training.
• Ideally, there should be unlimited access to drinking water to prevent the common migraine trigger of dehydration. Where this is not possible such as outside on industrial sites, there should be regular access to water.
• Hunger is another common trigger for some people, so making sure that the employee can eat when they need to can prevent migraines from occurring. Another strategy is to avoid meetings and travel over breaks.
• Fresh air and gentle exercise are good ways to reduce the likelihood of migraines. Going outside and for a short walk during break may prevent a migraine or at least a full attack.
• If someone does start to develop a migraine, it is helpful to have a room they can sit in that is dark and quiet. It may be that they need time to let their medication have time to work. If they are unable to work, it is essential that they can go home in a safe manner. This may mean taking a taxi. Driving with visual disturbances is not advised.
• Reduce the risk of tiredness by ensuring that the person does not work long hours without regular breaks. Unplanned overtime and shift work can be potential migraine triggers for some people, and alternatives or adjustments may be required. This may include a move to permanent day shift.
• Flexibility to arrange workload and work location to reduce the impact of a migraine can be beneficial in reducing any worry the person has about any potential disruption an employee may have due to their migraines. This is especially useful for women who have migraines related to their menstrual cycle.

Absence management

Despite the best efforts of all concerned, migraines may still happen. For some people, this may mean an absence of a few hours; for others, it can be a few days.

• It is good practice to have a policy in place that distinguishes between absences taken for a reason relating to a disability and general sickness absence. Any adjustments to managing absences mustn’t treat employees less favourably for a reason related to their disability.
• Allow time off to attend medical appointments.
• Provide a secure and confidential space to store and administer medication.
• Inform employees of any private healthcare provision that they may be entitled to access, especially those offering therapeutic assessments and support.
• Put in place provision for short notice cover for known employees with migraines.

Further information

For more information on suggested adjustments, specific barriers for migraine and information about the law, please see our other resources in the Knowledge Hub.

For more detailed information and advice about a specific situation, contact the Advice Service:

Tel: +44-20-7403-3020 | Textphone: +44-20-7403-0040

Email: advice@businessdisabilityforum.org.uk

Migraine Trust

Helpline: 0808 802 066

www.migrainetrust.org.

National Migraine Centre

Information and advice about migraines. Also runs migraine clinics.

• nationalmigrainecentre.org.uk.