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As an HR professional, you never know what situation is going to walk in the door- or in these COVID times, be on the other end of the phone. When an employee discloses that they have migraine disease, you might not know how to best support this employee. Here’s six things that will help.

1. Take care of the person first, the paperwork second. 

Migraine disease can be, and often is, classified as a disability condition under ADA. While you may be tempted to get the paperwork going right away, take a moment to stop and relate to the employee. For many people with hidden disabilities, they have been self accommodating for years, maybe decades. Coming to HR may be a giant leap for them, not only in terms of asking for help, but also for thinking of themselves as someone who needs assistance in order to keep working. Both of these aspects may carry large emotional burdens. Asking for help may be new for them, and some people may react very strongly to considering themselves disabled. This is why the first step, and the one that will set everything off on the right foot, is to thank the employee for sharing their condition with you, talk to them about how they feel about disclosing, and assure them that you have systems in place to help.

2. There’s no need to bring up your cousin’s migraine attacks.

In order to establish trust and empathize with the employee, many HR professionals make the mistake of saying, “I know about migraines’ because my sister/cousin/friend has them.” While this is a natural reaction, remember that every person’s experience living with this disease is unique. Triggers for them may be completely different from those which you have heard about, or even from those which you experience yourself. Migraine attacks, just like the people who have them, are unique. Instead of saying you understand, or comparing this employee’s challenges and fears to ones you know, validate their experience by saying that you understand migraine disease is very serious. Thank them for coming to you to discuss this. 

 3. Understand why the employee is informing you now. 

Now that you’ve done that, find out why the employee is coming to you now. The impact of migraine may be increasing. They may be worried their coworkers or managers are thinking poorly of them. They may just have finally gotten up the nerve. 

You may also have employees who come to you when they are put on a performance improvement plan, or who have just received a warning regarding poor performance. Unfortunately, some of these employees may think that informing the employer about their condition is a golden ticket to keep them from being fired. It isn’t. All employees must be able to perform the basic expectations of the job with or without an accommodation. 

Either way, your next step is the same.   

 4. Inform the employee of their ADA rights and work together to secure accommodations. 

Engage in a discussion with the employee about their needs. You don’t need to know about migraine disease. You do need to know how to listen and problem solve. Remind yourself that the employee is the expert on how they have been working to this point. If they know what they need, start there. This is the beginning of the ADA interactive process, but more than that, this is the beginning of enabling your employee to work more productively and contribute even more successfully to the company’s objectives. As always, don’t be so focused on the legalities that you forget that there is a person at the very center of this process. 

Remember, all people do not need all accommodations. Accommodations are specific to the individual’s particular challenges and should be affirmed as effective by the treating medical professional. Finding which accommodations work for which limitations is interactive- the employee will ask for some accommodations or you may offer some accommodations. Learn some common accommodation requests for migraine here. This discussion will help you create the accommodation plan. 

Employers are not required to accept every accommodation request. If the employee requests something you believe is not practical, continue to engage with the employee and problem solve. Your discussions should revolve around what your company can do for this employee that 1.) will enable this person to continue working and 2.) will not present an undue burden to the company. HR professionals should remember that the bar for undue burden is very high, and denials for that reason should be only after all possible discussions of alternatives have been exhausted. Everyone should be on the same team.

5. Know what to expect and where to look for accommodations. 

Know where to look when it comes to finding accommodations. The Job Accommodations Network lists possibilities based upon the specific limitations related to migraine disease. The more an employee can tell you about what their particular limitations involve, the more likely you are to be able to find a helpful accommodation. You and the employee may want to look at these together. These simple accommodations can help maintain- and increase- people with disabilities’ persistence in the workforce. Accommodations are often less expensive and more attainable than we expect.

The vast majority of accommodations for migraine disease cost very little money, and are often quite effective. One common accommodation that may help with unpredictable disabilities such as migraine is intermittent leave. Migraine attacks may flare with no warning and with no obvious trigger. 

The nature of migraine is such that it can strike due to a trigger or for no known reason at all. People with migraine disease often worry about how to complete their work if a migraine attack is looming, or what to do when it strikes. Similarly, people with migraine disease often struggle to find a medical solution that works for them. Introducing and calibrating new medication/techniques may require time off from work for medical appointments. There may also be periods of incapacity when a new medication or technique is ineffective or results in undesirable side effects. 

Working from home is a common request for people with migraine as they can control triggers like strong smells, bright lights, and uncomfortable temperatures. 

At the office, changes in the employee’s workspace can be very effective improvements. For many with migraine, triggers are often additive, meaning that when a person is exposed to multiple triggers in the same day, the more likely a migraine attack is to occur. Fortunately, this also means that the more triggers which can be mitigated, the less likely an attack is to occur. Small accommodations- changing a light source’s position relative to the computer screen, calibrating the color of the lightbulbs in the employee’s cubicle, moving the employee away from the loud copy machine – can be hugely helpful for employees with migraine disease. 

Employees may ask for flexible scheduling, allowing them to work alternate hours on days where they experience attacks. While they may have no notice that they are going to suffer an attack one morning, they can easily make up the hours in the evening, or the evening of a day later in the week. For exempt employees in the US, this is an extremely simple accommodation to grant; for non-exempt staff, granting this accommodation will depend on the nature of the work.  

Your ADA process will guide you through the legal obligations to your employee. You will be able, then,  to fully focus on your employee and how to best assist them in working to their fullest potential. And isn’t this exactly why we got into human relations in the first place? You’ve got this.

6. Keep in mind that migraine is a DEI issue and that protecting marginalized employees is one of our most important responsibilities as HR professionals. 

Migraine is a multifaceted diversity, equity, and inclusion issue. 

Migraine is a disability issue. Even though 90% of companies say they prioritize diversity, only 4% of companies include disability in these initiatives. Pave the way for your company to be a leader in this arena. 

Migraine is a women’s issue. Migraine affects women to men at a 3:1 ratio. It also peaks between the ages of 35 and 55- prime earning years. Companies spend millions recruiting and trying to retain women in the workplace, yet by not addressing migraine, they are losing this key demographic. Thus, migraine is a key aspect in the wage gap between genders. 

Migraine is a race and ethnicity issue. Black patients with migraine are significantly less likely than white patients to seek help from a medical provider, with percentages at 46% to 72%, respectively. While 37% white patients with headache receive acute medications, only 14% of Black patients will. Latino patients with headache are 50% less likely to receive a migraine diagnosis than white patients. Indigenous Americans have the highest rates of migraine disease. People of color tend to get migraine attacks which are more frequent, more severe, and more likely to become chronic. 

Migraine is a veteran’s issue. While the rates of chronic migraine or chronic daily headache in the general population fall around 3%, in post-9/11 combat veterans, the rates skyrocket to over 20%.

At the end of the day, remember that when you look out for your employees, they will look out for you.

Maureen Crawford Hentz is the Migraine at Work Human Resources Advisor.