Is Migraine a Disability?
How Can Migraine Classify as a Disability in the Workplace?
When Hannah first started her position as a corporate lawyer, her migraine disease was largely under control. When a migraine attack would occur, she would be completely out of commision for about three days. Luckily, this only happened a few times per year.
Now the attacks are occurring far more frequently. Even at only twice a month, she is now losing about six days of work every month. She has not spoken up about her condition as she is afraid to be perceived as weak or unreliable. Her boss is starting to ask questions and her colleagues have started to make snarky comments about whether she was going to need another sick day. Her job may be in jeopardy and Hannah needs to know her legal rights.
A disability is a physical or mental impairment that substantially limits one or more major life activity.
The Americans with Disability Act (ADA) provides the legal framework for disabilities including within the context of work. It is important to note that this is a legal- not medical- definition of disability. The ADA defines disability as “a physical or mental impairment that substantially limits one or more major life activity.” 1
What qualifies as a disability under the ADA may be different from what qualifies as a disability under the Social Security Administration for Social Security Disability Insurance (SSDI.) 2 This article solely focuses on the ADA requirements.
Migraine may be a disability, depending upon whether it impacts the employee’s ability to perform their job.
According to Shruti Kulkarni, JD, Principal Attorney at Sequel Legal/ Aimed Alliance, this answer is not as simple as a yes or no. “Maybe. Not everyone with migraine disease will be considered to have a disability because disability is determined on a case by case basis rather than based on a list of conditions.”
Basically, you need to prove that your condition is serious enough that your migraine attacks impact or limit your ability to complete tasks required for your job. You also need to prove that you are qualified for your position at work, and that- with or without reasonable accommodations– you will still be able to perform essential duties of your position. While the legal language of “with or without reasonable accommodations” seems confusing, it emphasizes that a worker may use accommodations, but they still must be able to complete the jobs. The tasks must still be performed, but the way the worker does it may be adjusted.
An ADA-defined disability impairs at least one major life activity. 3
Kulkarni explains, “Disability is defined as impairment that substantially limits one or more major life activities, such as the ability to work or care for oneself. Major life activities, especially as it relates to this population can be everything from seeing, hearing, eating, sleeping, walking, concentrating, thinking, communicating, working. All of these could be considered a major life activity.”
Migraine can affect multiple life activities, depending upon an individual’s symptoms.
Every activity Kulkarni listed above can be affected by migraine. However, every person experiences migraine attacks in unique ways. Unfortunately, due to the stigma of migraine, employees may need to convince their managers that their migraine disorder truly qualifies as a disability. Kulkarni states that, “Only about half of the HR professionals agreed or strongly agreed that migraine disease can be considered a disability in their organization,” in a survey of 300 HR professionals conducted by Aimed Alliance. 4
Migraine at Work can help take some of the burden off of the process of proving disability. If you are looking to prove that migraine affects these areas of your life, the list at the end of this article may help guide you to sources as scientific proof of your own lived experience.
A qualified disability provides certain legal rights, including accommodations and protections from discrimination.
You have the right to reasonable accommodations. You are legally protected from job discrimination on the basis of this disability. It cannot be used as a decision within the hiring or firing process. 5 In fact, you are never required to disclose a disability, including during the hiring process. 6
Reasonable accommodations may not cause ‘undue hardship’ on the employer.
Kulkarni explains that, “Under the ADA an accommodation must be provided to qualified individuals unless doing so would cause undue hardship. And accommodation is an undue hardship only if it would cause significant difficulty or expense to the business.” Luckily, most accommodations for migraine are inexpensive and largely effective.
If these rights are violated, an EEOC claim may be filed against the employer.
Contact the US Equal Employment Opportunity Commission (EEOC) to have them investigate your claim of discrimination. If your claim is successful, you may be entitled to backpay, re-hiring, accommodations, amongst others. Learn more about this process. 7
Resources on protecting one’s rights surrounding working with migraine are available.
These webcasts and articles may help:
Migraine at Work Webcast: Knowing Your Rights
Patients Rising: Women with Migraines: Addressing Discrimination in the Workplace
Migraine Again – Fired Thanks to Migraine?
Listing specific limitations can help prove that an individual’s migraine disease is serious enough to qualify as a disability.
Kulkarni stated that you must show that your condition impacts your life in ways which may include tasks like seeing, hearing, eating, sleeping, walking, concentrating, thinking, communicating, and working. Migraine attacks can affect each of these functions. Links to patient-focused articles as well as citations from medical journals are included below to provide you with additional information to help build your case.
Use this information to add medically-relevant information to your own experience. Create a list of any factors in the workplace which may trigger or exacerbate your migraine attacks. Think of any potential accommodations which may help mitigate these factors.
Seeing- Migraine can affect the way the brain interprets information from all five of the senses. 8 Sight may be impacted in numerous ways. Photophobia, or sensitivity to light, is a symptom in which the brain is hyperreactive to innocuous visual stimuli. 9 Migraine aura can present with numerous visual disruptions including scintillating scotoma, flashing lights, and visual floaters. 10 A more rare symptom of migraine is temporary loss of vision 11 .
Explain the specific tasks at work which can worsen these symptoms. Computer screens, fluorescent lighting, and even seemingly benign LED lights can exacerbate the symptoms of a migraine attack, leading to increased severity.
Workplace triggers like alarms or ringing phones, coworker chatter, or loud equipment may exacerbate symptoms or trigger a migraine attack. 14
Eating- Eating can also be affected during a migraine attack. Osmophobia, or sensitivity to smells, is the brain’s hyperreactivity to innocuous scent stimuli. 15 The body’s sense of taste is largely dependent on the sense of smell, 16 and thus consuming food or drink may be disturbed by migraine. In addition, there are numerous gastrointestinal symptoms of migraine, including nausea, vomiting, diarrhea, and gastroparesis, where digestion is slowed. 17
It can be difficult to work when you are unable to eat or are experiencing debilitating gastrointestinal symptoms with limited bathroom breaks or privacy.
Sleeping- Sleep and migraine attacks have a bidirectional relationship. 18 People with migraine are more likely to have sleep issues. 19 For some with migraine, sleeping through an attack can help ease the symptoms or prevent it from progressing. 20
Poor sleep quality leads to reduced work productivity and employee satisfaction. 21 If the workplace does not have a wellness room where napping or relaxation is possible, it may be more difficult to successfully manage or avoid an incoming migraine attack and the attack itself may be more severe.
Walking- Interestingly, some types of migraine can affect the ability to walk. Temporary paralysis can occur in certain people, like those with hemiplegic migraine. 22 In addition, those with migraine also report that movement exacerbates their symptoms. 23
If the job requires walking or standing, this may exacerbate symptoms, leading to further debilitation.
Concentrating / Thinking- Migraine attacks can affect cognition, including concentrating, thinking, and memory. 24 “Brain fog” is a commonly cited symptom.
In addition, stress, like that which may come from intense concentration, problem solving, or unreasonable deadlines, can trigger or exacerbate migraine attacks.
Communicating- A symptom of migraine is transient aphasia, or “migraine babble.” Aphasia results in difficulty understanding or expressing language. 25 Word finding may be difficult. Dysarthria can involve slurred speech, or speech that may come out incoherent. Serene Branson brought this symptom to the public eye reporting at the 2011 Grammys. 26
Communicating is essential in the vast majority of jobs. If an employee is unable to properly communicate with other colleagues, especially during a medical event or emergency, there is the potential for danger.
Working- In addition to all of the examples listed above, other symptoms which may impair one’s ability to work during a migraine attack include fatigue, dizziness, pain, tinnitus, mood changes, sensory hallucinations, frequent urination, and many others.
Think of specific tasks within your job which either trigger or exacerbate your migraine attacks. 27
While the ADA definition of disability requires the person to prove that their condition impairs daily activity, most people struggling to work with migraine can list several unique ways in which their disabling condition impairs multiple activities required for the job.
Be sure to take the time to prepare a detailed list on how your neurological disorder affects your ability to do specific tasks required for your job. Think of specific accommodations which will be able to help ease this burden. Be sure to document every step of this process and know there are legal options if your rights are not respected.
1) 2021, What is the definition of disability under the ADA?, ADA National Network, <https://adata.org/faq/what-definition-disability-under-ada>
2)Benefits for People with Disabilities, Social Security Administration, <https://www.ssa.gov/disability/>
3)2021, Migraine at Work Webcast- Knowing Your Rights, Migraine at Work, <https://migraineatwork.org/webcasts_migraine/knowing-your-rights/>
4)2021, The State of Migraine Disease in the Workplace 2021, Aimed Alliance, <https://aimedalliance.org/wp-content/uploads/2021/02/MigraineDiseaseReport2021_Final.pdf>
5)Your Employment Rights as an Individual with a Disability, US Equal Employment Opportunity Commission, <https://www.eeoc.gov/laws/guidance/your-employment-rights-individual-disability>
6)Schumer, 2019, How to Disclose a Disability to Your Employer (and Whether You Should), New York Times, <https://www.nytimes.com/2019/07/10/smarter-living/disclose-disability-work-employer-rights.html>
7)2021, How to File a Complaint at the EEOC, Disability Rights North Carolina, <https://disabilityrightsnc.org/resources/how-to-file-a-complaint-at-the-eeoc>
8)Goadsby, et al, 2017, Pathophysiology of Migraine: A Disorder of Sensory Processing, Physiological Reviews, <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5539409/>
9)2017, Photophobia (Light Sensitivity) and Migraine, American Migraine Foundation, <https://americanmigrainefoundation.org/resource-library/photophobia-migraine/>
10)Dumas, 2020, How to Know if You Have Migraine with Aura, Migraine Again, <https://www.migraineagain.com/how-to-know-if-you-have-migraine-with-aura/>
11)2019, Retinal Migraine, National Health System, <https://www.nhs.uk/conditions/retinal-migraine/>
12)Johns Pool, 2019, Migraine.com, <https://migraine.com/migraine-symptoms/sensitivity-to-sound>
13)Doherty, 2021, The Link Between Migraines and Tinnitus, VeryWell Health, <https://www.verywellhealth.com/link-between-migraines-and-tinnitus-4077631>
14)Dumas, 2020, 7 Reasons Why You Have a Headache at Work, Migraine Again, <https://www.migraineagain.com/tension-headache-causes-work/>
15)Kuruvilla, What’s That Smell?, American Headache Society, <https://americanheadachesociety.org/news/whats-that-smell/#:~:text=Osmophobia%2C%20a%20sensitivity%20to%20smell,some%20cleaning%20products%20and%20foods.>
16)Holbrook, 2018, More Than Taste Buds: How Smell Influences Taste, Mass. Eye and Ear., https://focus.masseyeandear.org/more-than-taste-buds-how-smell-influences-taste/
17)2019, Dumas, An Expert Explains Why Migraine Attacks Make You Nauseous, Migraine Again, <https://www.migraineagain.com/stomach-ache-with-migraine-nausea-vomiting/>
18)Tisseo, et al, 2020, Migraine and sleep disorders: a systematic review, Journal of Headache and Pain, <https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-020-01192-5>; Rodriguez, 2021, 6 Sleep Tips for People With Migraine, Everyday Health, https://www.everydayhealth.com/hs/sleep-tips-for-people-with-migraines/;
19)Rains, 2018, Sleep and Migraine: Assessment and Treatment of Comorbid Sleep Disorders, Headache, <https://pubmed.ncbi.nlm.nih.gov/30095163/>
20)Migraine and Sleep, The Migraine Trust, <https://migrainetrust.org/live-with-migraine/self-management/migraine-and-sleep/>
21)Chamorro-Premuzic, 2020, How Much Is Bad Sleep Hurting Your Career?, Harvard Business Review, <https://hbr.org/2020/07/how-much-is-bad-sleep-hurting-your-career#:~:text=Lack%20of%20sleep%20leads%20to,absenteeism%2C%20and%20counterproductive%20work%20behaviors.&text=If%20you%20sleep%20three%20hours,a%20half%20to%20succeed%20in.%E2%80%9D>
22)2017, Hemiplegic Migraine, American Migraine Foundation, <https://americanmigrainefoundation.org/resource-library/hemiplegic-migraine/>
23)2018, Timeline of a Migraine Attack, American Migraine Foundation, <https://americanmigrainefoundation.org/resource-library/timeline-migraine-attack/>
24)Martins de Araújo, 2012, Cognitive Impairment in Migraine: A Systemic Review, Dementia & Neuropsychologia,<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5619244/#:~:text=Despite%20mixed%20results%2C%20most%20studies,executive%20dysfunction%2C%20and%20attention%20deficit.>
25)2021, Dumas, The Migraine Babble: Why Your Words Get Jumbled, Migraine Again, <https://www.migraineagain.com/migraine-babble-words-get-jumbled/>
26)2018, How to Thrive in Your Career Despite Migraine, Migraine World Summit, <https://migraineworldsummit.com/talk/how-to-thrive-in-your-career-despite-migraine/> 2011, CBS2’s Serene Branson has a stroke on air?, YouTube, <https://www.youtube.com/watch?v=dwHpBwAxDIs>
27)2021, Migraine Trigger Guide, Migraine World Summit, <https://www.instagram.com/migraineworldsummit/guide/migraine-triggers/17897158031243182/?utm_source=ig_web_copy_link&utm_campaign=&utm_medium=>