Articles

“A migraine? Really? You can just take something and come in?”

“No…it’s not like that.”

“Hmmph. Well OK. We’ll talk when you’re back though.”

That was a conversation I overheard years ago when a coworker called out because of a migraine. It wasn’t too surprising, considering that I was working in retail, an industry notoriously unsympathetic of absence. But it’s a conversation that has played out for countless migraine sufferers across all sectors. And it’s one that has caused many to become fearful of their job security, and discriminated against because of their disabling condition. Let’s explore the impact of migraine stigma in the workplace.

So what is migraine stigma?

A stigma is an established construct in the social sciences that describes a characteristic, trait, or diagnosis that is used to discredit an individual and leads to prejudice, discrimination, and loss of status. ¹ Stigmatized people often have disrupted relationships, decreased quality of life, and lower employment rates. ² The common denominator with stigmatized conditions is that they often come with a perception that the person with them is at least somewhat at fault. Examples of stigmatized conditions include HIV/AIDS and mental illness. Fortunately, the hard work of individual advocates have helped chipped away at the stigma of these conditions, but much progress is still needed.

Migraine is an invisible- not imaginary- illness.

One of the most obvious causes for stigma about migraine is that it is an invisible illness. When someone has a broken leg or a stomach virus, the evidence is often graphically visible. Not so with migraine. With migraine, it can be hard to describe the disabling symptoms to someone who’s never had one, which can lead to the dismissive, “Just take an Ibuprofen!” response.

Migraine primarily affects women.

Around 75 percent of people affected with migraine are women. ³ This leads to another possible reason for stigma. This stigma of being a “women’s disease” prevents proper research, diagnosis, and treatment for patients of all genders. ⁴ According to Dr. William Young, in the 1700s, people perceived migraine as a disease of women who were overly sensitive and trying to escape from their social responsibilities. ⁵ Even today, women’s pain is often discounted by medical professionals and society at large. ⁶ However, a study of people with migraine showed that men were more likely to miss work with migraine, and were also less likely than women to mention the reason why they had to miss work. ⁷ This suggests yet another reason how the stigma of being a “women’s disease” harms people of all genders. 

The ‘migraine personality’ is a stigmatizing myth.

Is there such a thing as a “migraine personality”? Despite the aforementioned 1700’s view that migraine was an excuse to escape responsibilities, by the mid-20th century, that view had changed. Famed headache researcher Harold Wolff said the migraine personality consisted of individuals who were ambitious, successful, perfectionist, and efficient. Migraine patients were seen as good people who had trouble dealing with anxiety. Wolff also suggested that female migraine patients were sexually dissatisfied and uncomfortable with motherhood. Interestingly, Wolff’s study on male migraine patients found that they were by and large, sexually well-adjusted. This “migraine personality” further led to patients being discounted and yet again led society to place undue responsibility to those living with this neurological disease. ⁸

As science has progressed, the “migraine personality” view among medical experts has largely faded as a misconception of the past. But it’s been a relatively recent development- only in about the last 30 years has migraine been treated as a neurological brain disorder, rather than a psychosomatic condition.

Migraine research is underfunded.

Migraine research is also underfunded. In fact, it is the least funded neurological disease in regards to its economic burden. ⁹ The National Institute of Health estimates that funding for migraine research is only at $.50 per patient, a paltry figure. ¹⁰

It’s not difficult to see why these stigmas and history of discrimination makes it difficult for many to disclose that their migraine condition. The stigma of migraine has led to negative results for both people with migraine and their employers. Worldwide, migraine is the second most disabling condition (and the leading cause of disability in people under the age of 50). But 40% of patients most have not received an accurate diagnosis for either episodic or chronic migraine. ¹¹ The migraine diagnosis is further complicated by the fact that around half of migraine patients report experiencing anxiety disorders and depression, creating a sort of “chicken or egg” effect. ¹²  

Those with migraine may be forced to work through their symptoms.

Absenteeism from work occurs more often in people with migraine, although as previously discussed, the reason for absence is not always revealed. However, a phenomenon known as “presenteeism” is common for those with migraine and could be equally damaging to workplaces. Presenteeism is when employees work while sick as a performative measure. ¹³ Dr. Rashmi Walker Sangh describes presenteeism as “You just kind of slug through your day because you had to be there, but you really got nothing done.” ¹⁴ Productivity obviously suffers as a result, though it can be hard to quantify.

There is hope for those living with migraine.

Migraine is a condition that affects relationships, family, and life in the workplace. There is a long history of stigma about it, but increased awareness is bringing more visibility to this “invisible illness.” In the past few years, advertising for migraine medication has grown in the United States, hopefully inspiring more people with migraine to seek help for their condition, and making it clear to those without migraine that it’s not “just a headache.” There’s still an abundance of progress that needs to be made. 

Workplaces can help eliminate migraine stigma in their offices.

Workplaces can be more accommodating to people with migraine and discuss leave options such as FMLA. They can implement simple education programs and inexpensive accommodations. Dozens of peer-reviewed studies back up the claims that these simple strategies provide vast return of investment, not to mention an increase in employee satisfaction. While migraine research has historically been underfunded, it is slowly ticking up. There is unlikely to be a definitive cure for migraine, at least in the near future, but there is much hope that changing attitudes and behavior by both individuals and workplaces can improve the quality of life for people with migraines.

Want to change the culture of dismissing migraine in your workplace? Reach out today and we will guide you through potential ways to mitigate the stigma and burden of migraine in the workplace.

Josh Weinstein is a guest writer for Migraine at Work.

1)Young, 2018, The Stigma of Migraine, Practical Neurology, <https://practicalneurology.com/articles/2018-feb/the-stigma-of-migraine>

2)Hatzenbuehler, et al, 2013, Stigma as a Fundamental Cause of Population Health Inequalities, American Journal of Public Health,  <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3682466/>

3)Eisenstein, 2020, Closing the gender gap in migraine research, Nature, <https://www.nature.com/articles/d41586-020-02867-4>

4)2021, Migraine Stigma May Prevent Proper Diagnosis and Treatment in Men, American Headache Society, <https://americanheadachesociety.org/news/migraine-stigma-may-prevent-proper-diagnosis-and-treatment-in-men/>

5)Glaser, 2021, Hidden Pain: Migraine Stigma at Work Is a Big Problem, Migraine Again, <https://migraineatwork.org/news_articles/hidden-pain-migraine-stigma-at-work-is-a-big-problem/>

6) Zhang, et al, 2021, Womens’ pain not taken as seriously as mens’ pain, Science Daily, <https://www.sciencedaily.com/releases/2021/04/210406164124.htm>

7)2016, Isops, <https://www.reuters.com/brandfeatures/excedrin/employees-hide-headaches-migraines-from-supervisors>

8)Kempner, 2021, The Birth of the Dreaded “Migraine Personality”, Migraine Again, <https://www.migraineagain.com/the-birth-of-the-migraine-personality/>

9)2020, Migraine Facts, Migraine Research Foundation, <https://migraineresearchfoundation.org/about-migraine/migraine-facts/>

10)2020, Caduo, Migraine Research Is Underfunded, and Stigmas Are to Blame, Morning Consult,  <https://morningconsult.com/opinions/migraine-research-is-underfunded-and-stigmas-are-to-blame/>

11)2016, Headache Disorders, World Health Organization, <https://www.who.int/news-room/fact-sheets/detail/headache-disorders>

12)2017, Prieto Peres, et al, Anxiety and depression symptoms and migraine: a symptom-based approach research, Journal of Headache and Pain,  <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5360747/>

13)Begasse de Dhaem, 2021, Migraines Are a Serious Problem. Employers Can Help., Harvard Business Review, <https://hbr.org/2021/02/migraines-are-a-serious-problem-employers-can-help >

14)2020, The Benefits of a Company Addressing Migraine at Work, American Migraine Foundation, <https://americanmigrainefoundation.org/resource-library/the-benefits-of-a-company-addressing-migraine-at-work/>