Why is Migraine a Diversity, Equity, and Inclusion (DEI) Issue?
Diversity, Equity, and Inclusion efforts are critical to any successful business. However, many of these efforts focus only on the hiring process, and then leave these marginalized employees to fend for themselves once the job is secured.
It’s in the best interest of employers to make resources available to help ensure the success of all employees. Fortunately, we are seeing greater implementation for workplace programs in several different disease states including mental health and heart disease. A recent survey reports that almost half of US workplaces incorporate some type of health and wellness program1.
However, migraine has been almost entirely overlooked in these workplace programs. This may seem surprising since it’s a disorder which disproportionately affects several traditionally marginalized groups including women, people of color, people with disabilities, and veterans.
Women are three times more likely to be affected by migraine than men. According to the Migraine Research Foundation, 18% of women versus 6% of men are affected by migraine disease in the United States. Chronic migraine is when someone experiences migraine symptoms on fifteen or more days per month. 85% of those with chronic migraine are women. 92% of women with severe migraine consider themselves disabled (2).
In addition, women are most likely to be affected by migraine from the age of 33 through 55- their prime earning years. Because of this, migraine is a prominent factor in the United State’s gender wage gap. By educating employers and employees on how to better manage migraine, we can help more women reach the height of their professional aspirations without being held back by health disruptions related to migraine..
People of Color
People of color with migraine disease are more likely to get migraine attacks which are more severe, more frequent, and more likely to become chronic (3). These patients are also less likely to receive proper diagnoses and treatment plans for this neurological disease. Black, Indigenous, and People of Color face a variety of structural, institutional, social, and economic barriers. Limited English proficiency (LEP) , socioeconomic status, immigration status, and insurance status can all contribute to why certain groups are adversely impacted and underserved. All of these factors could have a role in the increased frequency and severity of migraine in marginalized populations.
Among patients with headache, only 46% of Black and African American patients seek help from a healthcare provider compared to 72% of white patients (4). These patients are also more likely to receive a probable migraine diagnosis compared to their White counterparts (5).
Hispanic and Latinx patients in the US with headaches are 50% less likely to receive a migraine diagnosis than white patients (6). Chronic migraine is also more prevalent in Hispanic and Latinx women compared to White females (2.26% v. 1.2%) (7).
Native Americans have migraine prevalence rates of 18%, ranking as the most affected demographic (8).
In addition, 1 in 3 Black Americans and 1 in 5 Latinx and Native Americans have reported discrimination from their healthcare providers (9).
For more information on how migraine affects BIPOC populations and what the migraine community is doing to address these disparities, see the Disparities in Headache Advisory Council (DIHAC), a committee organized by CHAMP and Jaime Sanders, the Migraine Diva. Be sure to read their DiHAC Issue Brief: Disparities in Headache.
Employees with Disabilities
According to the Harvard Business Review, while 90% of workplaces say they prioritize diversity, only 4% of these companies include disability in these initiatives (10). Migraine itself can be a disability.
Migraine also presents in a wide spectrum of severity and frequency. Some people may experience milder symptoms on rare occasions, whereas some people may experience disabling symptoms every single day. Research suggests that most employees with migraine are not chronic (11). But those with chronic migraine are likely to develop other health issues and comorbidities from migraine (12).
People with migraine have 5x the rates of anxiety, 2-3x the rates of depression, 2.5-3x the rates of bipolar disorder, and 2.5x the rates of suicide than the general population (13). These rates increase with the frequency and severity of migraine disease (14).
In this way, migraine that is left unaddressed may worsen over time and lead to other costly health issues. Fortunately, many of these disorders have a bidirectional relationship with migraine, and as one condition improves, so will the other (15).
Veterans are much more likely to experience migraine and other headache disorders than civilians. The Veterans Administration (VA) reported that of those who have completed a one year tour in Iraq, 36% were diagnosed or showed signs of migraine symptoms. This is three times more likely than the general population.
Veterans are also more likely to be diagnosed with chronic daily headache and/ or chronic migraine (see definition above). While the rate for either chronic daily headache or chronic migraine in the general population is around 3%, it is over 20% in the post-9/11 combat Veteran population.
How to support employees with migraine:
1.)Educate yourself and your employees about migraine. Education is crucial. Migraine is the second leading cause of disability in the world. It’s a genetic neurological disease with dozens of potentially debilitating symptoms- not just a headache.
The Harvard Business Review found that “simply instituting migraine education programs was associated with an increase in productivity of 29-36%, due to fewer workdays missed because of migraine attacks, fewer days worked with migraine attacks, and increased effectiveness on days when employees did work with migraine attacks.” (16)
Another study found that three US companies providing access to a website and newsletter on migraine education reduced indirect costs of migraine by 34.5% within just three months (17).
2.)Create an environment where employees are empowered to speak up about living with migraine disease. Even today, migraine disease still carries a significant stigma (18).
A 2016 survey found that just 22% of employers found migraine to be a serious enough reason to call out sick, coming in behind stress, back pain, anxiety, depression, and the common cold (19). This stigma forces employees to suffer in silence, even to the point of leaving their jobs without ever disclosing their condition to their bosses.
Carrying this secretive burden leaves employees feeling isolated, discouraged, and completely out of control of both their health and their employment.
Don’t let your employees suffer in silence. The more supported an employee feels, the more productivity they yield (20). Learn more about how to make your office a workplace where employees don’t need to hide their medical conditions.
3.)Make your workplace as accessible as possible. The best part of providing migraine accommodations is that what is beneficial for migraine management is often beneficial for overall brain health and performance. Optimizing brain health is beneficial for everyone.
These simple accommodations can often improve overall employee productivity, safety, and satisfaction for everyone in your workplace. For example, fluorescent lighting can be an intense trigger for migraine attacks (21). In addition, they have proven to reduce productivity in the general population, regardless of if this person has migraine (22). If you ask around the office, few people enjoy working under flickering fluorescent lights. Ergonomic seating can also prevent migraine attack initiation and exacerbation, along with improving productivity in all employees (23).
How does Migraine at Work help to ensure your employees are supported and overall productivity is increased?
Healthier employees are happier and more productive. Migraine at Work can provide a range of free resources as well as a proven workplace program to reduce lost productivity due to migraine.
Start by receiving a free impact evaluation to estimate the cost of migraine in your workplace. Validate these estimates with our assessment tool to precisely quantify the cost of migraine in your workplace. Once the estimate or assessment is completed we can share various options from providing educational materials and informal training through to a turnkey proven program to reduce the cost of migraine and increase productivity.
You will be supported in the delivery of every step with minimal effort required on your behalf. Don’t let your employees suffer in silence. Provide them with the support and information they need to improve their health, happiness and productivity.
1) Bottino, 2020, Workplace Health in America survey: ‘A lot of growing left to do’, Safety and Health, <https://www.safetyandhealthmagazine.com/articles/19333-workplace-health-in-america-survey-a-lot-of-growing-left-to-do >
2) 2021, Migraine is a women’s health issue., Migraine Research Foundation, <https://migraineresearchfoundation.org/about-migraine/migraine-in-women/>
3) Thorne, 2020, Racial Inequities In Migraine Treatment, Migraine World Summit, <https://migraineworldsummit.com/talk/racial-inequalities-in-migraine-treatment/ >
4) 2021, Racial Disparities in Migraine and Headache Care, American Migraine Foundation, <https://americanmigrainefoundation.org/resource-library/racial-disparities-in-migraine-care/ >
5) Silberstein S, Loder E, Diamond S, Reed M, Bigal M, Lipton R. Probable migraine in the United States: results of the American Migraine Prevalence and Prevention (AMPP) study. Cephalalgia. 2007;227(3):220-229. doi:10.1111/j.1468-2982.2006.1275.x.
6)2021, Racial Disparities in Migraine and Headache Care, American Migraine Foundation, <https://americanmigrainefoundation.org/resource-library/racial-disparities-in-migraine-care/ >
7) Loder S, Sheikh HU, Loder E. The prevalence, burden, and treatment of severe, frequent, and migraine headaches in US minority populations: statistics from national survey studies, Headache J Head Face Pain. 2015;55:214-228. doi:10.1111/head.12506 <https://pubmed.ncbi.nlm.nih.gov/25644596/>
8) Loder S, Sheikh HU, Loder E. The prevalence, burden, and treatment of severe, frequent, and migraine headaches in US minority populations: statistics from national survey studies, Headache J Head Face Pain. 2015;55:214-228. doi:10.1111/head.12506 <https://pubmed.ncbi.nlm.nih.gov/25644596/>
9)-2021, Racial Disparities in Migraine and Headache Care, American Migraine Foundation, <https://americanmigrainefoundation.org/resource-library/racial-disparities-in-migraine-care/ > 10-Casey, 2020, Do Your D&I Efforts Include Disability, Harvard Business Review, <https://hbr.org/2020/03/do-your-di-efforts-include-people-with-disabilities> 11-Stewart, et al, 2010, Employment and work impact of chronic migraine and episodic migraine, Journal of Occupational Environmental Medicine, <https://pubmed.ncbi.nlm.nih.gov/20042889/> 12-Wang, 2020, Comorbidities of Migraine, Frontiers in Neurology, <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3008936/ > 13-Baskin, 2020, Understanding Migraine-Related Mood Disorders, Migraine World Summit, <https://migraineworldsummit.com/talk/understanding-migraine-related-mood-disorders/; https://jnnp.bmj.com/content/87/7/741 > 14-Buse, 2009, Common Comorbidities, Association of Migraine Disorders, <https://amd.ianryan.com/A%20Migraine%20Toolbox%20A%20Practical%20Approach%20to%20Diagnosis%20and%20Treatment%20-%20Storyline%20output/story_content/external_files/8%20Common%20comorbidities.pdf> 15-2018, The Link Between Migraine Depression and Anxiety, American Migraine Foundation, <https://americanmigrainefoundation.org/resource-library/link-between-migraine-depression-anxiety/> 16-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 > 17-Page, et al, 2009, Evaluation of resource utilization and cost burden before and after an employer-based migraine education program , Journal of Occupational Environmental Medicine, <https://pubmed.ncbi.nlm.nih.gov/19209043/ > 18-Young, 2018, The Stigma of Migraine, Practical Neurology, <https://practicalneurology.com/articles/2018-feb/the-stigma-of-migraine > 19-LaBianca, 2018, This Is the Single Best Excuse for Calling in Sick, According to Your Boss, Reader’s Digest, <https://www.rd.com/article/calling-in-sick-excuses/ > 20-Peart, 2019, Making Work Less Stressful and More Engaging for Your Employees, Harvard Business Review, <https://hbr.org/2019/11/making-work-less-stressful-and-more-engaging-for-your-employees> 21-Karanovic, et al, 2011, Detection and discrimination of flicker contrast in migraine, Cephalalgia, <https://journals.sagepub.com/doi/10.1177/0333102411398401> 22-Craig, 2018, Study: Natural Light Is the Best Medicine for the Office, Cision, <https://www.prnewswire.com/news-releases/study-natural-light-is-the-best-medicine-for-the-office-300590905.html > 23-McKeown,2018, Ergonomic workplace design for health, wellness, and productivity, Ergonomics, <https://pubmed.ncbi.nlm.nih.gov/28574748/ >