Discussion Guide

 

Do you ever feel like no one at work quite understands your migraine, or what you actually go through every time you experience a migraine attack? Has anyone ever equated your migraine to ‘just a headache?’ Unfortunately, those who have never lived with migraine have a difficult time understanding just how much it can affect a person’s life, as well as their work.  

 

That’s why a conversation about Migraine at Work needs to happen in workplaces across corporate America. Starting a dialogue is a great way to help those at work better understand how migraine disease impacts you or others you care about. However, the choice to disclose whether you have migraine or not is a very personal decision. It will likely depend on a number of factors including your relationships at work, company culture, your situation and personal comfort level. 

 

While you are not required to disclose whether or not you have migraine, doing so can help address barriers and potentially facilitate reasonable accommodations to help you perform at your best. 

 

Before we proceed, please note that this information is not legal advice and you should consult legal advice or external counsel making any decisions. 

 

Approaching a boss, supervisor, or even a human resources representative can be a daunting task. Discussing personal health issues or chronic conditions in the workplace can be uncomfortable. Colleagues, supervisors, and even friends may have no idea about the realities of living and working with migraine. Luckily, with the right preparation and resources, those living and working with migraine can start a productive conversation at work.

 

Where do you begin? 

• Know Your Goals

Before sitting down with your boss or an HR representative, it’s important to think through what you’re going to say, and also what you’d like to get out of the conversation. 

Are you asking for accommodations at the office? Do you need flexible scheduling options? Are you suggesting that your workplace implements educational programs for migraine? Or are you simply explaining how you cope with migraine at work with the hopes of more understanding and empathy? Deciding what your goals are in advance will help you prepare for your meeting and provide clear, measurable outcomes that you’d like to get from the conversation. 

2. Decide if you are going disclosure your migraine condition or symptoms

 

You are not required to disclose that you have migraine. It is your decision but it may limit your ability to request some accommodations if the organization do not understand why you require them but there are other options. 

1. You could speak about your most bothersome symptom(s) and request accommodations. For example, if you have sensitivity to light you could ask to adjust the lighting in your area or change the position of your desk if you face significant glare throughout the day. 
2. If your health insurance covers family members you might be able to ask about support for access to a treatment to be included or for other resources or support to be made available to those with migraine. 
3. Have a trusted colleague at work advocate anonymously on your behalf. 

3. Remind Yourself That This Is A Worthy Cause

 

It can be intimidating to bring up a health issue in the workplace. Knowing these facts can help give you the confidence needed to begin. 

 

1. You’re not alone, and you’re helping others. Remember that migraine is the second leading cause of disability, and is prevalent in virtually every office. By speaking up, you are not just helping yourself- you are making it easier for every other employee with migraine to come forward. Once a boss is informed about migraine, the accommodation process will likely become simpler for each employee.  
2. It’s your legal right. If you can show that migraine substantially limits at least one or more major life activities (including working), then it is legally protected under the Americans with Disabilities Act as a disability.  
3. You’re actually saving the company money. The unseen cost of migraine cost US businesses $78 billion annually. For every 1,000 employees, migraine costs a company an annual average of $84,000 in direct costs and absenteeism. Numerous studies have proven that accommodations are often inexpensive and effective, and educational programs have substantial positive ROI.  

 

4.  Establish the framework for your conversation.

 

Tailor your conversation based upon your goals. Know that you only need to share information in which you are comfortable.

 

If your goal is to work with your employer to (A, B, or C), consider the following: 

• Set up a plan which will allow you to work around your migraine attacks.

• Start the conversation by explaining how you are proactively working to manage the disease. We also recommend providing a note from your doctor if you have one. This can help legitimize migraine disease in the eyes of your employer even though it’s an ‘invisible disease.’
• If you are comfortable, explain your symptoms to help emphasize that this is not just a headache where you can “tough it up” and continue working. It’s helpful to have documentation (i.e. a journal or data from a migraine tracking app) to help explain how migraine can affect you, and impact your work. 
• Explain your workplace triggers, and brainstorm a few ways in which these could be mitigated through accommodations. 
• Devise a plan of attack when dealing with a migraine attack. While this plan is unique to the person suffering from migraine and their work environment, we recommend including a few key steps, like giving as much notice as possible if you need to miss work, identifying a colleague who can help cover your workload, and sharing a strategy for how you will make up any work you may have missed.

 

• Implement changes to your office that will benefit all employees with migraine. 

• Start the conversation with information about symptoms and severity of migraine. Explain potential triggers and exacerbating factors in the workplace.
• Provide statistics on the prevalence and cost of migraine disease in the US workforce. 
• Bring evidence of how accommodation and education programs can drastically reduce this burden. 
• Highlight how comprehensive health insurance policies can benefit the company’s bottom line, as well as the health of all employees and their dependents. 
• Explain how Migraine at Work is a nonprofit eager to help make these goals attainable for every office. We offer both free and paid resources, including a free prevalence study to evaluate the economic impact of migraine in your own organization. 
• Know that if you do not want to have this conversation, we can do it for you. We are also more than happy to provide you with any resources to ensure you feel as prepared as possible. 

 

• Have these conversations as an ally rather than a person living with migraine. 

• For a number of factors- especially the stigma surrounding migraine and other chronic conditions- it can be too intimidating to self-advocate if it means “outing” oneself at work. Having a confidant do the advocating can provide an employee a level of discretion. This confidant can be a trusted coworker or even a friend or spouse advocating for migraine awareness in another office. 
• If you know a coworker who is struggling with migraine, it may help to ask for their suggestions for your pitch. You may not realize how many triggers may be in an office, or how debilitating the symptoms can become. 
• If you are advocating with a specific person in mind, assure them that their name and identifying details will not be mentioned in the meeting. Mention how they are likely not alone with their diagnosis, and how this conversation could have far-reaching impacts for other anonymous coworkers. Above all, respect their wishes and ensure that they are comfortable with any information you will discuss. 

 

With this preparation, you will have the tools necessary to start a productive conversation. 

 

Approaching your boss or HR representative isn’t always easy, and talking about migraine disease can be challenging, but by following these steps, you can better control your situation and proactively work towards a more migraine-friendly workplace. 

 

Know that Migraine at Work is here to help. Reach out today with any questions. 

 

Helpful Resources to Consider:

 

It may help to read through the relevant articles or even print them out to provide your employer or HR department with additional information.

• Harvard Business Review: “Migraines Are a Serious Problem. Employers Can Help.”
• How Much Does Migraine Cost?
• How to Request Workplace Accommodations
• Accommodations for Migraine in the Workplace
• What is Migraine Stigma?
• Is Migraine a Disability?
• Migraine is Not “Just a Headache”
• When Companies Take On Migraine in the Workplace
• ​​Why Does Migraine Not Appear in Claims Data?
• HR Professionals Corner: Help! An Employee Just Told Me They Have Migraine Disease and I Don’t Know What to Do
• Are Accommodations Worth It?

 

Example Scripts for Each Conversation 

 

Conversation A: Set up a plan which will allow you to work around your migraine attacks.

 

Lindsay Videnieks, JD suggests starting out this process with an informal conversation and following this conversation with an email explaining that you do need an accommodation. Set the tone as friendly and helpful. Focus on educating your employer that there are successful options available.

 

Introduce yourself and present the goal of mutual support.

Hello Cassandra, I want to thank you for taking the time to talk with me today. I’m Jack, and I have been with this company for three years and have truly enjoyed working here. Unfortunately, I have been struggling with health issues and would love to talk this over with you and see how we can best maximize my performance here at work while improving my health all at once.

 

I am a bit nervous describing something so personal, so I will be consulting my notes and taking a few more throughout our conversation to ensure that I do not forget anything we discuss. 

 

Describe the prevalence and severity of migraine.

I live with migraine, which is a genetic neurological disorder. While it is incredibly common, it’s also misunderstood. Migraine is the second leading cause of disability and can be a huge- yet largely unseen- financial burden on most companies. One in every six US employees live with migraine. For every 1,000 employees, a company loses an annual average of $84,000 from direct costs and absenteeism. One of the reasons I felt compelled to speak up about this issue is that it is highly unlikely that I am the only employee struggling with symptoms, and I would love to help raise awareness to help others in the future.

 

Describe your symptoms.

Many people will have a bad headache and incorrectly refer to this as a migraine. However, migraine attacks can have dozens of disabling symptoms. When I get an attack, I have severe head pain, along with nausea, dizziness, and severe gastrointestinal issues where I am unable to leave the restroom for long bouts of time. Migraine exists on a spectrum, so while many people only experience seldom migraine attacks a few times a year, I experience attacks a few times per week, which is very disruptive to my work and productivity. 

 

Describe your workplace triggers.

There are several factors in our office, which can both trigger and exacerbate a migraine attack. The fluorescent lighting is a very common trigger for me. I have severe light and sound sensitivity during, and even in between attacks. The flicker or flashing buzz of the fluorescents can worsen this. 

In addition, during an attack, it is very difficult to work in an office with strict hours. I frequently wonder if other coworkers have noticed how long I have been in the bathroom, which can be embarrassing and leaves me feeling self-conscious that others may think I am slacking off. 

 

Describe potential accommodations.

I want to be as productive and effective as possible at work. I love this job and take it very seriously. I have brainstormed a few possibilities for accommodations and would appreciate your input and suggestions as well. 

 

As migraine impacts multiple major life activities for me, it is protected as a disability under the ADA. Fortunately, these accommodations are inexpensive and have proven to be effective for many workers. 

 

For the fluorescent lighting, I have researched a few potential solutions. There are fluorescent light filter covers. If provided with incandescent desk or floor lamps, I can turn off the overhead lighting or attempt to drown out the flickering by using these lamps. For particularly bad attacks, I would like to be able to wear dark lenses and baseball caps without being questioned in the office.

 

For working around my attacks, I would like to consider the possibilities of remote work and flexible scheduling. Working from home would allow me to provide my own accommodations which I may be too embarrassed to utilize in the office. These include ice packs, heating pads, and even lying down while working. The flexible scheduling would help me cope with my attacks significantly. If I experience a bad attack in the morning, I would not have to push through and work ineffectively while drastically worsening my symptoms and delaying my recovery back into productivity. I could take an hour to ice my head and nap through the pain. This often lessens the severity and length of my attacks. I will ensure that I make up the lost time in the evening or the next day. These measures will ensure my overall productivity and output will increase.

 

Your input is valuable to me, and I would like to work together with you to deliver the best outcomes for both of us. I welcome your thoughts and any other possible accommodations that have not yet been considered. 

 

Offer resources for further support. 

I know that not everyone is familiar with migraine and which accommodations may help, so I have printed off some resources for you to consider. Here is an article from the Harvard Business Review on how prevalent and costly migraine is in the workplace. I have also included two articles describing accommodations for migraine and triggers in offices. 

 

I would also like to direct you to a nonprofit organization called Migraine at Work. They have numerous resources and can provide any guidance you may need. 

 

Review the conclusions and thank them again for their help.

Based on today’s conversation, we are considering a few potential accommodations including fluorescent light filters, remote work options, and flexible scheduling. I greatly appreciate your  understanding and providing me the support I need to excel in this position. 

 

Conversation B: Implement changes to your office that will benefit all employees with migraine. 

• Start the conversation with information about symptoms and severity of migraine. Explain potential triggers and exacerbating factors in the workplace. Note: Having a letter from your doctor is helpful.
• Provide statistics on the prevalence and cost of migraine disease in the US workforce. 
• Bring evidence of how accommodation and education programs can drastically reduce this burden. Refer to migraineatwork.org for more resources and evidence. 
• Highlight how comprehensive health insurance policies can benefit the company’s bottom line, as well as the health of all employees and their dependents. 
• Explain how Migraine at Work is a nonprofit that can help make these goals attainable for every office. They offer both free and paid resources, including a free prevalence study to evaluate the potential economic impact of migraine in your own office. 
• Know that if you do not want to have this conversation, we can do it for you or on your behalf, allowing you to remain anonymous. We are also more than happy to provide you with any resources to ensure you feel as prepared as possible.

 

Introduce yourself and present the goal of mutual support.

Hello Monica, I want to thank you for taking the time to talk with me today. I’m Jill, and I have been with this company for just over a year and have truly enjoyed working here. I wanted to take some time to talk to you about a problem that affects an average of 1 in 6 employees and lowers productivity. 

 

Describe the prevalence and severity of migraine.

Migraine is a genetic neurological disorder. While it is incredibly common, it’s also unfortunately misunderstood. Migraine is the second leading cause of disability. It has a very significant- yet largely unseen- financial burden on most companies. For every 1000 employees, a company loses an annual average of $84,000 on direct costs and absenteeism. 

 

Migraine is a neurological disorder. It’s not just a headache. Many people will have a painful headache and incorrectly refer to this as a migraine. However, migraine attacks can have dozens of disabling symptoms. This can include excruciating pain, nausea, vomiting, GI discomfort, musculoskeletal pain, vision disturbances including temporary total loss of vision, and even stroke-like symptoms of one-sided weakness or paralysis.

 

Migraine exists on a spectrum, so while some people only experience seldom migraine attacks a few times a year, others may experience symptoms every day. 

 

Describe what can be done.

The Harvard Business Review released an article in 2021 explaining the heavy financial burden of migraine in the workplace. It also highlighted several peer-reviewed studies that illustrate the effectiveness and ROI of management programs. These strategies center around accommodations and educational programs. 

 

Introduce Migraine at Work.

Migraine at Work is a nonprofit organization working to help companies implement changes to improve both personal and professional lives of employees and help relieve the financial burden of migraine for businesses. They offer resources such as informational webinars, handouts, and workplace programs. They can share more information about migraine at work and what might be helpful – whether that’s a list of low cost accommodations, free posters, or tools, to an educational program to help those with migraine improve their treatment and management.   

 

Offer resources for further support. 

I have printed off some resources for you to consider. Additional information is available at MigraineAtWork.org

 

Conversation C: Have these conversations as an ally rather than a person living with migraine. 

 

Note that this conversation can be similarly modeled after Conversation A, B, or a combination of both, depending upon your goals.

 

If you are advocating for a specific coworker, create a discussion guide in advance alongside them. Ask for specific triggers which affect them and which accommodations which may help them. Above all else, respect their privacy and the level of detail they are comfortable with you sharing to your employer. Ask if there are any identifying descriptors that this person would prefer you keep confidential. 

 

Introduce yourself and present the goal of mutual support.

Hello Sean, I want to thank you for taking the time to talk with me today. I’m Kate, and I have been with this company for four years and have truly enjoyed working here. I am actually here to speak about an issue that does not affect me directly, but is affecting a colleague, and likely many of my colleagues.

 

I know that this company prioritizes employee support and satisfaction, and so I am proud to be an advocate for this issue. 

 

Describe the severity and prevalence of migraine.

I am here today to talk about migraine, a neurological disorder which affects 1 in 6 American employees, and costs US businesses $78 billion annually. For every 1,000 employees, a company loses an annual average of $84,000 from direct costs and absenteeism. 

 

There’s a lot of misinformation about migraine. It’s not just a headache. Many people will have a bad headache and incorrectly refer to this as a migraine. However, migraine attacks can have dozens of disabling symptoms. This can include excruciating pain, nausea, vomiting, GI discomfort, musculoskeletal pain, vision disturbances including temporary total loss of vision, and even stroke-like symptoms of one-sided weakness or paralysis. Migraine exists on a spectrum, so while some people only experience seldom migraine attacks a few times a year, others may experience symptoms every day. 

 

Describe workplace triggers.

While working with migraine, the office can be a difficult place to navigate. Each person with migraine has unique triggers, symptoms, and potential accommodations. With that being said, a few of the most common triggers include rigid hours, loud sounds, and harsh lighting. 

 

Describe a few potential accommodations.

Luckily for many of these triggers, there are many accommodations that can help. The majority of accommodations used for migraine are inexpensive and effective. These can include noise canceling headphones, screen and light filters, teleworking, and flexible scheduling so that the person can work around their migraine attacks and symptom levels. 

 

Describe educational programs designed for migraine in the workplace.

One of the most effective ways to mitigate the physical and financial losses of migraine in the workplace is to implement an educational program. These can help employees realize that their symptoms have a diagnosis behind them and introduce them to effective treatment options, lifestyle changes, and accommodations. The Harvard Business Review review of these programs found that they were effective in reducing lost productivity and had a high ROI.

 

Introduce Migraine at Work. 

There is a nonprofit organization founded to help companies implement accommodations for migraine and provide educational resources. Migraine at Work can help walk you through the process and offer numerous free and paid resources which will help make this process simple.