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Why is Migraine a Veterans’ Issue?

veteran in front of American flag

Prioritizing the hiring of veterans is not only good for patriotic and moral reasons, it’s also good for business. Veterans have proven to perform at higher levels and reduce employee turnover more than the general population. Through their military service, veterans develop dedicated work ethic and heightened problem-solving skills under high stress environments. There are also tax benefits for hiring previously unemployed veterans through the Work Opportunity Tax Credit (WOTC) program. While restrictions apply, WOTC allows for $5,600 for hiring unemployed veterans, and the Wounded Warrior Tax Credit doubles this amount for any veteran with service-related disabilities.

These illustrate powerful reasons to hire veterans. Yet, like any group of employees, some veterans will have particular needs that need to be met. They are much more likely to experience migraine and other headache disorders than civilians as a result of their experiences. Responding to disabilities in the workplace is essential; it represents another form of diversity. However, while 90% of workplaces say they prioritize diversity, only 4% of these companies include disability in these initiatives. This needs to change. It’s not enough to provide a job if the employee cannot succeed in a workplace’s conditions. Luckily, this task is much easier than it may seem.

How common is migraine in veterans?

The Veterans Administration (VA) reported that of those who have completed a one year tour in Iraq, 36% were diagnosed with or showed signs of migraine symptoms, which 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, which requires symptoms of migraine attacks on more than 15 days per month. 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.

In addition, migraine is more common in those with Traumatic Brain Injury (TBI), which is known as the signature injury for the Iraq and Afghanistan conflicts. TBI, including concussion, can trigger or exacerbate pre-existing migraine. According to Migraine Again, about 50-70% of those who have sustained a TBI then developed a headache disorder; this headache either is, or closely resembles, migraine. The Veterans Administration reported that 20% of soldiers with deployment-related concussion developed chronic daily headache, as well.

What comorbidities exist in veterans with migraine?

It is important to note that many veterans with migraine also live with debilitating comorbidities, such as post-traumatic stress disorder (PTSD), depression, anxiety, insomnia, and chronic pain conditions. In the VA system, 80% of veterans with positive screens for TBI also have a comorbid psychiatric condition. These vets with positive TBI screens were two times more likely to live with depression and/or a substance use disorder, and three times more likely to live with post-traumatic stress disorder (PTSD.) Veterans with a history of TBI are 1.55x more likely to die by suicide than the general population. Migraine and mental health disorders have a close relationship, and improving one condition may often help to improve the others.

How does the workplace affect veterans with migraine?

Migraine is a spectrum disease. While some people experience migraine attacks a few times across their lifetime, others experience symptoms every single day. Each person with migraine experiences a unique set of symptoms and triggers, and each workplace presents its own challenges, preventing migraine management programs from being one-size-fits-all. Establish an environment where your employees feel comfortable disclosing their personal needs, and allow these requests to guide your own protocol.

Common symptoms of migraine are sensitivities to lights, sounds, and odors, known respectively as photophobia, phonophobia, and osmophobia. These categories can also trigger or exacerbate an attack once it is already in process. These can be obstacles in a workplace filled with computer screens, fluorescent lighting, perfumes, toxic chemicals, loud machinery, among others.

Lifestyle factors outside the workplace, like those encompassed in the SEEDS mnemonic (sleep, exercise, eating, drinking, and stress reduction), can also contribute as migraine triggers. Stress is one of the most prevalent triggers, with 4 out of 5 people with migraine reporting it as a trigger. Even in those without migraine, stress makes an employee three times more likely to leave their job. Of course, all jobs have some degree of stress and that cannot be entirely eliminated, nor does it need to be. Allowing employees flexible schedules and providing an understanding environment can help with employee resilience and prevent burnout. 

Why do I need to care about migraine in the workplace?

Migraine, when not addressed, requires far more of most businesses than they can afford. Migraine costs employers in a multitude of ways, including absenteeism, presenteeism, and healthcare costs. Over 47 million Americans live with migraine disease, breaking down to about 1 in 4 women and 1 in 6 men, and  tends to peak during peak wage earning years, between 25 and 55 years of age.

Surprisingly, 89% of the costs incurred from migraine are actually due to presenteeism: when an employee tries to work through an attack at reduced productivity. According to a literature review in the Journal of Headache and Pain, employees with migraine tend to miss an extra 4.4 days of work and work with reduced productivity on 11.4 days of work per year. How much are you wasting on these 15.8 days per year per employee with migraine?

Prevention is far more preferable to treatment. This is applicable to each individual attack, and also regarding the potential for the progression of the disease. The chronification of migraine looms as a possibility for anyone living with migraine, especially those who are not properly educated on the condition and/ or treated adequately.

If veterans in my office are struggling with migraine disease, why haven’t I heard any complaints?

There is a huge stigma associated with many conditions prominent in veteran populations. Mental health is the signature set of conditions associated with stigma. This is due to decades of advocacy helping to raise awareness of this stigma to help combat these preconceived notions. Advocacy for migraine disease is unfortunately still in its infancy, which is why many people do not even think to consider it a problem in the workplace.

 Similar to mental conditions, migraine is often ignorantly associated with signs of weakness, making excuses, or not even “being real.” Because of this stigma, few people are willing to jeopardize their jobs by confiding in co-workers or employers who hold these incorrect biases, worrying that the information will lead to further discrimination against them. In fact, of those people not coming to  work because of a migraine attack, only 42% disclose that it is due to migraine. This fear of employers not understanding is not unfounded. Only  22% of employers believe that a migraine attack is a justifiable reason to miss work, despite the fact that 90% of people say they cannot function normally during an attack.

Even in health care claims data, migraine is frequently invisible. About 40% of those living with migraine are undiagnosed. These employees can have disabling symptoms and yet not know the best ways to manage their own care. Claims data fail to highlight the issue even for those actively being treated for migraine. It wasn’t until 2018 that there was ever a medication specifically designed for migraine. Classes of drugs such as anticonvulsants, antidepressants, beta blockers, and over-the-counter pain relievers were repurposed to ease the symptoms of migraine attacks; therefore, the prevalence of migraine in claims data would simply go unnoticed.

What can you do for veterans with migraine in your workplace?

 Finding accommodations for these triggers may be easier than you may think.

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 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 work days missed because of migraine attacks, fewer days worked with migraine attacks, and increased effectiveness on days when employees did work with migraine attacks.” 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. 

Create an environment where employees are empowered to speak up about living with migraine disease. Even in the twenty-first century, migraine disease still carries an enormous stigma. A 2016 survey found that just 22% of employers found migraine to be a serious enough reason to call in sick, coming in behind stress, back pain, anxiety, depression, and the common cold. 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. Learn more about how to make your office a workplace where employees don’t need to hide their medical conditions.  

 Make your workplace as accessible as possible. The best part of providing migraine accommodations is that what is typically beneficial for migraine management is beneficial for brain health. What is beneficial for brain health is typically beneficial for everyone. Accommodations are typically inexpensive, one-time costs, often ranging between free and $500. 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. In addition, fluorescent lights have proven to reduce productivity in the general population. If you ask around the office, it is doubtful that anyone claims to enjoy working under these flickering lights. Ergonomic seating can also prevent migraine attack initiation and exacerbation, along with improving efficiency in all employees.

How can my organization collaborate with Migraine at Work to ensure our veterans are getting the best possible workplace experience?

Veterans are a large and important part of the workplace, men and women who have served their country and deserve our support. It is essential to meet their needs so they can better every organization that hires them. Migraine at Work can provide you with endless resources to better accommodate veterans, and all employees, with migraine disease. The best part is that many of these resources can be provided free of charge.

Some of our resources include personal consultations with management or human resources; educational posters; educational courses for employees; webinars with esteemed headache specialists; and one-on-one training programs for employees living with this disabling condition.

For more information, contact us via our contact page.