Migraine in the workplace

Transcription

1 Migraine in the workplace

2 Helping yourself in the workplace a guide for employees Helping yourself in the workplace a guide for employees Claiming to have a migraine has become one of the most popular excuses for pulling a sickie from work, a survey suggests. A recent YouGov poll of 2,105 people found 15% of workers who admitted to making up illness to get a day off used migraine as their excuse. [ 1. ]. The research suggested the fact that people were faking migraines put real sufferers in a difficult position. Some said they feared they would not be believed when phoning in sick. These excuses do very little to help migraineurs who are struggling, not only with their migraines, but also with the need to earn a living. The aim of this booklet is to provide you with advice, information and facts so that you can feel more confident in managing your migraine at work. Remember the Migraine Action helpline ( ) is always available to those who need further help and advice, and that as an organisation, we are committed to increasing understanding of the condition and the problems it causes amongst the general public and employers. Let us look at some hard figures. While you may feel alone and isolated, that feeling could not, in fact, be further from the truth. In the UK alone there are more people with migraine than with diabetes, epilepsy and asthma combined. Over 6 million of us suffer, with a resulting loss of over 25 million working days at an estimated cost to the economy of 2.25 billion each year. Migraine and chronic headache (49%) is the second most commonly reported cause of short term absence. [ 2. ]. While these statistics may seem intimidating especially if seen from an employer s perspective - they do reinforce the fact that co-operation between employer and employee is vital if migraine is to be managed effectively, and costs to everyone (employer and employee alike) and society as a whole are reduced. Employers are often happy to help their staff if they are educated and made fully aware of the potential impact of migraine in the workplace.

3 Helping yourself in the workplace a guide for employees FAQs My employers have asked me to change to another job within the company because I have taken four days off during the past year because of my migraine. I enjoy my current job and the one I have been offered is lower paid. Do I have to accept? It depends on the terms of your contract of employment, but it would be surprising if there was a term giving the employer the right to impose (that is, without your agreement) a change so much to your disadvantage. As in the circumstances described immediately above, you could possibly have grounds for a claim under The Equality Act 2010 and, more straightforwardly, under the employment protection laws generally. It is best to try and find an amicable solution before resorting to legal action. I have to attend a return to work interview as I ve had five days off work this month due to migraine. I m really worried having migraine will be used against me. If your employer follows the rules, when your absences are being investigated, they should be looking at whether there is an underlying reason. It can be all sorts of things: under too much stress, unhappy at work, being bullied etc. They should be investigating why you are away and not just going through the motions and saying: Oh you re back now, but if you re off twice more, you will be out. If they find after talking to you that there is an underlying medical condition, they are entitled to ask for a report from your GP or specialist about your condition. You have to give your consent to that report being requested and you are allowed to see that report before it goes to your employer if you wish to. There are time constraints on this and your employer will have to pay your GP or specialist to produce that report. If you are identifying your migraine as a reason for your sickness absences and you refuse to allow your employer to get the medical report, that would appear to be uncooperative and you could potentially face disciplinary procedures or even dismissal. However, if you do go through these procedures and your absence from work is related to a disabling condition, you need to agree with your employer that your migraine should be classed as a disability. Any migraine related workplace absences should then be recorded separately from any other sickness periods and should be completely disregarded in any decisions that are made about your employment, for example, promotion, redundancy or training opportunities.

4 Helping yourself in the workplace a guide for employees Should I include migraine as an existing medical condition on a job application form? Yes, if you don t declare migraine as an existing medical condition and you subsequently take a lot of time off for migraine, your employer will have good grounds to take issue with you. So it is best to be honest. Can I be sacked because of my migraine? Ultimately, the answer is yes. There are lots of procedures that need to be followed before it gets to that point, but if it s identified that you do have a particular condition which makes it impossible for you to fulfil the job that you have been employed to do and your employer cannot find you anything more suitable or anything that you find acceptable, then once all the various procedures have been followed, you could lose your job. Very often on the helpline, people will ring and say: My employer is making life difficult for me. There are all these triggers and he is not making a reasonable adjustment. I just can t continue. Rather than fight, they leave their employment voluntarily. Everyone has a right to ask their employer to make reasonable adjustments. How can I make my employer implement reasonable adjustments? There are so many factors implicated in this: what your definition of reasonable is, the size of the company, the cost of the adjustment. It is a matter for negotiation. If it involves Health and Safety or a requirement of Employment Law, they should implement the requests. Very often we hear from people who are having these problems at big companies which you expect would know better. Many migraineurs think they cannot take on the company and just leave. So what happens is that the employers are not encouraged to make workplace changes which benefit migraineurs. For migraineurs it is even more stressful to fight every step of the way than to put up with the problems or just find another job. So it can be an uphill struggle.

5 Helping yourself in the workplace a guide for employees I have been overlooked for promotion on two occasions because of my migraine. Many migraineurs feel that their career prospects have been damaged because of their migraine. This may be because employers feel that additional responsibility may exacerbate their illness or that they feel that they cannot make the necessary commitment to the company. Alternatively, fear of the next attack can make migraineurs themselves less positive about their capabilities than their colleagues or reluctant to take on extra responsibilities. In circumstances where it seems that a migraineur, for a reason related to their condition, has unjustifiably been treated by the employer less favourably than would another employee, then a claim may be possible under The Equality Act In all such cases, the advice of a professional (e.g. a solicitor or a union) is essential and, in any event, before resorting to legal action, it is almost invariably best to try to resolve the matter amicably.

6 Helping yourself in the workplace a guide for employees Top workplace tips for employees There are some steps which you can take to manage the work / migraine balance: Developing a clearer understanding of your own particular condition will help. Keeping a migraine diary can be of great help when it comes to identifying triggers. Take particular note of any warning signs that you get including yawning, unusual hunger or cravings for certain foods, a heightening of your senses, irritability, exhilaration or excitability, confusion or speech difficulties as any one or combination of these may indicate the onset of a migraine. Ensure that your treatment regime is up to date. Consult your doctor if you feel that your existing medicine is not being as effective as it should be and take particular care not to overdose on painkillers just to keep yourself at work. Avoid sugary snacks and snack on some fruit instead. Why not have some pasta or a sandwich for lunch to stabilise your blood sugar levels? Drink plenty of water - you should aim for at least two litres a day. It s easy to forget to drink when you re busy at work!

7 Helping yourself in the workplace a guide for employees Limit your intake of coffee, tea, fizzy drinks if caffeine is a trigger. Get some fresh air during your break or lunch hour. Practise some deep breathing exercises - these are great for relaxing if you are having a particularly stressful day at work. Ensure that ventilation is adequate and where possible keep your office environment at a constant temperature. Avoid strong perfumes and ask your colleagues to be considerate if you are scent sensitive. Make sure your desk has adequate lighting - if you sit next to a window ask your employer for some window blinds to avoid any bright sunlight. Ensure that computer screens are properly adjusted and fitted with anti-glare filters. Take regular breaks - particularly if you work on a computer or if your work is repetitive. Try to make your working environment as comfortable as possible (e.g. adjust your chair to a suitable position, avoid sitting or standing in a position which means you have to twist or stretch to carry out your work). Vary your position as much as possible during your working day to avoid stiffness and tension (e.g. if you sit at a desk all day, stand up sometimes when talking on the telephone or walk over to do some filing etc). Try to keep your work well organised and up to date so that colleagues can take over with a minimum of fuss, if you need to be away without warning.

8 Helping yourself in the workplace a guide for employees Your employer Some of these measures may be difficult to achieve on your own. However, one important aspect of managing migraine in the workplace is your relationship with your employer. By telling your employer about your condition you may find it easier for them to accommodate any request you may have about lighting, for example. Many migraineurs find it difficult to discuss their illness, fearing that they may be stigmatised. However, you have responsibilities in this regard: under the Management of Health and Safety at Work Regulations 1999 it states that you should tell your employer if there are any problems with the health and safety arrangements in place where you work. Never forget that employers have responsibilities to their staff, especially those who are deemed to suffer from a disability. How you can help Help your employer and work colleagues to understand more about your migraine by educating them and if you feel a migraine starting and need help, ask sooner rather than later. You could hold your own training session in a team meeting to raise awareness about the condition or organise a health awareness day. With 10% of individuals affected in the UK, there are likely to be other individuals with migraine at your organisation who will benefit and may be willing to help. Migraine Action has a Power Point presentation you can download from our website at for this purpose; alternatively, please contact the office on to request a copy. If you feel your employer and colleagues would benefit from a visit from Migraine Action, please contact the office on or info@migraine.org.uk. We can help set up a health awareness day in conjunction with your line manager or HR department.

9 The Equality Act 2010 The Equality Act 2010 The Equality Act 2010 has now superseded The Disability Discrimination Act 2005 (DDA). It has been created to provide a new legislative framework to protect the rights of individuals and advance equality of opportunity for all; it aims to update and strengthen the previous DDA legislation. The Equality Act 2010 defines a person as disabled if they have a physical or mental impairment that has a substantial and long-term adverse effect on a person s ability to carry out normal day-to-day activities. Normal day-to-day means things that people do on a regular or daily basis, such as reading, writing, using the telephone, having a conversation and travelling by public transport. Long-term usually means the impairment should have lasted or be expected to last at least a year. Substantial means not minor or trivial. The key thing is not the impairment but its effect. Some people don t realise that impairments, such as migraines, dyslexia, asthma and back pain can count as a disability if the adverse effect on the individual is substantial and long-term. Employers must treat job-seekers and disabled employees fairly to avoid: Disability discrimination. Victimisation. Harassment. The three types of unlawful discrimination are: Direct discrimination. Failure to make a reasonable adjustment. Disability-related discrimination. Direct discrimination cannot be justified and happens when: A disabled person is treated less favourably than a non-disabled person whose relevant circumstances are the same or not materially different. The treatment is on grounds of disability. For example, an employer having a blanket ban on employing someone with a particular disability. Failure to make a reasonable adjustment cannot be justified by an employer. THE EQUALITY ACT 2010

10 The Equality Act 2010 Employers are required to make reasonable adjustments to jobs and workplaces for disabled workers. This is to ensure disabled people have equal opportunities in applying for and staying in work. The adjustments can include: Adjustments to the workplace to improve access or layout. Giving some of the disabled person s duties to another person, e.g. employing a temp. Transferring the disabled person to fill a vacancy. Changing the working hours, e.g. flexitime, job-share, starting later or finishing earlier. Training for disabled workers and their colleagues. Getting new or adapting existing equipment, e.g. chairs, desks, computers, vehicles. Modifying instructions or procedures, e.g. by providing written material in bigger text or in Braille. Improving communication, e.g. providing a reader or interpreter, having visual as well as audible alarms. Providing alternative work (this should usually be a last resort). Examples of adjustments to working arrangements include: Allowing a phased return to work when an individual returns from sick leave. Changing an individual s working hours. Providing help with transport to and from work. Arranging home working, providing a safe environment can be maintained. Allowing an employee to be absent from work for rehabilitation treatment. Examples of adjustments to premises include: Moving tasks to more accessible areas. Making alterations to premises.

11 The Equality Act 2010 Examples of adjustments to a job include: Providing new or modifying existing equipment and tools. Modifying work furniture. Providing additional training. Modifying work patterns and management systems. Arranging telephone conferences to reduce travel. Providing a buddy or mentor. Providing supervision. Reallocating work temporarily within the employee s team. Providing alternative work. Varying absence and sickness policies. For further information about The Equality Act 2010, please visit: Your co-workers As we all know, people do not necessarily understand the reality of migraine. One of your responsibilities and challenges in the workplace is helping your colleagues understand exactly what migraine involves. This may include not only a description of the symptoms and of the effects of an attack but also explanation of how it is episodic and to a certain extent unpredictable. Telling your colleagues also has a practical implication; should you be subject to an attack at work it is helpful for them to understand what is happening to you, so that they can respond appropriately. They could for instance point out that you seem unduly tired which could be an early warning for the onset of an attack. However, you should make your colleagues aware that you take full responsibility for your condition and that you are not looking for any favours in terms of less work or responsibility, just support in terms of temporary cover when you have an attack.

12 Migraine and the benefits you may be entitled to Migraine and the benefits you may be entitled to Migraine and Employment & Support Allowance (ESA) Most migraineurs can manage their condition with the aid of appropriate medication and attention to lifestyle. They may need to take occasional days off sick during severe attacks but will normally try to work through them with the aid of medication. Sometimes the condition escalates for some individuals and a period of sick leave may be required to break the pattern: this can range from one week to three months and is usually covered by Statutory Sick Pay (SSP). However, for a very few unfortunate people, migraine attacks are frequent and severe and prove resistant to all forms of treatment. Some migraineurs never know when an attack may strike and it may leave them unable to work for around three days during many weeks of the year; they are unable to find employment and therefore require Employment & Support Allowance (formerly Incapacity Benefit). Unfortunately, the criteria for awarding ESA are not best suited to migraineurs or others with an intermittent but debilitating illness (unless the attacks are life threatening). As migraineurs are usually quite well between attacks, they are often not awarded sufficient points in some categories. The Work Capability Assessment seems to be a particular problem as you have to be deemed unable to undertake any kind of work, not necessarily that which you are trained for or experienced. No recognition appears to be given to the unreliability factor ; migraineurs often never know when an attack will strike and few employers are willing to accept staff who, without warning, may or may not be well enough to come to work at the appointed times. Although the criteria should be applied uniformly throughout the country, much appears to depend on the knowledge and experience of the examining doctor and Tribunal members regarding migraine. Migraine Action is active in lobbying for a change in the way eligibility for ESA is assessed. You may wish to write to your MP to tell him / her about your difficulties and enlist his / her help. An All Party Parliamentary Group on Primary Headache Disorders has been formed to highlight key issues such as this; please consider asking your MP to join.

13 Migraine and the benefits you may be entitled to We suggest that the following may help your claim: Documentary evidence from a published source which outlines the symptoms of migraine and its effects on your quality of life. There are many books available about migraine in libraries etc. and a description most appropriate to support your individual case can be chosen. Visit for further related reading materials. Strong support from your GP and any specialist consulted is vital. Evidence from former employers (to give details of the amount of time taken off, working under par etc.). If you are a member of a Trade Union, they may have specialist advisers who can help you. Your local Citizens Advice Bureau will have people experienced in completing the necessary forms and they will be able to help and advise you. (What is put on the application forms from the very beginning can have a substantial influence on the way your claim is processed). The Work Capability Assessment seems to be a particular stumbling block and, in the section of the form where you are asked to state whether you can perform certain tasks. e.g. stand unaided, walk upstairs, dress yourself etc, some applicants have created two columns: one for when they are well and can do everything without a problem and another for during an attack when they may have severe problems with some of the tasks. This combined with the information on frequency and length of attacks can help to illustrate how difficult it can be for some people to find suitable employment. Keep a diary giving details of frequency of attacks, how long they last, the symptoms and the effect that they have on your quality of life both during attacks (e.g. if you had to stay in bed, were unable to stand, were unable to prepare a meal etc.) and between them (e.g. if you feel unable to make plans for fear of an attack, are unable to drive or operate machinery because of the effects of the medication you take etc.). A note of any trigger factors would also be a good idea particularly with proof that a migraine follows (for example, if when shopping a migraine is triggered by fluorescent lighting, this may indicate that you are not able to work in artificial light; if a migraine follows a spell at a computer screen, this may indicate that you cannot work in an office etc.). See the useful resources section in this booklet for further information.

14 Migraine and the benefits you may be entitled to Migraine and Disability Living Allowance Most people know of Statutory Sick Pay and Employment & Support Allowance, which are all dependent on national insurance contributions, employment and income, but few have heard of Disability Living Allowance (DLA). You may be able to get DLA if you are under 65 years and need supervision or help with personal care. You may also be able to claim if you have walking difficulties because of a physical or mental disability. This must have lasted for three months and you are likely to need this help or have these difficulties for at least another six months. Should I claim? DLA can definitely make a big difference. It can give you back some feelings of independence and control. It may make you feel that others recognise the far reaching impact of your condition and that it is taken seriously by society; this can bring a real improvement to the quality of your life. Getting support Claiming DLA can be challenging in a number of ways. For example: The forms are long, complex and time consuming to complete. It will force you to focus on the things you are unable to do, the very negative side of migraine. You may be visited by a Department of Work & Pensions (DWP) doctor. Your own GP may not support your claim. Your claim may be unsuccessful, and you could be left feeling frustrated and disappointed. You may want to consider enlisting support from close family and friends who have experienced your suffering, and can offer support and help. As well as emotional support, you may need professional help, perhaps from your local Citizens Advice Bureau. Healthcare professionals, such as your GP or consultant, may be able to help support your claim by writing letters about your condition.

15 Migraine and the benefits you may be entitled to Obtaining a form Ring the Benefit Enquiry Line on and request one. You ll be asked your name and address, also your age to confirm the right form goes to you. These forms can take up to 14 days to arrive, and will be stamped with two dates. The first date will be the date you rang and requested the form, and the 2 nd will be the date by which the claim form should arrive back at the regional Disability Benefits Centre. Provided the forms are returned within the time limit, if the benefit is awarded, it will be backdated to the date you made the phone call. This usually results in a sizeable first payment to cover the intervening period for successful applicants. Whilst you are waiting for the form to arrive, you may wish to start a daily 24 hour diary, detailing all the things you cannot do. A diary may prove invaluable if you need to attend a Tribunal as it will be evidence of what problems you had at the time you made your claim. To claim Disability Living Allowance online, please visit follow the on-screen instructions. Completing the claim form These are the main sections to the claim form: About you - your name, address, post office or bank details, doctor s name, your illnesses or disabilities and what medication you use. About your condition and any treatments you take. Getting around. Your care needs during the day and night. Time spent in hospital. At the end of this form it asks for a statement from someone who knows you. This can be a partner or friend but many people prefer to use their GP s name here. It is important that this person knows of your mobility and care requirements; if you have written a diary, give them a copy of it. Once the form has been signed, ideally post it yourself, in the pre-paid envelope, do not rely on the GP s surgery to do this. Send any supporting evidence with your claim, such as a diary, letters from specialists / consultants. The important thing is to make the form fit your condition, rather than trying to make your condition fit the form!

16 Migraine and the benefits you may be entitled to You need to answer all the applicable questions as if you were in the midst of a really agonising migraine attack. You may wish to use a step-by-step process to answer each question and draft each answer on note paper first: Step 1 - what causes the problems with the activity? Step 2 - what are the problems in detail? Step 3 - give an example. Step 4 - highlight how someone could help. Make a list of the tasks that you cannot do when you are having a migraine attack, starting from as soon as you wake up - Could you get out of bed? Could you walk downstairs? Could you dress yourself? Could you clean your teeth? Could you prepare a meal for yourself? Then using the 4 step plan, describe in detail your reasons why you cannot do these everyday things. Example: During a migraine I experience a constant agonising pain, loss of co-ordination, confusion and an inability to concentrate. I also get violent diarrhoea and vomiting without any warning; this happens several times an hour, which leaves me completely exhausted, sometimes just the smell of the food makes me nauseous. Because I find it impossible to concentrate, I can t seem to get all the meal cooked at the right time. Last time I tried to cook a meal, I was so exhausted and confused, I left the meal roasting in the oven, because I was in so much pain I went back to bed and it was only when the smoke alarm went off, that I woke up and remembered that I was cooking a meal. If someone was with me, they could help prepare and oversee the cooking. As you answer each question, don t be afraid of repeating your symptoms and the effects they have; often the same symptoms will affect your ability to conduct several of the activities.

17 Migraine and the benefits you may be entitled to Keeping records Keep a photocopy of everything you send to the DWP, especially your claim form (this may be costly and time consuming), but imagine if your completed form was lost in the post or at the DWP - it does happen! Keep every letter that you receive from the DWP; keep them in date order along with copies of correspondence from you. Keep a record of all phone calls made, and always ask for the name of anyone you speak to. Don t use scrappy bits of paper for these records - make a telephone record sheet. It may look something like this: Date Calls to DWP Calls from DWP Time of call About / Details 04/04/10 Yes I asked if they had received my form. Spoke to Julie Brown in the claims dept. Yes they had got it. 10/04/10 Yes Sarah Lewis, admin dept. Wanted to confirm my GP s telephone number. What happens next After you send your pack in, you should receive an acknowledgement within five working days. Your claim form will be looked at by a decision maker who will make a decision based on your information. They may contact your GP or ask a DWP doctor to visit you if he requires more information. You should receive, in writing, the decision on your claim within 40 working days. If your claim for DLA is turned down, or you do not agree with the level of benefit you have been awarded, you have one month from the date of the decision to ask them to look at your claim again, this is called a revision. When you ask for a revision, your whole claim is reviewed. Be aware that they can take away or reduce the rate you have just been awarded. You may also wish to lodge an appeal, again this must be made within one month of the revised decision.

18 Migraine and light sensitivity in the workplace Migraine and light sensitivity in the workplace Understanding and addressing the link between migraine and light sensitivity For many migraineurs (32-40%) light sensitivity can be a trigger for an attack, or a symptom experienced during one, but either way, migraine and light are very often linked. [ 3. ]. Common sources of bright light that are everyday potential hazards in the workplace include sunlight, fluorescent tubes, halogen spots, computers, TV screens (especially LCD and plasma), as well as reflected glare e.g. from whitewashed walls. The link between light and headache was better understood through the work of Dr Andy Dowson (Headache Service, King s College Hospital, London) and Alan Maine (European Institute of Health and Medical Sciences) who found migraineurs are specifically sensitive to the red and blue parts of the spectrum. [ 4. ]. Further research conducted by the Dyslexia Research Trust found that people who are dyslexic and complain of migraine type headaches reported that blue filters often relieved their symptoms. [ 5. ]. Research continues to look at the issue of light sensitivity and migraine. In early 2010 new research was published by Harvard scientists suggesting that a new visual pathway had been uncovered which underlies a migraineur s sensitivity to light. [ 6. ]. The research found that migraine patients who were totally blind (unable to see images or to sense light) did not experience any worsening of their headaches from light exposure, but in migraineurs who were classified as legally blind but could detect the presence of light, pain intensified when they were exposed to light. As a result, researchers suggest that the mechanism of photophobia must involve the optical nerve, because in totally blind individuals the optic nerve does not carry light signals to the brain. This research provides scientists with a new avenue to explore and Dr Dowson believes the identification of this pathway may lead to new targets for treatment of migraine in the future.

19 Migraine and light sensitivity in the workplace Help is available for light sensitivity and glare MigraLens glasses are available direct from MediView either as non-prescription or prescription lenses, as well as clip-ons for use over existing glasses. They were designed specifically to filter blue and red light. Research was conducted and the study showed significant improvements in key areas: 90% experienced a reduction in headache intensity and 60% a reduction in frequency and duration of headache. Their effectiveness in sunlight and other sources of bright light was rated as very good or excellent by up to 90% of people, with 91% preferring MigraLens over all other tinted glasses previously used. People chose how often and when to wear them; some individuals even benefited from wearing them in the workplace. So, for the first time, there is now a spectacle lens specifically designed for light sensitivity in migraine and daily headache. For more information about MediView, call , info@mediviewspecs.co.uk or visit Alternatively, some migraineurs may need a more personalised approach; is a website that shows all the specialist optometrists that can create personalised coloured lenses to suit your own individual needs.

20 Migraine and light sensitivity in the workplace Flicker and glare Flickering lights can trigger a migraine attack for some individuals. There are ways of reducing the effect through small changes in the work environment. Ensure that lighting is adequate and well positioned. Fluorescent lighting should be properly maintained to minimise flicker. Fluorescent lights should be fitted with the correct type of diffuser to imitate natural daylight as much as possible. Avoid reflected glare from shiny / polished surfaces, plain white walls etc., opt for matt finishes and break up surfaces with pictures, posters or plants. Fit adjustable blinds to windows. Dazzle Some members report that their migraine is almost instantly triggered by bright colours or patterns: stripes or zigzags, chequered designs, especially on floors (black and white tiled floors seem to be the main culprit). VDUs The increasing use of computers at work has been found to cause problems for many migraineurs, for example, time off work or a need to change career. Adjust and maintain computer screens to eliminate flicker or glare (e.g. static rather than pulsating cursors). Consider a computer with a flat screen. Position computer screens to avoid reflection from windows. Get a good adjustable chair and find ergonomic designs for your workstation, paying special attention to seating position and posture. Insist on a VDU that is on a rock steady surface. Set brightness down to the minimum legible level. Take regular breaks from the computer. If using a VDU at work, have a look at the Health and Safety Executive Guidance notes for VDUs and discuss with your boss. For further information on Health and Safety, visit or contact the HSE helpline on Migraines could be triggered by eye strain and many employers offer free eye tests for their staff if working with computers forms a significant part of their job. Speak to your HR department about your workplace policy.

21 Migraine and light sensitivity in the workplace Light bulbs The news that traditional light bulbs are being phased out has generated a great deal of concern amongst light sensitive migraineurs. Migraine Action has been voicing the concerns of migraineurs since the news of an impeding ban of the traditional light bulb and that the use of energy saving light bulbs was to be made compulsory by Our concern was not voiced because we are environmentally unfriendly, but was instead based on evidence from migraineurs that the new bulbs caused them to have migraine attacks. We noted too that no real trials had been done into the health implications of these bulbs. Because of this lack of formal data many government agencies dismissed our concerns describing them as anecdotal! We are working in partnership with lighting manufacturer Megaman UK Ltd and are conducting a low energy light bulb trial. The trial is home based and volunteers will use a range of bulbs over a period of three months. Data will be collected looking at symptoms and attack frequency versus lamp type, output and colour temperature. We hope the results will highlight if there are particular types of low energy bulbs which are more migraine friendly. Migraine Action has also joined forces with Spectrum, an independent UK light lobbying group, whose members face difficulties as a result of the traditional light bulb ban. For further information please visit Why is there a problem? The new energy saving bulbs are in reality Compact Fluorescent Light bulbs (CFLs), a type of fluorescent lamp specially designed to replace an incandescent (traditional) lamp. Fluorescent bulbs have a tendency to flicker because they radiate a different light spectrum. While this flickering may not be noticeable to the naked eye, to some sufferers of migraine it is a well documented problem and can be a trigger for an attack. However, environmentally, CFLs do use less energy which means they have become a popular option for use in carbon reduction initiatives. As an example, in the United States, CFLs have been shown to save 2000 times their own weight in greenhouse gases.

22 Migraine and light sensitivity in the workplace What does the Health Protection Agency (HPA) recommend? The advice from the HPA is not specifically targeted at migraineurs. It broadly states that out of the types of CFL bulb available, the encapsulated variety - which looks more like the traditional light bulb - is preferred over the single envelope variety (the light bulbs which look like prongs or coils). The advice is based on new research by the Agency itself which has shown that some energy saving compact fluorescent lights may emit ultraviolet radiation at levels that, under certain conditions of use, can result in exposures higher than guideline levels. The HPA s view is that single envelope CFLs should not be used where people are in close proximity - closer than 30 cm or 1 ft - to the bare light bulb for over one hour a day. The new advice is that in such situations these CFLs should be replaced by the encapsulated type. Alternatively, the light should be moved so that it is at least 30 cm or 1 ft away. Lighting in the workplace To help minimise workplace light triggers, your employer should install and maintain a good lighting system, especially fluorescent lighting to minimise any flickering. Ensuring that lighting is adequate and imitates natural daylight as closely as possible is a key factor. A migraineur may prefer to have a fluorescent strip switched off and use a lamp with special daylight bulb on their desk. Adjustable blinds should be fitted to windows so that any unwelcome glare can be excluded and VDUs should be positioned to avoid reflection from windows etc. and fitted with anti-glare screens. For further information about employer hints and tips for the workplace, please see the Helping colleagues in the workplace a guide for employers section.

23 Helping colleagues in the workplace a guide for employers Helping colleagues in the workplace a guide for employers This section of the Migraine in the workplace booklet provides you with information, advice and ideas about creating a migraine friendly work environment and is written for your employer. You may want to show this to your line manager or HR department and discuss it with them. It is likely that 10% of colleagues within your workplace are suffering from episodic migraine attacks. Because a migraine attack can last up to three days you may see colleagues well one day, off sick for a few days and then back to work looking seemingly healthy and normal. This is why it can be hard to appreciate how ill your colleagues may have been. Migraine is more than just a headache Most people will suffer from headache at sometime during their lives and this can usually be resolved with simple painkillers, a short rest or something to eat. A migraine can be much more debilitating. It affects the whole body and symptoms can include visual disturbances such as flashing lights, zigzag patterns or blind spots in the vision, an intense throbbing headache, often on one side of the head only, nausea and vomiting and increased sensitivity to light, noise and strong smells. Some people can also experience other neurological symptoms such as difficulty in co-ordination or articulation, tingling, pins and needles or numbness of the limbs on the affected side of the body. A migraine attack can last for anything from four to 72 hours. There is no definitive test for migraine, such as an X-ray or blood test; diagnosis depends on careful history taking, so there is no absolute proof that an individual is a migraineur. During an attack, some people will appear deathly pale or take on an almost grey appearance with dark circles under their eyes. Their concentration may deteriorate, they may have difficulty in focusing, be less able to articulate as clearly and concisely as usual or move more slowly and deliberately in order to overcome co-ordination problems. However, unless you know a person well or observe them closely, these changes may not be immediately noticeable. Obviously, some people are more severely affected than others and many migraineurs are accomplished in managing their condition and disguising it from their employers and colleagues. Migraine has sometimes been described as the hidden disease, as there are often no external signs of the sometimes extreme pain of the sufferer; a broken limb will attract a good deal of attention but may not be as painful as a single migraine attack.

24 Helping colleagues in the workplace a guide for employers How can employers help to create a migraine free environment? Helping to minimise migraine triggers in the workplace doesn t have to come at a great cost to the organisation. Migraine is triggered by a huge variety of factors (not just cheese, chocolate or red wine) and is very individual. For most people there is not just one trigger but a combination of factors which individually can be tolerated, but when they occur together a threshold is passed and a migraine is triggered. Stress, irregular eating and sleeping patterns and dehydration are common triggers. There are many steps that can be taken to help reduce the frequency and / or severity of a colleague s migraine attacks: Many migraineurs are light sensitive so a good lighting system is essential and regular maintenance can ensure flickering is minimised. Flicker and glare play a big part in the workplace but there are a few things that employers can do to help you minimise your attacks. Avoid glare from plain white or very light coloured walls, or highly polished surfaces. Computer screen positioning is important so that reflections from windows are minimised. (See Migraine and light sensitivity section). The work environment needs to be kept at a comfortable temperature suited to the work being carried out and ensure ventilation is adequate. Make available a quiet room, which can be darkened if required, for migraineurs to retire to if an attack strikes. Sometimes medication accompanied by a short rest can enable them to carry on with their work. Flexible working hours can really help to make a difference. Employees can manage their time more effectively and won t have the additional worry of always taking sick leave or being late. Reviewing absence policies allowing short term sick leave without repercussions would help migraineurs to manage their migraine more effectively and may prevent their condition from worsening. It is important to create understanding of the impact of migraine in the workplace for managers and how this can be minimised to ensure workloads are covered.

25 Helping colleagues in the workplace a guide for employers FAQs A colleague claims to suffer regular migraine attacks but she has never spoken of any visual disturbances. Surely this is the most common symptom? It is a common misconception that, if you don t see flashing lights, you can t be suffering from migraine. In fact, only 10-15% of migraineurs experience visual disturbances. This type of migraine is called migraine with aura, formerly known as classic migraine. I met a colleague out shopping this morning and she seemed absolutely fine but when I got to work for the evening shift, the supervisor told me that she wasn t coming in because of a migraine. I think she just felt like an evening at home. It is a feature of migraine that sufferers are quite well between attacks. Migraine attacks can strike at any time, often without any warning. Attacks can develop very quickly in some people. Non-sufferers find it difficult to understand how someone can be perfectly well one minute but almost totally debilitated a couple of hours later. Some migraineurs experience a feeling of exceptional well being shortly before an attack strikes and, during this period, they may be especially bright and chatty, making it even more difficult to believe that they can be so ill a short time later. I regularly experience migraine attacks but I don t make a fuss. The attacks only last for about half a day and then I feel fine. However, one of my employees often takes two or three days off at a time because of migraine. I think he is taking advantage of me. Migraine is a complex and individual condition. It can affect people in different ways and at different levels of severity. An attack can last for anything from four hours to three days and sufferers often feel under par for another couple of days afterwards.

26 Helping colleagues in the workplace a guide for employers I understand that migraine attacks are triggered by chocolate, cheese and red wine. If you are affected, surely it s simple enough to cut these out of your diet? Migraine triggers are numerous and varied and occur in combinations almost peculiar to each individual. They include stress, over tiredness, emotional traumas, insufficient food or long gaps between food, changing sleep patterns (e.g. shift work) and environmental factors such as poor lighting, a hot, stuffy or smoky atmosphere, loud noises or strong smells. Food may not be implicated at all. It can be helpful to keep a migraine diary to try to identify trigger factors. For most people, an attack is not triggered by one thing but by a combination or accumulation of factors which, individually, can be tolerated but, when they all occur together, a threshold is passed, triggering an attack. It can work like a kind of points system: if, for example, your migraine threshold is 10, eating chocolate may be two points, a stressful day four points, missing lunch three points and you will still feel fine; but if you then have a glass of wine (possibly two points) or a late night (three more points perhaps?), an attack may be triggered. It is easy to cite the wine as the trigger factor when, in fact, this could quite probably have been drunk without any ill effects, if the other trigger factors were not also present. Migraineurs are neurotic perfectionists who bring their attacks on themselves. It is believed that everyone has the potential to experience a migraine attack. We all have a personal threshold beyond which an attack will occur. For the 10% of the population who regularly suffer migraine, this threshold is lower, possibly because of a genetic predisposition. The threshold can also be lowered at certain times of your life, such as times of additional pressure (e.g. coming up to an important deadline), during emotional traumas (e.g. bereavement, divorce etc) or when the immune system is lowered by other illness. Migraine can affect people from all age groups, all social classes and all ethnic origins and research has shown that there is no such thing as a migraine personality. However, migraine is most prevalent in the age group.

27 Helping colleagues in the workplace a guide for employers Only women suffer from migraine. Although over twice as many women as men suffer from migraine, possibly because of the involvement of hormonal factors, around 8% of the male population experience migraine. Their attacks can be exacerbated by pressures of being the principal breadwinner for the family (especially if loss of earnings is a result of taking time off) and a tendency to hide their condition for fear of being branded a wimp or a malingerer, particularly by male colleagues. I employ mostly women. Hormonal factors seem to be implicated for the half dozen or so who regularly take time off for migraine. Most of us feel a bit under par around the time of our period but this is part of being a woman and I dislike the precedent of allowing some members of staff to take time off because of this. Hormonal factors can be a major migraine trigger factor for many women. They can be particularly susceptible to attacks premenstrually and during the first few days of their period. Using the threshold theory again (see previous page), the chances of attacks may be reduced, if other known triggers are eliminated around this time. Migraines can be particularly bad during the first three months of pregnancy (when it is not advisable to take your normal medication) or during the menopause. At the first sign of a migraine attack, I take my medication and am able to continue to work as normal. Why doesn t everyone else do the same? There is a wide variety of treatments for migraine now available both over the counter from the chemist and on prescription. However, the fact that there are so many indicates that there is no definitive treatment. Migraine is a complex condition and a treatment which works well for one individual may be of no benefit or have unacceptable side effects for another. It can take a good deal of time and trial and error to find a treatment or combination of treatments which work for you as an individual. Encourage your colleagues to persevere and to keep going back to their doctor, if necessary, until they develop a management plan which works for them.

28 Helping colleagues in the workplace a guide for employers I take daily medication prescribed by my doctor and now rarely have a migraine and, when I do, a couple of painkillers soon gets rid of it. However, my secretary won t consider trying it as she says she doesn t want to take drugs every day. Isn t she being unfair to me and the company? Everyone s migraine is different and we all have to cope with it in our own way. Forcing someone to try a treatment that they are not happy with can be counter productive as the tension and anxiety that this causes may exacerbate their condition. There may also be other reasons for not taking the same medication as you which she does not wish to discuss with you (e.g. she is taking other medication, her doctors don t think it is suitable for her, she has tried other preventative treatments before without benefit, a poor relationship with her GP, pressures from a partner etc). Migraineurs often feel very guilty about letting people down when an attack strikes and will try to avoid the pain and suffering if at all possible. I consulted an osteopath and, after being treated, I have never had another migraine. I have told my colleagues but they refuse to try it and I still have to cover for them when they have time off because of a migraine attack. Complementary therapies are still not widely accepted by many people and are often treated with some scepticism. Although complementary therapies, such as osteopathy, chiropractic, acupuncture, herbal remedies etc., have helped many migraineurs, they are not a guaranteed cure. Benefits will vary widely amongst individuals. Most of these types of treatment are not available on the NHS or on some types of private health insurance. Your colleagues may not be able to afford them or may be unwilling to risk money on something that may not help.

29 Helping colleagues in the workplace a guide for employers I avoid employing migraineurs as they are unreliable and can disrupt production. You are effectively denying yourself access to around 10% of the workforce, probably some of the people who are just what your business needs, maybe people who have only one migraine attack a year. By discriminating in this way, you could encourage an environment of fear and deceit, if employees fail to tell you about their migraine or develop it at a later date. You may also be contravening The Equality Act Migraineurs are usually conscientious and anxious to keep their work up to date. Many are able to work through an attack with the aid of medication. Research has shown that migraineurs tend to overestimate the amount of time they take off work and, therefore, try to avoid taking time off for other reasons. In a study of 2081 working migraineurs, 78% had attacks at least once a month but 34% had taken no time off work at all and over half had been absent for two days or less over the previous year. One member of our team regularly takes time off because of migraine. We don t doubt that he is unwell but, because we all know what problems any unplanned absence causes, the rest of us struggle in, however ill we feel. He is always apologetic about letting us down but, if he was sincere, wouldn t he try to do it less often? For some migraineurs, struggling on at work is not a realistic possibility: they are so debilitated that they are unable to function effectively. In such cases, it can be much better to take time off than to make errors or disrupt the work of other members of your team who may have to look after you. For some people, a day or half day off will enable them to recover, whereas struggling on may leave them working under par for up to a week.

30 Helping colleagues in the workplace a guide for employers Our company has to meet tight deadlines and, often, when one is approaching, we need to work overtime. One excellent member of our team always refuses to do this without prior notice because of his migraine. He also always insists on taking regular breaks, when the rest of us would prefer to work through and get home earlier. Migraine attacks can be very painful and debilitating and your colleague obviously wishes to avoid them, if at all possible. He has recognised that long gaps between food and over tiredness are trigger factors for him and, therefore, takes steps to avoid them. If you do not accept this and give him support, you may find that he has a migraine attack and you have to manage without him completely. This is a sensible way of working for you all, as it is well recognised that regular breaks and stable blood sugar levels can improve concentration and productivity. My boss has asked me not to wear perfume to work as it triggers his migraine. I consider this unreasonable and an infringement of my personal freedom. Strong smells can trigger migraine in some people. It can take a great deal of courage to ask personal favours such as this and I m sure that you would not wish to unwittingly cause him to be ill. I m sure that you have plenty of opportunity to wear your favourite perfumes outside working hours.

31 Helping colleagues in the workplace a guide for employers Top workplace tips for employers Install and maintain a good lighting system, especially fluorescent lighting to minimise flickering. Ensure that lighting is adequate and imitates natural daylight as closely as possible. A migraineur may prefer to have a fluorescent strip switched off and use a lamp with special daylight bulb on their desk. If the building has natural lighting from windows, fit adjustable blinds so that any unwelcome glare can be excluded. Avoid glare from plain white or very light coloured walls or highly polished surfaces (use matt finishes and break up plain walls with posters, pictures or plants). Position VDUs to avoid reflection from windows etc. and fit anti-glare screens to VDUs. Ensure adequate ventilation and keep the workplace at a comfortable temperature suited to the work being carried out. Install efficient extractors if fumes or strong smells are produced. Supply ear protection, if noise is a problem, and restrict the volume and duration of background music if necessary. Design workstations as ergonomically as possible to avoid unnecessary twisting, stretching or bending. Supply adjustable seating so that working positions can be comfortable. Allow regular breaks during which employees can move away from their work stations, especially if their work is repetitive. Do not ask employees to work through meal breaks (lack of food or long gaps between food can trigger an attack). Do not ask employees to work overtime without prior warning. Allow them to take a break, if they wish, before starting the extra time.

32 Helping colleagues in the workplace a guide for employers Supply readily accessible clean drinking water (dehydration can be a trigger factor and drinking plenty of water at the onset of an attack can sometimes abort it). Make available a quiet room, which can be darkened if required, for migraineurs to retire to if an attack strikes. Sometimes medication accompanied by a short rest can enable them to carry on with their work. Put in place provision for short notice cover for known migraineurs. Educate managers about migraine and how it can affect sufferers. Be understanding. The employee will be much more likely to try to work through attacks if she / he knows that she / he can take a break or go home, if necessary. Suggested work station set-up and requirements to minimise workplace migraine triggers 1. Maximum reach. 2. Comfortable work area. 3. Adequate lighting. (Wherever possible light sources should be at right angles to the screen. Where window coverings are necessary, vertical blinds are more effective than horizontal.) 4. Comfortable heating levels and circulation of air. 5. Distracting noise minimised. 6. Leg room and clearances allow changes in posture and position. 7. Software appropriate to task, adapted to user, provides feedback on system status, no undisclosed monitoring. 8. Screen: stable image, adjustable, readable, free of glare and reflections. 9. Keyboard: undamaged, adjustable, detachable and legible. Seating and posture for typical office tasks. 10. Work surface: allows flexible arrangements, spacious and free from glare. 11. Copy holder adjacent to screen (where necessary). 12. Mouse within easy reach.

33 Helping colleagues in the workplace a guide for employers Suggested seating and posture for typical office tasks helping to reduce muscle tension which can trigger migraines 1. Adjustment for seat back. 2. Good lumbar support. 3. Adjustment for seat height. 4. No excess pressure on underside of thighs and backs of knees. 5. Foot support if needed. 6. Space for postural change. No obstacles under desk. 7. Forearms approximately horizontal. 8. Minimal extension, flexion or deviation of the wrists. 9. Screen height and angle should allow comfortable head position. 10. Space in front of keyboard to support hands / wrists during pauses in keying. How Migraine Action can help your organisation We can set up a health awareness day or training session in conjunction with your HR department if you feel your organisation would benefit from a visit from Migraine Action; please contact the office on or info@migraine.org.uk for further information. Alternatively you can visit our website at and learn more about migraine.