Migraine is a debilitating condition with huge implications for people living with migraine, across all aspects of their life, work and relationships. The next episode of the ground-breaking six-part series Beyond Migraine, brought to you by the Migraine Association of Ireland and Teva Pharmaceuticals Ireland, sheds light on the condition, and its management, in a series of interviews with well-known people who live with migraine and healthcare professionals.

In episode five, the discussion focuses on the management of migraine in the workplace. Esther Tomkins, a clinical nurse specialist at Beaumont Hospital, Dublin is joined by Nicola Halloran, chef, author, blogger and founder of successful food blog, the Wonky Spatula, who lives with migraine.

Migraine symptoms vary, but are typically defined by a light-and/or sound-sensitive headache, focused around the upper part of the face. Because migraines are attributed to a combination of factors, including but not limited to hormonal changes, poor sleep hygiene, dehydration and stress, they are difficult to track. Therefore, people who live with migraine are not always afforded the luxury of preparing for an attack.

“It’s hard to know when they’re going to come on, and how bad they’re going to be,” explains Nicola. “I might start off a day perfectly fine and then suddenly it just takes over. Working from home has been great, because I can just turn the lights off and nobody knows. It does affect your work life and your personal life because you never know when they are going to strike.”

For many people who live with migraine, like Nicola, certain triggers play a bigger role than others. “They’re definitely related to how busy I am – they happen when I’m really stressed. But there’s a sweet spot – I can be simply too stressed to have time to have one, and when I reach mid-level stress, it hits. More recently, they have come out of the blue, like when I’m having a day off. To be honest, that’s the worst time to have them.”

Clinical nurse specialist Esther confirms that migraines commonly occur immediately after a period of high stress or tension. “The “let-down” phase is what we call it. During a stressful time, you become more susceptible to your triggers and to the migraine. So, it is important to keep hydrated, not skip meals etc., as those are recognisable triggers.”

As stress plays a significant role in migraines, learning how to manage an attack at work – where we tend to be at our most stressed – is key for migraine management. The first step is attempting to identify one’s own personal warning signs.

“What we do know [about migraine] is that there is definitely activity in the brain, probably started in the hypothalamus”, according to Esther. “We now understand more about the prodrome and the different phases to the migraine attack.” The prodome, also known as the ‘preheadache’, is the phase that marks the beginning of a migraine attack. “During the prodrome, even if the symptoms are cravings of cheese and chocolate, we know now that is a signal of activity within the hypothalamus, and a warning sign.”

So, at prodrome stage, you might be able to identify if a migraine is soon to occur. But how can you prepare yourself for it while at work? The answer: being clear about your condition with your employer.

A recent survey carried out by Teva Pharmaceuticals Ireland revealed that 24 per cent of people felt they needed to hide their migraine because of a work-related concern, and 41 per cent felt that migraine had really impacted their careers.* The stigma of migraine being defined commonly as ‘just a headache’, means that employees feel they can’t disclose their condition, and suffer in silence.

A means of support is available via your GP in the form of a medical cert. According to Esther, a specialist clinic can offer help too. “We regularly write letters of support for people to present to their employers. I often put these people in contact with the Migraine Association of Ireland for support from the organisation as well. Having that understanding that you will have fluctuations in your productivity because of the migraine condition, is productive in your relationship with your employer and better for your work, too.”

Don’t forget that many people in your workplace may be familiar with the severity of migraine, even your employer. Nicola, a manager of quite a large team, sympathises with her employee who also lives with migraine. “I actually have somebody on the team who also experiences really bad migraine, and they came to me. They said, look, when it happens, I just need to log off and get time away from the screen. I said, you’re in safe hands, not a problem with me.”

For employers, ways of accommodating migraine attacks in their employees need not cost money, or productivity. Understanding goes a long way. For those in-office, provisions such as a designated, well-ventilated ‘dark room’, as well as ice packs and snacks, could cut the persons attack length in half.

If you are someone living with migraine, speak to your GP. For more information about migraines, visit www.migraine.ie. Listen to the Beyond Migraine podcast here or wherever you get your podcasts.

People living with migraine can also check out Life Effects. Life Effects is an initiative shaped by patients, for patients. It explores the latest science and thinking around your condition, it contains tips and patients share stories about the reality of living with chronic conditions. Find out more about migraine on lifeeffects.teva/eu/migraine.

This article is part of a sponsored series linked to each Beyond Migraine podcast episode brought to you by the Migraine Association of Ireland and Teva Pharmaceuticals Ireland.

The Beyond Migraine podcast is supported by funding from Teva Pharmaceuticals Ireland. Speakers have received an honorarium for their contribution to the podcast.

* Beyond Migraine: The Real You Research by Teva Pharmaceuticals. Research conducted by Empathy Research. Prepared October 2020.