Migraine is a disability and you have the right to reasonable accommodations, but the situation is often more complicated. Sometimes, the nature of your job may not be compatible with migraine accommodations. Sometimes, the stress comes from your boss and there is no room for discussion. Below, we will discuss tips to deal with migraine at work.

Although the migraine attacks come and go, migraine is a chronic disease. Although you may not always have a migraine attack, you always have the disease. Hence, it is best to practice the migraine prevention tips daily, even on non-symptomatic days.

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• Posture is so important. We must be mindful to keep our head, neck, and back straight to make sure the weight of our head is evenly distributed on our vertebrae. Moving our head forward or to the side unevenly distributes the weight of our head on our vertebrae, making all the vertebrae carry proportionally more weight, which leads to neck muscle tension and may aggravate or lead to headaches. If you work at a desk, it is important to sit with a straight back, hips and knees at 90 degree angles, with the center of the computer screen within 20 degrees of eye level. Please use headsets and do not hold a phone between your head and your shoulder. 
• Daily neck care is crucial. Realistically, some jobs make it very difficult and sometimes even impossible to keep a healthy posture - such as janitors, painters, construction workers, plumbers etc. In that case, it is important to take small but frequent breaks to change position and stretch. Even a few minutes regularly will help. A few minutes of daily neck stretching in a hot shower could also help. Please discuss appropriate neck stretching exercises with your headache provider before starting. Start slow and laying down; neck stretching exercises may initially make you feel dizzy. 
• Keeping a schedule is important. The migraine brain does not like changes. As much as possible, try to keep a regular schedule in terms of work, breaks, meals, exercise, and sleep. If possible, scheduling different work tasks around migraine attacks is helpful to work on the most physically and cognitively challenging tasks when you feel at your best and save the “easiest” tasks for when an attack is coming. If possible, try to not push too hard on your “good days” - it is a marathon.
• Stay hydrated. Eating foods with high water content like cucumber and watermelon may help, especially if water access is limited at work. Although it is important to stay hydrated, please don’t stress about exactly counting how many cups you are drinking in one day. A good rule of thumb is to drink enough to go to the restroom every few hours. If you feel better counting, there are some motivational water bottles with times and measurements. 
• Stress management won’t cure migraine, but it can help a lot. Stress can definitely make migraine worse. Unfortunately, not much can be done about stressful external events at work. The good news is that we can work on our individual response to stress. Stress management techniques are most beneficial when practiced daily (or at least very regularly) even if for a short period of time. There are so many stress management options out there, it is helpful to try them out and find out what works for you. whether it's yoga, mindfulness, walking your dog, hiking, drawing, brushing your teeth, stretching, cardiac coherent breathing, self-hypnosis, guided imagery, or meditation. If you find yourself in a stressful situation at work, try to take a short break outside or in a quiet room or restroom, take a deep breath, and try to bring back the peaceful energy you have been working on with your stress management activities. 
• Ask for accommodations. Schedule a meeting with your boss to explain the issue and genuinely open the discussion. Stay calm and try not to get emotional. There is so much stigma against migraine and headache disease. Most people don’t understand migraine, the pain, the severity and wide range of migraine symptoms, the feeling off, the dizziness, the vision changes, the inability to think “right.” Explain how migraine affects your work functions and what accommodations are needed to help you be even more productive. Example of reasonable accommodations for migraine include light adjustment, scent-free environment, noise reduction, ergonomic workspace, regular breaks, and flexible time. There are currently advocacy efforts to support remote work from home on a flexible schedule as a reasonable accommodation. It is to your boss’ advantage to improve your efficiency at work. Unfortunately, sometimes stress comes from your boss or the nature of your work not being compatible with the severity of your disease. When looking for a job, it is important to consider that some companies value employee wellness more than others. 

Several programs exist to raise awareness, educate, and support people with migraine in the workplace: the Migraine Fitness Program from the International Headache Society Global Patient Advocacy Coalition, WorkMigraine from the National Headache Foundation, Migraine at Work from the World Health Education Foundation, and the Migraine at Work Program from the European Migraine & Headache Alliance. These programs can be a resource for you and your employer. Some of these programs recently started to offer a migraine-friendly certification stamp for the companies that participate in their program and sustainably support people with migraine in the workplace. Hopefully, a few years from now, you will be able check whether a workplace is “migraine-friendly” before applying for a job. 

At Neura Health we offer virtual visits with certified neurologists and care coaches who can help you navigate through the challenges of living with a chronic illness like migraine, and help you manage your relationships at a workplace.