Mindpath Health’s Taish Malone, Ph.D. helps discuss how to get your boss to take your horrible migraines seriously.
When migraine hits, it can cause hours of distressing symptoms, including severe, throbbing head pain, nausea, vomiting, and sensitivity to light or sound. And migraine doesn’t wait for you to finish work and take refuge in a dark room: It can strike at any time of the day or night, interfering with work, school, and your social life—a fact that more than 37 million people in the United States can attest to, per the American Migraine Foundation.
The worst part is an attack can be so bad it leaves you unable to function until it’s over. Unsurprisingly, that can make it nearly impossible to show up at work, let alone perform at the top of your game, Joey R. Gee, DO, neurologist and medical director at Providence Mission Hospital in Mission Viejo, California, tells SELF. Although recent data is limited, research from the last two decades estimates that the neurological disorder costs employers around $13 billion in lost productivity each year, along with more than 112 million lost days of work.
“Even after the migraine attack is over, many patients are not able to function due to what’s termed a ‘migraine hangover,’ when the brain is still trying to recover from the chemical cascade that triggers the migraines,” Shae Datta, MD, director of cognitive neurology at NYU Langone Hospital, Long Island, tells SELF.
All of this is to say that working with migraine can be extremely challenging, but it’s worth talking with your employer to see if there are some accommodations that can be made. Remember, migraine is a chronic condition, and you deserve to have the best environment possible to help you perform at your best.
First, you’ll need to get comfortable with self-advocacy.
People with lifelong health conditions like migraine tend to encounter a range of issues at work, which vary considerably in relation to how well the condition is managed and the level of sensitivity and accommodation an employer is willing to give, Matt Lundquist, LCSW, MSEd, founder and clinical director of Tribeca Therapy in New York City, tells SELF. (Employers are required to make reasonable accommodations per the Americans with Disabilities Act and will want to do so for a valued employee.)
“Many of the problems are structural, such as workplaces that aren’t built to accommodate certain employee needs, like breaks, flexibility, and training of peers and colleagues,” Lundquist says. He adds that a common emotional issue is an employer or colleagues not believing that someone is really struggling or in need of certain adjustments. This is particularly relevant to people with migraine and other “invisible” conditions, in which there are no physical identifiers to “prove” the existence of symptoms.
The thing is: Many bosses don’t understand but want to, so it’s up to you to educate them on what your experience is and what reasonable accommodations you might need when a migraine hits, Lundquist says. “Self-advocacy is often the best and only path.” Meaning that the only way to get what you need is to speak up and ask for it.
So how do you have a conversation about migraine with your boss?
Knowing that you need to speak up for yourself and doing it in a way that makes you feel empowered are two different things. Here are a few things to keep in mind when the time comes to talk with your manager.
Before you even approach your boss, avoid guilt-tripping yourself.
Many people with chronic conditions like migraine feel like they’re letting people down when they need time off work due to illness, doctor’s appointments, etc. “This is a huge issue and one I wish non-suffering individuals could understand,” Lundquist says.
Remember, everyone needs modifications at work—be it breaks, glasses, a step stool, or vegan options at a staff lunch. “The accommodations that individuals with chronic illness need are more controversial, not because they’re more burdensome, but because they receive less attention,” Lundquist points out.
While feeling guilty is a totally normal, human response to a situation like this, it can lead to thought distortions that can trigger unhealthy emotions and even unhealthy choices, Taish Malone, PhD, a licensed professional counselor with Mindpath Health who specializes in treating people with chronic health conditions, tells SELF.
“Work-life balance has become a popularized but misleading phrase,” she says. “It should be seen as what is equitable and not what is equal when it comes to ‘life,’ and I would argue this is especially the case for those with chronic health conditions.” Equal means everyone is given the same opportunities; equity means recognizing that everyone’s needs are different, and some people may need different things to truly be put on an equal playing field.
Dr. Malone encourages those who are struggling with guilt to reaffirm themselves with reminders that they’re doing their very best—and that no more is possible.
Then, consider your timing.
The best time for this conversation depends on your unique situation, as you may take a job knowing you have migraine or end up getting a diagnosis well into your time at a particular company. In any case, though, chronic illness can be unpredictable, and you may be forced to address the issue sooner rather than later.
Whenever it happens, whether that’s during your orientation or the day after your diagnosis, make sure it is a formal discussion, like during a one-on-one check-in, in which the focus is on your needs. You might want to have an HR rep present too, if you’re going to have the discussion with a new manager or if you feel like you need another person there to back up your company’s policy or benefits.
Present the potential problems and solutions.
Self-advocacy might start with a simple conversation with your boss or manager about your migraine attacks. Have a frank discussion with your direct supervisor about your particular needs and present some potential solutions, Dr. Malone says.
She has counseled some clients to bring their list of duties to their doctor, so they can add notes to the areas for which they may need modifications. “This should then be shared with your supervisor and documented in your HR file,” she says. You can also come prepared with a list of questions for your supervisor, so they can respond to any concerns you might have and ask questions themselves.
“The conversation should discuss all the areas of your condition that either already pose some difficulty or are likely to,” Dr. Malone says. For example, you’ll want to let them know if you tend to have attacks a certain number of times a month, and that they are unpredictable. If you get unlucky and one strikes on a workday, you should communicate that you’ll need to take a certain amount of time (it’s okay to give a range) to fully recover.
Then, suggest solutions, which should emphasize how you can still perform what is needed and meet the expected standards of your role. “Giving your supervisor some alternatives that you’ve already considered is a great way to highlight that you are willing to find solutions that are best for both you and the company,” Dr. Malone says. This may mean asking for a reasonable extension, taking some work home to do when you’re feeling well, or delegating to teammates or direct reports when necessary and/or if appropriate.
“The better prepared you are, the less anxious you’ll be,” she explains. “This translates to less stress, potentially fewer migraine attacks, and hopefully more favorable health overall in the long run.”
Know when it’s simply too much.
If you can’t keep up with your current workload or fulfill your job requirements due to migraine, Lundquist suggests asking for whatever you think would help. “If you have a good relationship with your employer, give them a chance to make things work—for example, can reduced hours or other kinds of flexibility help?”
Above all, your quality of life is crucial. “If your current position impedes your health, identify what transferable skills you have that can help you secure a less straining job” if you have the means of taking this route, Dr. Malone suggests. She points out that the job market has changed drastically over the past 10 years (and even more so due to the pandemic), allowing for many more positions that offer both flexibility and remote options.
“Whether it’s working for yourself using more viable platforms, such as social media, or finding a position that is within the same field yet allows you to stay at home with less physical strain or stress, there are more opportunities developing that could be a great solution,” she says.
While making a job change can feel like a daunting task, it may end up being the best thing you do for yourself if you feel like it’s time to make a change. “Mental and physical health go hand in hand,” Dr. Datta says, “So the best course of action for those who already struggle with their health is to make life choices that support the stability of both.”
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