One billion people worldwide live with migraine; that’s about one in seven. At those odds, there’s a high probability that each of us works with someone who experiences migraine. And if you’re an employer, this could mean that migraine in the workplace could have a significant impact on your workforce.

Migraine is a debilitating neurological disease that causes intense pain in the head, as well as other sensory and/or motor dysfunction. Migraine attacks usually include symptoms like nausea, vomiting, and sensitivity to light and/or sound. Notably, migraine peaks during prime working years (ages 25 to 55).1 It’s probably not surprising then that people living with migraine report missing an average of more than 4.5 workdays per month2 and say they spend more than 11 days per month “powering through” symptoms.3

“Sometimes you can barely lift your head off a pillow, let alone make decisions during a meeting,” says Dr. Nicole Shaffer, DNP, CRNP-BC, COHN-S, FAAOHN, Senior Director, People Experience, Colleague Wellness at Pfizer. Shaffer herself experiences migraine attacks regularly. “People who don’t experience migraine sometimes don’t understand just how debilitating it can be.”

Despite its impact, migraine is often not discussed—especially in the workplace. One study found that this is largely due to colleagues feeling a sense of invalidation associated with the disease, influencing their decision to stay silent. This study also found that four out of five employees thought migraine attacks were not a valid reason to be absent from work, and almost half of employers agreed.4

“While some people are transparent, there are also people who believe they may be judged,” says Shaffer.

A Personal Journey with Migraine in the Workplace

Known around Pfizer as “Dr. Nikki,” Shaffer has been at Pfizer for over a decade and understands how important migraine-friendly work policies are, both as a doctor and as someone who has migraine. She’s been living with migraine for over a decade, almost the same time that she’s been at Pfizer. Thirteen years ago, she began experiencing severe headaches on the right side of her head and had trouble maintaining her balance. Her doctor diagnosed her with migraine.

"I remember having to learn how to adapt to living with this disease while starting a new position,” Shaffer says. “I remember having to learn how to talk about my migraine experience with others and realizing that describing the pain was much more difficult than I thought it would be. I wanted to make sure people actually understood what I was going through, but finding the right words wasn’t always easy.” Since then, she’s learned how to navigate the many challenges that all people living with migraine face in the workplace.

“My migraine attacks are not as debilitating as others’, but it sometimes takes me a day or two to finish something normally taking a couple of hours,” explains Shaffer. “Knowing how migraine affects me, I’m conscious of how it may affect other team members. So, I’m always saying, ‘Take time for yourself, take care of yourself. Make sure you’re OK.’”

Knowing More About Migraine in the Workplace

There’s still a lot that is not known about what causes migraine and why it can differ, not only among people, but also from attack to attack for each person. What we do know is that migraine disease severity exists on a spectrum. That is to say that some people may experience milder symptoms rarely while others may experience severe disability on a daily basis. This spectrum can even change for each person, allowing them to work through an attack one day and then become completely incapacitated during the next attack.

“That migraine doesn’t look the same for everybody, I think that’s huge. Just because I can sometimes work through an attack doesn’t mean I can next time, or that someone else can,” Shaffer says.

That’s why educating colleagues about the severity and variability of migraine is critical for cultivating a culture of understanding and inclusivity, according to Shaffer. She believes it empowers people to authentically share and manage their conditions in personal and professional environments. These open conversations can help to break down the stigma associated with migraine and create a more inclusive workplace.

Creating a Migraine-Supportive Workplace

Advocacy leaders in the migraine space suggest several things companies can do to help foster inclusive and supportive environments for those living with migraine. In August 2023, Pfizer received designation from European Migraine & Headache Alliance as a migraine-friendly workplace. Here are some of the policies and programs Pfizer has adopted to help support employees with migraine:

  • Flexibility: Migraine is very unpredictable and can strike unexpectedly, so offering flexible work schedules and remote options can help employees retain their productivity while prioritizing their health.
  • On-site Accommodations: For employees who work on-site, adjustments can be offered to help mitigate a migraine attack or recover from one. For some, intense sensory or environmental stimuli can trigger a migraine attack or make it worse—so offering anti-glare screens, adjusting office lighting, providing quiet spaces to work, and minimizing use of air fresheners or other strong scents can help. Providing employees with a private, quiet place to retreat to during a migraine attack can help them rest and recover. Ensuring easy access to water, healthy snacks, and cooling packs can also be beneficial.
  • Disability Benefits: Informing employees about Social Security Disability Insurance (SSDI) eligibility and helping them gather required medical documents can help ensure their migraine diagnosis is registered within the company’s systems.
  • Educational Programming: Many people who don’t live with migraine themselves may not understand how debilitating it can be. Raising awareness of the burden of migraine among employees can help foster a culture of understanding, empathy, and support for coworkers with the disease, and reduce the stigma associated with it.

What’s Next?

So, what can you do if you’re not an employer, but have a colleague who experiences migraine? Shaffer offers a suggestion rooted in basic kindness. “Give them grace and space to ensure they can look after themselves when needed,” she says. “We aren’t machines, and we can’t treat each other like we are if we are going to succeed. A little compassion and understanding in our day-to-day goes a long way.”