Migraine in work: a test of the Government’s plans to Keep Britain Working

At some point today around 190,000 people, many of whom are of working age, will experience a migraine attack: struggling with pain, nausea, visual disturbance, dizziness or overwhelming sensitivity to light and sound. Others will be recovering from an attack or worrying about when the next one will come. Too many people will be doing this silently, without support.

Indeed, in The Migraine Trust’s research, 91% of respondents told us that they had worked while experiencing migraine symptoms, with many using annual or unpaid leave to avoid reporting sickness.

Migraine affects one in seven people in the UK. It is a complex neurological condition, not ‘just a headache’, and yet it remains poorly understood in workplaces with damaging consequences for employees, employers and the economy.

Research by The Migraine Trust found that 34% of people with migraine had felt discriminated against at work because of their condition, while 30% had felt harassed or victimised. 43% said their workplace had not believed them when they needed sick leave for an attack. More than half said their employer had not made reasonable adjustments.

This can have a long-term effect on people’s jobs and careers. 29% of respondents had moved from full-time to part-time employment because of migraine, and 33% had left a job altogether. Migraine is estimated to cost the UK economy £9.2 billion each year, with more than 98% of that attributed to lost productivity. We cannot be serious about tackling health-related economic inactivity while treating migraine as a marginal workplace issue.

A timely opportunity for change
The Government’s Keep Britain Working review offers a timely opportunity. Its focus on prevention, early support, disability inclusion and helping people remain in, or return to, work is a chance to tackle these issues. The Migraine Trust has joined more than 150 employers and organisations working with government as ‘Vanguards’ to develop practical, scalable solutions across the healthy working lifecycle.

Migraine will be an important test of this programme. It is common, can fluctuate dramatically in terms of duration and severity of symptoms and is often invisible day-to-day. Support needs to be personalised, but is often simple and low-cost. If a new approach to workplace health works for people with migraine, it is likely to work for millions of people living with other fluctuating and long-term conditions too.

An important test will be whether the approach can reach smaller organisations without HR or occupational health teams. Good practice cannot remain confined to a handful of exemplary employers.

What Government and the NHS must do
We are calling on the Government to ensure that migraine and other fluctuating conditions are considered and reflected in the Healthy Working Lifecycle being developed through the Keep Britain Working review. The resulting standards, guidance and employer tools should explain how to respond to episodic illness, such as acting early and making adjustments before someone reaches crisis point. The programme should involve people with lived experience and track whether those with fluctuating conditions are more able to remain and progress in work – not simply whether sickness absence falls.

There needs to be sustained awareness effort with employers, trade unions, professional bodies and organisations such as British Safety Council, that challenge stigma, reinforce employers’ responsibilities under the Equality Act 2010, and give managers practical tools. Support should include accessible templates and advice, not just another standard that organisations lack the capacity to implement.

The progress made on menopause at work shows what is possible. A subject that was once rarely discussed has increasingly moved into mainstream workplace policy, supported by campaigning, people sharing their experiences, employer leadership and clearer government and regulatory guidance. Many employers now have menopause policies, train managers and offer practical adjustments, while larger organisations are being encouraged, and are expected in future to be required, to publish plans setting out how they support employees experiencing menopause. There is still much further to go, but the shift from silence and stigma towards open discussion, practical support and greater accountability provides a model for migraine. We now need the same concerted effort to ensure migraine is understood and properly supported in every workplace.

Workplace reform must be matched by improved healthcare for people living with migraine. An understanding manager cannot compensate for a person waiting too long for a diagnosis, effective treatment or specialist support. In fact, in our recent research, 69% of respondents reported that trying to find a satisfactory migraine treatment made it harder to work or study.  

Improved education across primary care, both through pharmacy and general practice, would help update healthcare professionals on the latest treatment and care options. Integrated Care Boards should review the migraine pathways and specialist support options in their areas and ensure these meet the needs of their populations.

Finally, government and NHS bodies should measure the problem robustly. Data on migraine-related employment outcomes, access to care and workplace adjustments would reveal inequalities, identify what keeps people in work and make employers and public services accountable for progress.

What can employers do now?
Employers do not need to wait for national reform. They can begin by treating migraine as a serious health, inclusion and workforce issue; training managers and creating a culture in which disclosure leads to a supportive conversation rather than doubt or disadvantage.

Adjustments should be agreed with the individual as migraine affects everyone differently. The most commonly reported workplace triggers in our research were lighting (83%), stress (80%), screens (58%), noise (54%) and long hours (46%). Small adjustments such as softer lighting, screen breaks, a quiet space, flexible hours, home working where possible and time for medical appointments can make the difference between losing an employee and enabling them to thrive. It is essential that absence policies should recognise that migraine is a long-term, fluctuating condition rather than automatically treating repeated attacks as a conduct or capability problem.

Employers should review recruitment too. Our research found that 60% of people without migraine would be concerned about hiring a qualified candidate who disclosed the condition; among C-suite executives, this rose to 83%. That should prompt urgent reflection on how bias may shape appointment and promotion decisions.

The Migraine Trust’s Workplace Pledge, workplace hub and training packages give organisations practical ways to start. But individual goodwill can only go so far. We need nationally implemented policies designed with conditions like migraine in mind. Every worker with migraine should be able to expect informed management, fair policies and timely adjustments, wherever they work.

People with migraine want to work and contribute, as evidenced by the vast majority of respondents in our research saying they had pushed through migraine symptoms at work. The challenge is not a lack of commitment from employees. It is a system that too often asks them to endure, conceal or leave.

Our vision is for all employers to prevent avoidable harm, respond early and retain people’s skills. To achieve this, migraine must be visible in government policy, understood by the NHS and taken seriously by every employer.

Many people with migraine experience not being believed about the severity or impact of the condition. That’s why this Migraine Awareness Week, on 21–27 September, we’re highlighting the difference that being believed, understood and taken seriously can have.

Support Migraine Awareness Week here.

Rob Music is chief executive of The Migraine Trust.