Whether one strikes at home, at school, in the office, or in the car, there is no good time to have a migraine. Having a migraine at home is one of the least inconvenient spots, since all of the comforts, medications, remedies, and other tools to fight migraines are generally located there.

Managing Migraines at Work

When migraine symptoms begin at work, the migraineur has decisions to make. Should she continue working or inform her superiors and go home for the day? Does she have enough sick time saved up to afford to leave, or does she need to use a vacation day? Does her office have a place where she could lie down and rest if necessary?

While pushing through a migraine that appears during the workday may seem unavoidable, sometimes it is simply not possible. The combination of light sensitivity, aura, dizziness, and a throbbing head can easily render the workday a complete loss. In such cases, migraine sufferers have no choice but to go home, thereby presenting a cost to the employer.

Taking Its Toll

With enough episodes of missed time on the job, employers may (either consciously or subconsciously) start leaving a migraineur out of key work decisions. She might be overlooked for promotions or not given opportunities that are presented to other employees. Her own productivity may start to decline, with enough missed days, and she will almost certainly be left out of the loop on important occurrences.

While such discrimination may be illegal, it can still happen, and its effects can be hard to erase. The solution lies mainly in having an understanding employer who can make reasonable accommodations for migraine attacks that occur during the workday.

Unfortunately, there may be a stigma in some offices about people with migraines. Migraine is a hidden disability, and because migraineurs “look fine,” coworkers and supervisors may not provide the support and accommodations necessary during a migraine attack. Migraineurs may be perceived as receiving unfair advantages not provided to other employees and may even be accused of feigning illness or avoiding work responsibilities.

Some migraineurs have been accused of alcohol abuse or drug dependence. Someone with a migraine may walk around, indoors or out, with dark sunglasses to shield them from bright lights. They may be seen or heard vomiting in the restroom, might have slurred speech or walk with a veering motion, or might be forced to leave work early. All of these signs may be misinterpreted as drug or alcohol related by an uneducated coworker.

Being Proactive

Proper and timely education of coworkers and superiors is usually the best defense for those who must work with a migraine. Start by explaining that migraines are a disease, not simply a “really bad headache.” Those with migraines should not try to hide their pain and symptoms, as such efforts will likely only further coworkers' confusion.

Where possible, reduce triggers in the office. Turn off fluorescent lights that cause sensitivity. Reduce eyestrain by getting frequent eye exams, using anti-glare screen coatings, and making sure never to work on a computer in a completely dark room. Ask coworkers to avoid wearing strong perfumes and request to be moved away from smokers — secondhand smoke that lingers on coworkers' clothing and furniture can easily trigger a migraine. Keep abortive medications close at hand, and ensure that adequate drinking water and healthy snacks are available.

Line of Work

If migraines strike fast, hard, and often, career choices may be affected. Some positions require specified working hours every day, and failure to appear (especially on an irregular basis) can be grounds for dismissal. Consider the degree of structure required by a potential place of employment before applying for a job. Employment with flextime and telecommuting may be a good choice for the migraineur who frequently requires an adjusted working schedule.

In some cases, those prone to chronic and severe migraine cannot maintain steady employment. If there appear to be no job prospects due to the amount of time missed for migraine-related illness, filing for SSDI (Social Security Disability Insurance) coverage and SSI (Supplemental Security Income) may be the last recourse.

Remember that employers have a duty to provide reasonable accommodations for disability, but it may or may not be reasonable to provide a work schedule that changes on a weekly basis. Other possibilities include short-term medical leave under the federal Family and Medical Leave Act. Proving that a migraine sufferer is a qualified individual for Americans with Disabilities Act (ADA) coverage can be tricky, so contacting an employment or disabilities attorney may be required.