Submitted:
27 November 2024
Posted:
27 November 2024
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Abstract
Migraine affects around one billion individuals worldwide, many in their working life, leading to significant personal and societal burden. As the modern working environments continue to change, as do expectations of new generations of employees. The importance of creating migraine friendly workspaces becomes pressing. The Swiss Headache Society’s migraine friendly workspace (MFWS) proposal aims at reducing direct and indirect costs associated with migraine in the workspace and provides practical recommendations and interventions for designing environments that promote employee well-being and productivity.
Keywords:
corporate health management
; headache
; cost effectiveness
Introduction
Migraine is more than just a severe headache. The disorder typically has a cyclic character with recurrent attacks that last hours to days and culminate in head pain, sensory hypersensitivity, and nausea. Often the attack is preceded and followed by neglected symptoms as tiredness, concentration problems, mood problems and reduction of drive or energy. As a function of frequency, migraine attacks may have a profound impact on the individual’s private and professional life [1,2]. Around 10% of the migraine population are affected by a chronic form, where migraine occurs on 15 or more days per month [3]. The prevalence of migraine in the workforce, and its well-known dependence on endogenous and exogenous triggering factors, has spurred interest in understanding how the work environment can contribute to or alleviate migraine symptoms. Thus impacting both, quality of life of patients, but also productivity of the companies.
Migraine often leads to absenteeism and presenteeism, significantly affecting productivity at work. Employees experiencing migraine may find it challenging to concentrate, to complete tasks efficiently, or even to show up for work consistently. The costs associated with loss of productivity due to migraine underscore the need for employers to address this issue proactively [4]. A very recent study showed that migraine diagnosis and severity is associated with an occupational burnout, after controlling for various psychological and work-related factors [5]. The authors conclude that workplace adjustments would support and improve migraine patients’ participation in the work market.
Almost 90% of productivity loss associated with migraine is attributed to presenteeism [6]. During the attack, individuals may be less than half as effective due to factors such as migraine symptoms, emotional impact, unpredictability, and the associated stigma [7]. The repercussions of migraine-related productivity loss extend beyond the immediate workplace, impacting career choices, job status and security, financial well-being, work relationships, mood, and confidence [8,9]. Notably, migraines are estimated to contribute to around 15% of total presenteeism in the US workforce. Strategies to support individuals with migraine in the workplace and enhance their productivity are therefore clearly needed and should be implemented in the workspace.
Two recent studies showed that running workspace migraine education and management program may reduce absenteeism and presenteeism and thereby improve direct and indirect cost for a company [10,11]. In the study of Schaetz et al. the return on investment was calculated to be 490%.
Implementing workspace migraine care programs, integrating education and management initiatives, fostering a migraine-friendly work environment, optimizing migraine treatment, and advocating the needs of individuals dealing with migraine will therefore have not only an effect on the individual’s quality of life, but also direct economic impact. Here, we present a proposal for a framework to address the importance of a migraine-friendly workspace with a strategy for potential and effective implementation in Switzerland.
How to Promote a “Migraine-Friendly Workspace”?
Studies conducted in large companies indicate that raising team awareness about migraine fosters better understanding among colleagues, resulting in improved workplace climate, reduced migraine-related absenteeism, and increased productivity [12]. By supporting such an initiative, employers demonstrate that they prioritize their employees’ well-being, embrace modern, solution-oriented approaches, and commit to the health of their teams. Several forward-thinking companies have successfully implemented migraine-friendly initiatives. Case studies and success stories highlight the positive impact of prioritizing employee well-being on both individual health and organizational performance. Workplace social support may reduce the impact of migraine [13].
The goal of MFWS is to encourage employees and employers to create a workspace environment that accommodates employees with migraine through simple but effective measures. Although general recommendations for ideal workspaces are found in labor law, people with migraine have disease-specific requirements.
Based on literature research, interviews with patients, and clinical experience, we propose a few key points which we consider being of high impact for the well-being and functioning of employees suffering from migraine. We found that similar existing initiatives span a range from merely providing information (e.g., European Headache & Migraine Alliance, EHMA 1 star) to more or less precisely tailored individual intervention.
In a compromise between putative efficacy and generalization and feasibility we developed a concept with three separable but synergistically interacting lines of action, the “Triple E” framework with the pillars of Empowerment, Environment, and Engagement (Figure 1). Different from the advanced levels in the EMHA framework with up to 14 possible initiatives categorized into 6 topics, we chose to condense the approach into three lines that are defined by the targets, the employee for empowerment, the material workspace for environment, and the employer for engagement.
The reasoning behind this choice was that for the initiative to be successful it should be easily communicable but also involve identifiable responsibility for each line of action. Another reason for a simple but comprehensive framework is generalization across a wide range of workspaces differing in types of activity, material environment, working conditons and requirements and governance structure. The current stage of this initiative involves the analysis of experiences collected in the context of a pilot project and the attempt to define meaningful, tractable and affordable quantitative outcome measures of the intervention. See Table 1 for further details.
Discussion
Migraine is frequent and accounts for a significant disease burden that can exacerbate other health problems. In addition to mental health comorbidities, migraine can increase cardiovascular risk through mechanisms as heightened stress responses or disadvantageous lifestyle [14]. Migraine prevention is hence a form of long-term global and brain health preservation. Indeed, the “Migraine-Friendly Workspace” initiative launched by the Swiss Headache Society (Schweizerische Kopfwehgesellschaft, SKG), is aligned with the “Swiss Brain Health Plan,” which was again initiated by the Swiss Federation of Clinical Neurosocieties (SFCNS). This preventive brain health approach reflects similar initiatives in Europe and beyond [8] following an initiative of the European Academy of Neurology (EAN) and the World Health Organization (WHO).
Across the life span, migraine hits hardest during the decades of professional activity and therefore the majority of the related economic burden is generated by indirect costs. The situation for migraine is hence very different from most other highly prevalent diseases with incidence occurring at a higher or even very advanced age and therefore usually after retirement. This difference becomes glaringly relevant when comparing cost efficiency analyses for modern preventive migraine treatments that either consider only costs generated within the healthcare system or in a more adequate and responsible way weigh in the entire societal cost [15].
Beyond medication and especially new but also expensive preventive drugs, an obvious leverage can be obtained from considering the exquisite sensitivity of migraine to environmental and lifestyle factors. It is therefore imperative to educate individuals with migraine but also their employers early on about this condition.
The Swiss MFWS initiative presented here provides a tangible and significant step towards better controlling but also destigmatizing this prevalent neurological condition, contributing to improved brain health and quality of life. One could even speculate if there are good reasons to have more employees with migraine in your company. Some authors speculate about advantages of migraine [16]. And there is further evidence, that some professions are even associated with higher prevalence of migraine [17].
Conclusion
Creating a migraine-friendly workspace is not only a matter of compassion but also a strategic business decision. The direct and indirect costs associated with migraine in the workspace underscore the importance of investing in environments that support employee’s health and productivity. By implementing practical, simple but effective changes provided by the e3-program, organizations can create inclusive workspaces that benefit both employers and employees.
References
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Figure 1.
Table 1.
The e3-checklist for the migraine friendly workspace framework.
| Empowerment | Education | - provide information material about: migraine, patient activities |
| - offer at least once per year expert lectures to interested employees | ||
| Emergency treatments | - provide access to analgesics, antiemetics and cool packs | |
| - keep fresh water, healthy snacks available | ||
| - offer standardized guidance for acute headache treatment / emergency contacts | ||
| Prevention | - inform about preventive activities | |
| - facilitate participation in sport programmes (running, sports clubs, relaxation...) | ||
| Environment | Room to retreat | - provide a dark, quiet room allowing to lay down |
| Advice and support in trigger management | - identify individual triggers and support adjustment of workspace | |
| - e.g., reduce odors, direct light, noise, provide anti-glare filters on computer screens | ||
| Create a climate of understanding | - teach the team what migraine is and what that means for affected employees | |
| Engagement | Show one’s colours: oppose stigmatisation | - encourage employees to talk openly about their migraine |
| - show that you oppose stigmatisation or trivialization | ||
| - show your migraine-friendly attitude to the outside | ||
| Flexibility | - allow home office, flexible working hours if possible (sick leave) | |
| - allow delays in submitting medical certificates | ||
| - avoid shift work for employees with migraine | ||
| Social and legal support | - provide job rotation opportunitie |
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