Migraine-Friendly Workspace: A Swiss Brain Health Initiative

Abstract

Migraine affects around one billion individuals worldwide, many in their working life, leading to significant personal and societal burdens. As modern working environments continue to change, so do the expectations of new generations of employees. The importance of creating migraine-friendly workspaces is becoming increasingly pressing. The Swiss Headache Society’s migraine-friendly workspace (MFWS) proposal aims to reduce direct and indirect costs associated with migraines in the workspace and provides practical recommendations and interventions for designing environments that promote employee well-being and productivity.

1. 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 such 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 is affected by a chronic form, where migraine occurs on 15 or more days per month [3]. The prevalence of migraines in the workforce, and their 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. This, in turn, impacts not only on patients’ quality of life but also on company productivity.

Migraine often leads to absenteeism and presentism, 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 are associated with 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 presentism [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, migraine is estimated to contribute around 15% of total presentism 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 a workspace migraine education and management program may reduce absenteeism and presentism and thereby improve direct and indirect costs for a company [10,11]. In the study by Schaetz et al., the return on the 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 (MFWS) with a strategy for potential and effective implementation in Switzerland.

2. 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 that we consider to have high impact on 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 Migraine & Headache Alliance, EMHA 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). For this purpose, the authors discussed available literature and information from similar international initiatives in several meetings, to adapt a comprehensive approach for a contribution to the Swiss Brain Health plan initiative. Different from the advanced levels of the EMHA framework, which include up to 14 possible initiatives categorized into six topics, we chose to condense our approach into three key area, each defined by its target: the employee (empowerment), the material workspace (environment), and the employer (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 conditions 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. The e3-checklist for the migraine-friendly workspace framework.

Empowerment	Education	- provide information materials about migraines and patient activities
		- offer expert lectures at least once per year to interested employees
	Emergency treatments	- provide access to analgesics, antiemetics, and cool packs
		- keep fresh water and healthy snacks available
		- offer standardised guidance for acute headache treatment/emergency contacts
	Prevention	- inform about preventive activities
		- facilitate participation in sports programmes (running, sports clubs, relaxation)
Environment	Room to retreat	- provide a dark, quiet room allowing employees to lie down
	Advice and support in trigger management	- identify individual triggers and support adjustment of workspace
		- e.g., reduce odors, direct light, and 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 trivialisation
		- 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 migraines
	Social and legal support	- provide job rotation opportunities

for further details.

3. 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 such 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 lifespan, migraine hit hardest during the decades of professional activity, making indirect costs the primary contributor to their economic burden. The situation for migraine is hence very different from most other highly prevalent (neurological) diseases, which typically have higher incidence at older or advanced ages, usually after retirement. This difference becomes glaringly relevant when comparing cost-efficiency analyses of modern preventive migraine treatments—some consider only healthcare system costs, while more comprehensive and responsible approaches include the full societal impact [15].

Beyond medication—especially newer, yet expensive, preventive drugs— an obvious advantage can be obtained from considering the exquisite sensitivity of migraines to environmental and lifestyle factors. It is therefore imperative to educate individuals with migraine and their employers early on about this condition.

The Swiss MFWS initiative presented here provides a tangible and significant step towards better controlling and destigmatising 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 the advantages of migraine [16], and there is further evidence that some professions are even associated with a higher prevalence of migraine [17].

4. Conclusions

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, organisations can create inclusive workspaces that benefit both employers and employees.