Migraines Take a Toll In The Workplace
by Lisa Young

Nearly 18 percent of women and 6 percent of men develop migraines each year. The inability to focus in the office can bring on periods of decreased productivity, difficulty concentrating, avoidance of new projects, missed promotions, missed workdays, and even loss of employment. According to Jerry Swanson, M.D., a neurologist at Mayo Clinic, "Being able to quickly and effectively treat a migraine episode isn't always easy when someone is at work. Workplace productivity is ultimately affected when a person has an attack." In The Burden of Migraine in the United States: Disability and Economic Costs, the estimated economic burden for employers and individuals with migraines that require 112 million bedridden days, is $13 billion a year from missed workdays and impaired work function. (Arch Intern Med 1999; 159:813-818.)

Migraine headaches account for about six percent of headaches that have no apparent underlying disease. A migraine usually begins in the early morning or during the day with intense, gripping pain on one or both sides of the head. The migraine reaches the height of severity in minutes to an hour and lasts for hours to days, unless it is treated. The frequency of attacks can range from daily to once in several months. These attacks can be associated with nausea, vomiting, and extreme sensitivity to light and sound, forcing a person to be incapacitated for hours or even days.

About 10 percent of people who suffer from migraine headaches experience a warning symptom called an aura. The aura is a visual disturbance, such as sparkling flashes of light, dazzling zigzag lines, or slowly spreading blind spots. Other auras include dizziness and weakness or tingling on one side of the face, arm, or leg. Many people can have subtle indications of an oncoming migraine that can start several hours or even a day before the headache. These signals include feeling elated, full of energy, thirsty, hungry for sweets, drowsy, irritable, or depressed. If one or both of the sufferer's parents have or had migraines or if the sufferer is young and female, then he/she is more likely to suffer from migraines. In addition, three times more women are diagnosed with migraines then men.

Some researchers think migraines may be caused by changes in the trigemenal nerve system and by imbalances in the brain chemical serotonin. During a headache, serotonin levels drop causing the trigeminal nerve to release substances that cause blood vessels to become dilated and inflamed resulting in severe headache pain. Brain scans have shown that the volume of blood reaching the brain drops during migraine attacks. Some experts speculate that migraines occur when blood drains from the blood vessels in the center of the brain to the outer blood vessels.

Whenever the exact mechanism of migraines, they don't occur without a trigger. Triggers range in nature from physiological to environmental. Common triggers include stress and fatigue; changes in the weather, season, altitude level or time zone; changes in sleep patterns, sensory stimuli such as bright lights, noise, and unusual odors; certain medications; low blood sugar from changes in mealtimes or skipped meals; intense physical exertion; tobacco, including secondhand smoke; certain foods and beverages to include beer and red wine, chocolate, fermented, pickled or marinated foods, monosodium glutamate, aspartame, caffeine, aged cheeses that contain high levels of tyramine (i.e. blue, cheddar, Muenster, Parmesan, and Brie); and fluctuations in estrogen levels.

Migraine pain management has improved dramatically in the last decade. Though there is still no cure for migraines, medications can help reduce the frequency of these headaches and stop the pain once it has started. Abortive drugs stop or decrease pain after a migraine starts. Better results may be obtained if you rest or sleep in a dark room after taking these medications. Over-the-counter and prescription analgesics such as acetaminophen and ibuprofen, aspirin, or other non-steroidal anti-inflammatory drugs may ease mild to moderate migraines. If taken too often or for too long, these drugs can lead to ulcers and gastrointestinal bleeding. If you take over-the-counter or prescription headache medications more than three times a week, you may be setting yourself up for rebound headaches. While these medications give temporary relief, your body gets used to them over time, resulting in harsher or more frequent headaches. Prophylactic drugs help reduce the frequency and severity of migraines and may increase the effectiveness of abortive medicines during migraine attacks. These medications are used only after other measures have been tried or if your headaches are disabling or occur more than three times a month.

Headaches can be both incapacitating and unpredictable, interfering with your job, your relationships and your overall quality of life. Recent advances in research are expanding the medical community's understanding of headaches and are creating more options for effective treatments. Headache management involves understanding the problem, identifying factors that precipitate headaches, and working with your physician on self-care measures, coping strategies, and possibly drugs to help reduce the number and severity of migraines.

More information on headaches and their treatment can be obtained from the National Headache Foundation at http://www.headaches.org/; the American Council for Headache Education at http://www.achenet.org; the Journal of the American Medical Association Migraine Information Center; and the May Foundation for Medical Education and Research.

Headache Management Tips

• Keep a diary to determine what triggers your migraines.
  
• Avoid trigger foods and eat a regular healthy diet.
  
• Try muscle relaxation exercises and techniques such as biofeedback & progressive muscle relaxation.
  
• Exercise regularly for 30 minutes on most days, but be sure to warm up slowly.
  
• Reduce the effects of estrogen by avoiding medications containing estrogen.
  
• Get adequate rest, but do not oversleep.
  
• Rest and relax in a dark quiet room when you feel a headache coming on.
  
• Quit smoking.
  
• See a counselor to learn techniques for managing stress and coping with pain.
  
• Consider nontraditional complementary therapy such as acupuncture, massage, or the herb feverfew.
  

Article first appeared Pages 34-35, July 2001 USACHPPM Today.