How do you work with Migraines? Migraine disease is recognized by the World Health Organization as one of top 20 most disabling conditions worldwide, and this is no surprise to any of us who have tried to function during a severe Migraine attack. It is possible to receive disability status if your Migraines are frequent and severe enough, and I will be writing more about that soon. For most of us, disability will not be the best option - for a number of reasons, we will need to try our best to stay employed.
~This sharepost is legal education, not legal advice. No attorney-client relationship is created.~
There is no perfect answer, but there are several laws that protect you here in the U.S. I've posted several articles lately about your rights: to be free from workplace discrimination for having Migraines and to receive accommodation to make it possible to work with Migraines (under the ADA) Working with Migraines: Rights under the Americans with Disabilities Act, and to receive unpaid time off when you need it due to your Migraines (under the FMLA) When Migraines Make You Miss Work: Intermittent Leave under the Family Medical Leave Act.
Some months ago we had a question asked here on My Migraine Connection where a member's employer was trying to get her to trade off her FMLA leave for accommodations under the ADA. While dealing with these laws may be a Human Resources challenge for employers, they need to understand that the two laws are not mutually exclusive - employees don't have to choose to use one or the other. You can exercise your rights under both.
The member had been using intermittent FMLA leave when needed for a severe Migraine. She experienced a change in her Migraine pattern (as often happens) and the Migraines became more frequent. At around the same time her employer transferred her to a location with more light and noise than where she had previously worked. Her doctor wrote a letter to her employer requesting a transfer back to the original location as an accommodation, informing them that the new location would trigger more Migraines and cause her to miss more work. The employer responded that they would make the accommodation if she gave up her FMLA status.
The fast answer to her question was an unequivocal "No, they are not allowed to do that!" The ADA requires that employers make "reasonable accommodations" to make it possible for their otherwise qualified employees with a known disability to perform their job functions. The employer was well aware of her disability, and already had a letter from her doctor about the effect of the work environment on her Migraines. For a Migraineur, reasonable accommodations under the ADA could include adjustments to the lighting, and sound in the work area, assigning a better shift time, or rearranging work schedules in a way to make it less likely to trigger Migraines, among other things. The employer is not required to agree to a particular accommodation, but must propose an alternative.
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12 Tips for Living Well with Migraines 
I have stated in my own blog that my work place is very accomodating to me and I am very lucky and know it because I've heard these horror stories before. Before my migraines got so severe to be daily, I had open conversations with work about my migraines as a disorder. I also am a valued employee and approached the conversation from a business perspective rather than emotional or something I needed. I talked about how they were most able to get the most value out of me. My doctor wrote a letter as well indicating what hours I could work, etc. My work has allowed me good accomodations - an inside office where I can leave the lights off and I can where my sunglasses if I go elsewhere. And now more recently have allowed me to work from home. I showed them that my productivity increased significantly - with numbers and facts - when I worked from home and then asked to work from home 3 days a week. The president came back with "work from home all the time and just come in for meetings." This is because I was able to show them logically and with facts that I was more of an asset to them if they accomodated my migraine disorder than if they didn't. I didn't approach it from an emotional level describing my pain and how hard it was for me. I am grateful for my employers' handling of my situation and feel for those that don't have that.
That's a great approach, Elizabeth, and a great piece of advice for anyone in a position to follow it. One of the crucial issues will be to decide when to talk about Migraine disease. If you wait until it has already become a severe problem for your job perfomance, it will be hard to keep the emotion out of it and hard to show the kind of positive results from accommodations that you are talking about.
Well, also I'm a CPA so facts and results approach comes more naturally to me. I have to prepare to be non-emotional for the meetings that we still have while my pain is severe. I prepare a schedule and an outline of what we are going to discuss and that helps me follow that rather than my emotions. Plus I see a therapist once a week for dealing with my chronic pain and I discuss with her how I'm going to approach it and we role-play so I'm prepared to keep emotion out of it. The first role play I don't do very well, but practicing helps with a professional. If you don't have that then role play with your friends/family/support group and get their take on how you come across. I just know the boss cares more about his/her bottom line so you have to come at it from their perspective. Sad but true.