How can I manage my migraines in the workplace?

I would like to request your opinion on managing migraine in the workplace. I would like to know if there are migraine medications that provide quick relief, and enable a migraineur to resume functioning? Secondly, are there simple measures that can help minimize episodes at work?

Managing migraine in the workplace can be quite a challenge. My patients report that stress at work frequently precipitates or aggravates their migraine headaches. Another common aggravating factor at work is fluorescent lighting. I have also had patients tell me that staring at a computer screen aggravates their headaches. One simple solution for the computer issue is to obtain a tinted plastic sheet that can be affixed over the video monitor to reduce glare and flicker and this may reduce migraine aggravation.

Also take a few minutes every half-hour to turn your focus away from the computer and gaze out the window at a distant point to relax your eyes. Not only can this reduce migraine aggravation but also eye strain. If fluorescent lights can be turned out and regular light bulbs (incandescent light) or natural light from outside can be utilized, migraine attacks may be reduced. The million-dollar question is how to reduce stress at work. I have had patients who have actually switched jobs because of stress, and in their new lower-stress job (usually one that they like more), their migraines are less frequent.

Another observation is that certain occupations may expose you to strong odors that could precipitate or aggravate a migraine such as working in a photo shop, a factory with exposure to solvents, or even a gas station. If possible, I suggest avoiding these occupations if you are a migraneur.

There are many medications that can be used to provide relatively quick relief and enable a migraineur to resume functioning. Over-the-counter analgesics, nonsteroidal anti-inflammatories (NSAIDs), “triptans,” ergotamines, and mild narcotics all provide varying degrees of relief in individual patients. Each medication has its benefits and drawbacks. In the workplace, I try to avoid medications that can cause sedation or cognitive dysfunction.

The newest kids on the block are the class of medications called triptans (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan). Triptans cause vasoconstriction (constriction of arteries that are dilated during a migraine) to resolve the migraine headache. Ergotamines work in a similar fashion; however ergotamines frequently cause nausea and vomiting which makes them less well tolerated compared to the triptans. Triptans are the most selective migraine-specific acute treatment currently used for migraine attacks because of the infrequent side effects, overall effectiveness, and various routes of administration (pills, orally disintegrating tablets, nasal spray, and subcutaneous injections).

I would suggest meeting with your physician to discuss the various medication options. By reviewing your medical history and current medication list, your physician can choose the most effective medication with the lowest likelihood of side effects.