A migraine is not merely a severe headache, but a complex neurological event involving abnormal brain activity that affects the entire body and cognitive function. This primary neurological disorder is often accompanied by symptoms far beyond head pain, significantly impairing an individual’s ability to function. Deciding whether to attend work during an attack requires a careful assessment of personal health, safety implications, and performance capacity. This framework provides a guide for making that difficult decision based on both health and professional considerations.
Assessing Migraine Severity and Functionality
The decision to work must begin with an honest self-assessment of the attack’s severity. A migraine attack typically progresses through phases, including the prodrome (pre-headache), the main pain phase, and the postdrome (hangover), with cognitive impairment possible throughout the entire process. If the level of pain is so intense that it prevents you from sustaining a conversation or concentrating for more than a few minutes, functionality is already compromised and work should be reconsidered.
A simple self-assessment should focus on three criteria. First, consider the pain level: if it is debilitating, meaning you cannot move without intensifying the pain, staying home is necessary for effective treatment and recovery. Second, evaluate neurological symptoms, such as visual aura, slurred speech, or significant dizziness. These symptoms indicate a widespread disruption of brain function that makes safe and effective work highly improbable. Third, assess cognitive function, which is objectively slower and less accurate during an attack. If you experience confusion, memory loss, or an inability to focus on basic tasks, your capacity to perform is compromised and your brain needs rest.
Safety Risks and Productivity Decline
Attempting to work with significant migraine symptoms introduces considerable risks, not only to your output but potentially to the safety of yourself and others. Cognitive impairment during an attack reduces the ability to remember, make quick decisions, and maintain concentration. This is particularly hazardous in roles involving operating machinery, driving, or making high-stakes decisions in fields like healthcare or finance, where errors can have severe consequences.
The impact on work performance, known as presenteeism, is far more costly than absenteeism. Employees who try to “push through” a migraine often see their productivity drop by 25% or more. This lost effectiveness translates into a higher error rate, poor decision-making, and often requires colleagues to pick up the slack, increasing their workload unnecessarily.
Presenteeism, where an employee is physically present but functionally impaired, contributes significantly to the billions of dollars in economic loss attributed to migraines annually. Staying at work prolongs recovery and ensures poor performance. Realistically, if you are functioning at a quarter of your normal capacity, your time is better spent on restorative rest to facilitate a quicker return to full productivity.
Communicating Needs and Workplace Adjustments
Effective communication with a manager is paramount, whether you decide to stay home or attempt to work with reduced capacity. When notifying your manager of an attack, set expectations for reduced capacity, such as focusing only on low-stakes, non-urgent tasks. Having an open, confidential discussion about your condition allows you to proactively establish a plan for managing acute episodes when they occur.
If you attend work, immediate environmental adjustments can mitigate symptom triggers and improve comfort.
Workplace Adjustments
- Reduce screen brightness or apply a blue-light filter to combat light sensitivity (photophobia).
- Switch from harsh fluorescent overhead lighting to a warm-toned desk lamp.
- Relocate to a quieter area or use noise-canceling headphones for noise sensitivity (phonophobia).
- Take frequent, short breaks to reduce eye strain and stress.
- Ensure access to a designated quiet area if symptoms worsen suddenly.
Understanding company policies on flexible scheduling and remote work options is also helpful. These accommodations allow you to manage the attack while maintaining contribution without compromising your health further.
Long-Term Health Costs of Pushing Through
Consistently ignoring the body’s need for rest during a migraine can have serious long-term health consequences. The concept of “migraine debt” suggests that pushing through an attack without adequate rest increases the sensitivity of the nervous system. This heightened sensitivity makes the brain more vulnerable to future attacks and contributes directly to a cycle of escalating pain and frequency.
Working through an attack often leads to the excessive use of acute pain medications, risking medication overuse headaches, also known as rebound headaches. This creates a cycle where the medication intended to treat the pain actually causes it to return more frequently and severely. This pattern of insufficient rest and medication overuse can contribute to the progression from episodic migraines to chronic migraine status. Rest is a necessary component of migraine treatment, not a luxury, and is essential for preventing the condition from worsening over time.