One in four Canadian households is affected by migraine, and most employers remain unprepared to help
Migraine affects between 14 and 18 per cent of Canadians, with one in four households having at least one person living with the condition, yet most employers remain unprepared to support affected workers. June is Migraine Awareness Month, and two Canadian experts are calling on health and safety leaders to treat the neurological condition with the seriousness it deserves.
"Migraine is a brain disorder that people don't have a choice in," said Dr. William Kingston, a headache neurologist at Sunnybrook Health Sciences Centre in Toronto, Ontario. "While it's not curable, it's modifiable. We have effective, safe, well-tolerated treatments that can really improve upon migraine, and even some things in the workplace can make a world of difference."
More than a bad headache
The most persistent barrier to workplace accommodation is perception. Migraine is routinely dismissed as a severe headache, but Susan Cape, a registered social worker in Ontario and sessional faculty member at McMaster University's School of Social Work and the Department of Health and Aging in Hamilton, says that framing causes real harm.
"In order to break through that stigma, we really have to emphasize that migraine is not a headache," Cape said. "I really like framing it now as a sensory processing disorder, or at least a neurological disorder, to get people out of that habit of thinking about it that way."
Cape, who lives with chronic vestibular migraine, described what the condition can look like beyond a headache. "Most of my symptoms are sensory processing issues," she said. "It affects my balance, I get vertigo, I get nauseous, I have trouble seeing. I have cognitive issues at the onset of an attack where I can't think straight or speak properly."
Dr. Kingston confirmed the scope. A migraine attack involves a disabling headache combined with neurological symptoms including cognitive slowing, nausea, vomiting and extreme sensitivity to light. The condition affects women at a ratio of three to one and most commonly strikes between the ages of 25 and 50, the peak career years.
"It affects people in the most productive years of their life," Cape said. "How do you do all those things we're expected to do to thrive and build your career if you're managing these symptoms on top of it?"
The scope of the problem
Based on the World Health Organization's Global Burden of Disease study, migraine is the second or third most disabling condition worldwide in terms of years lived with disability. For women under 50, it ranks first.
Cape, who recently completed her PhD studying women's experiences of migraine and migraine care, said the condition is also significantly underdiagnosed. "At least 5 million Canadians suffer from migraines," she said. "That number is likely an underestimate because most people who have migraines may not know they have it." A significant portion of those affected have chronic migraine, defined as 15 or more attacks per month, which can substantially affect job performance, career progression and disability outcomes.
A concept central to occupational health planning is presenteeism, which refers to being physically at work while operating below full capacity. "Does migraine completely inhibit someone from doing tasks like operating heavy equipment? No," Dr. Kingston said. "But it may impair their efficiency, or it may impair their ability to meet their targets."
For employers in mining, forestry, oil and gas and construction, that impairment carries added risk. Cognitive slowing, balance problems and impaired reaction time are among the neurological symptoms that can arise during an attack. Understanding how neurological conditions affect workers in high-risk industries is a growing area of workplace health and safety practice across Canada.
What employers can do
Both experts agreed that meaningful support does not require significant cost.
Dr. Kingston pointed to two straightforward accommodations: occasional flexibility to work from home during an attack, and a 30-minute break to allow medication to take effect. "Understanding is probably the most important factor," he said. "Really minor modifications can go a really long way."
Cape urged employers to start with what they already have. During her time at a health-based nonprofit, a scent-free workplace policy existed but was never enforced, despite her flagging it as a health and safety issue that directly triggered her symptoms. "Employers have a responsibility to look at the policies they already have in their workplaces and ask whether they are actually following them," she said. "That's a good place to start."
Reviewing and consistently enforcing existing health and safety policies is one of the most effective and low-cost steps employers can take when addressing invisible disabilities in the workplace.
She also cautioned against assuming a single approach will work for everyone. Some workers require only a dark room and time for medication to take effect. Others may need hours of rest. Needs vary considerably, she said, and accommodations must be individualised.
On disclosure, Dr. Kingston said the decision rests entirely with the worker. "How much somebody wants to disclose about their diagnosis is a very individual decision," he said. "But knowing that it's a safe space to disclose is important for an employer, and knowing there's an understanding that they'll work with them on it."
Building awareness this June
As part of Migraine Awareness Month, Pfizer Canada and Migraine Canada are launching the third annual Out of Office campaign. The initiative asks Canadians to set a 72-hour out-of-office alert reflecting the maximum duration of a migraine attack, building empathy for what those who live with the condition experience. Migraine Canada also offers patient tools and discussion guides that can help workers navigate migraine care and prepare for healthcare appointments.
"Everyone definitely knows somebody who is heavily affected by migraine," Dr. Kingston said. "Just knowing that it's a safe space to disclose is important, and knowing there's an understanding that the employer will work with them on it."
