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Migraines are recurring primary headaches that can cause severe throbbing or pulsing pain, and often come with additional symptoms such as nausea, light and noise sensitivity, weakness, and fatigue. The two most frequently discussed types of migraines in the literature are migraine with aura and migraine without aura. Migraines have no known cause, but are influenced by genetics, stress, diet, environment, medications, and more.
- Migraine with aura — less common; are accompanied by additional neurological symptoms usually related to visual disturbances
- Migraine without aura — the most common; 70-90% of those who experience migraines will not have an aura
The four phases of migraines.
- Prodome. This phase starts up to 24 hours before the migraine. Early signs and symptoms include food cravings, unexplained mood changes, uncontrollable yawning, fluid retention, and increased urination.
- Aura. If auras are present, they might include flashing or bright lights or zig-zag lines. Muscle weakness or a feeling of being touched or grabbed may occur. An aura can happen just before or during a migraine.
- Headache. A migraine usually starts gradually and then becomes more severe. It typically causes throbbing or pulsing pain, often on one side of the head. But sometimes a migraine can occur without a headache. Other migraine symptoms may include
- Increased sensitivity to light, noise, and odors
- Nausea and vomiting
- Worsened pain when moving, coughing, or sneezing
- Postdrome (following the headache). Symptoms may include exhaustion, weakness, and confusion after a migraine. This can last up to a day.
Migraines and the Americans with Disabilities Act
The ADA does not contain a list of medical conditions that constitute disabilities. Instead, the ADA has a general definition of disability that each person must meet. A person has a disability if he/she has a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or is regarded as having an impairment. For more information about how to determine whether a person has a disability under the ADA, see How to Determine Whether a Person Has a Disability under the Americans with Disabilities Act Amendments Act (ADAAA).
Accommodating Employees with Migraines
People with migraines may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people with migraines will need accommodations to perform their jobs and many others may only need a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist.
Questions to Consider:
- What limitations is the employee experiencing?
- How do these limitations affect the employee and the employee’s job performance?
- What specific job tasks are problematic as a result of these limitations?
- What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine possible accommodations?
- Once accommodations are in place, would it be useful to meet with the employee to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?
- Do supervisory personnel and employees need training?
Situations and Solutions:
An employee who works in a cubicle setting was experiencing migraine headaches that were triggered by the noise level; she was located in a high traffic area by the copy machine.
The employer accommodated this employee by moving her to an area with less traffic and providing an environmental sound machine.
An accountant had a migraine headache about twice a week, which prevented him from coming to work.
As an accommodation, the employer allowed this employee to work for home when he had a migraine headache. If his migraine was too severe to work from home, the employee was allowed to use comp time.
A computer programmer experienced migraines that were triggered by the noise level in his cubicle and the overhead fluorescent lighting.
As an accommodation, his employer provided him with a noise canceling headset, disabled the fluorescent light above his cubicle, and provided natural task lighting.
A journalist had difficulty recovering from shingles.
She was experiencing chronic migraines and depression from six weeks of shingles, which manifested around her right eye. Her employer granted her extended leave to work on her recovery.
A police officer experienced migraines that were triggered by fragrances.
The employer allowed the employee to work a modified schedule and assigned them to low volume areas where it would be less likely that the individual would come into contact with people wearing fragrances.
An assembly line worker’s migraines were triggered by various fragrances.
The employees around him often wore overwhelming perfumes that caused him to have a migraine. As an accommodation, the employer asked other employees to voluntarily refrain from wearing fragrances. The employee was also moved to a part of the assembly line where the fragrances were not as strong.
A human resource representative had migraines several times a month, which prevented her from working.
As an accommodation, the employer provided unpaid flexible leave after all of her paid leave was exhausted.