To work, or not to work

Working with migraine is challenging even under the best circumstances. We’ve all heard about the need for fragrance-free workplaces, replacing fluorescent lights with incandescent ones, and offering flexible scheduling, generous paid time off, and FLMA. Yet even with generous accommodations, some of us simply have triggers that are difficult to avoid. When I first applied for disability benefits, I took the time to write out a full list of accommodations I would need in order to be successfully employed. Obviously, no employer was ever going to agree to my requirements.  When my current treatment started working, I thought about returning to full-time work. So I pulled out that old list of accommodations to see if any still applied. Here are just a few that would still cause trouble.

Weather changes

An approaching thunderstorm, a sudden cold snap, or even high winds can be enough to set off an attack. I can minimize the impact by staying indoors during high risk times. If I had to leave the house every day, there is no way I could avoid this trigger. If I were to get another job doing home-based therapy, I would be out in the elements all day long and exposed to any number of triggers in client homes.

Performance expectations

I can’t always predict when a migraine attack will strike, but I can guarantee that I will get at least one every week. When an attack starts, I become a stupid version of myself – prone to mistakes and unable to communicate effectively. Imagine if your therapist was suddenly unable to speak coherently or couldn’t remember your name. Yes, that has actually happened to me! One of the big requirements for my former career was strict documentation with hard and fast deadlines. Writing progress notes during a migraine attack is a sure-fire way to get an insurance denial.

Staff meetings

The room is too cold. The chairs are too hard. Every stinking florescent light in the room just has to be turned on. The co-worker sitting next to me smells like she bathed in perfume. There’s a sign-up sheet for after-hours volunteers. And the whole thing just goes on, and on, and on…

Uniforms & dress codes

It’s bad enough that shoes and undergarments are required (both disappear quickly during a migraine), but they expect me to show up in dress shoes, slacks or skirt, with make-up and a nice hairstyle. Um…how does that go? Ain’t nobody got time for that!


I have a beautiful home office. It gets used for 1-2 hours on a good week. The rest of the time I can be found in various places throughout the house, ice pack strapped to my head, hauling a laptop and migraine toolkit in my pink polka-dotted backpack. The reclining seat of the sectional is usually where you will find me. Sitting upright at a desk all day is NOT going to happen no matter how “ergonomic” it is.

Crisis management

Clients can call or show up in crisis any time, even if it’s your lunch hour or time to go home. Skipping meals, eating on the run, and generally ignoring physical needs is just part of the job. The state board isn’t going to care that I took time out to eat in order to prevent a migraine attack if my client makes a suicide attempt while waiting.

No job in my future

Reality hits hard. Given my specific triggers, there is still no way I could return to a full-time counseling job without risking a worsening of migraine. The relief I feel is largely due to the accommodations I can make for myself at home. Trying to restart my career would be a mistake I can’t afford to make.

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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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