Disability Status Improves Migraine Health

A recent study published in Cephalalgia examined the long-term outcomes for patients undergoing medication withdrawal therapy to treat both Chronic Migraine and Chronic Tension-Type Headache.  They found that most patients who initially responded well to treatment, continued to report improvement 9 years later. That’s the good news.

Strange findings

However, they also discovered something unexpected. Patients reported that the greatest improvements occurred after they stopped working. One year after treatment 38% of patients were receiving disability benefits. Nine years later, that number increased to 61%. Strangely, there was no correlation between frequency of attacks and disability status. Those with Episodic Migraine and those with Chronic Migraine we equally likely to improve after receiving disability benefits. The researchers expected improvements in migraine frequency to result in greater workforce participation, but that was not the case.

Personal insight

Like the patients in this study, my migraine health improved after receiving disability benefits. I’ve heard similar stories from others. While not as compelling as clinical trial results, my personal experience may shed light on their findings. Hopefully they will continue to study this phenomenon and discover a true explanation for the odd results. In the meantime, here are some possible explanations.

Trigger Avoidance

For some of us, workplace triggers are so prevalent that no amount of accommodation can protect us. When we are able to stop working, those triggers go away. If there’s a storm coming, I can now choose to stay indoors. Nobody in my house wears perfume or smokes. Incense, potpourri, perfumed candles, or other noxious triggers are non-existent. There are only incandescent light bulbs, loud music is off-limits, and nobody sneaks MSG, nitrates, or artificial sugars into my food.

Routine

People with migraine need routine. The ever-changing fast pace of most work environments is counter-productive to our health. I don’t know about other people, but my last job required me to constantly adjust my schedule, skip meals, delay bathroom breaks, and be able to change priorities “on a dime“. Now that I don’t work, I get to set a routine that is comfortable for me. When sudden changes do occur, it is easier to recover because I actually get to return to normal long enough for my nervous system to calm down. When you have migraine, it takes longer to recover from those changes. Few work environments will ever allow sufficient recovery time.

Focus

Not working frees up our time to focus on our health. Managing migraine becomes a full time job. We are more focused on keeping a headache diary, taking our medicines, and maintaining the necessary lifestyle changes. There are no more deadlines, so we no longer justify ignoring our health in order to get the job done. Sacrificing our needs in order to keep a job is a thing of the past. That freedom allows us to take better care of ourselves.

Access to better health care

I actually have a better health care plan with Medicare than I ever did while working. Doctors also take me more seriously. That “disability” label has worked in my favor by giving me  legitimacy. Before, it was all too easy to get labeled “needy” or “histrionic” rather than get a referral for the right treatments. I would actually get sicker if I went back to work because I would lose access to all the treatments that are helping me function and stay out of the ER.  Plus, there would no longer be time in the day for the coping strategies I use to stay healthy.

Can you think of any other explanations for this unusual finding? In your opinion, why would leaving the workforce due to disability actually improve migraine health?

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.
View References
Boe, M. G., Thortveit, E., Vatne, A., & Mygland, A. (2016, October 05). Chronic headache with medication overuse: Long-term prognosis after withdrawal therapy. Cephalalgia, 1-7. doi:10.1177/0333102416672493

Comments

View Comments (13)
  • INPAIN81
    2 years ago

    Stress is a big trigger. I switched to working from home a year ago, but there is still so much stress. I have researched disability online, but got discouraged. No one believes chronic migraines are delilitating, and now that I work from home it’s harder to document everything.

  • Pam
    2 years ago

    I always say that having a chronic illness is a full time job. I have migraines and Fibromyalgia. I found great relief this year eating gluten free and without chemicals. But it takes so much more time. However having had daily migraines the extra time is worth the lost time from migraines. I went to daily to 6 migraines in a month. My head pain specialist is amazing. Some new medication (Lamitical and Mobic) and life style changes have made me a new women.

  • DonnaFA moderator
    2 years ago

    Hi coreysmompam! Thanks so much for sharing your success with us here. The wisdom of using food as a healing force is not new, Hippocrates said, “Let your food be your medicine and let your medicine be your food.” Our busy lives make it difficult to make the commitment, but even small changes can pay off in big ways. Our family went vegan and I do most everything homemade, and each of us has felt better in general and in relation to specific conditions as well.

    Thanks for being part of the community. We’re glad you’re here! -All Best, Donna (Migraine.com team)

  • youkayn00b
    2 years ago

    I mulled on this overnight, and then I realised something that may have affected the results… I have frequent migraines but I work full-time, so various medicines make that possible. If I stopped taking the meds then I would have eliminated some medication overuse headaches, but what about the rest? They would be untreated, or not as effectively treated, so I would become disabled and unable to work. Medicine patches me up so I can keep a job, and I guess the risk of some medication overuse headaches is just something I have to live with

  • RBarker
    2 years ago

    I agree with Youkayn00b. I feel like I take more meds to help patch me up to go to work. And many abortives aren’t effective for me or I can’t take them at work. Triptains used to work, but not anymore. I unintentionally “overdosed” on Maxalt because I was so frazzled by my migraine that I didn’t know how many I had taken & eventually chose the ER rather than yet another Maxalt. Now I won’t take any Triptains because I’m scared of them. I now have Norco and Fioricet that work about half of the time, but because 50% of my job is driving an ambulance & the other 50% is patient care, I can’t take either while I’m at work. (I know that sounds like an awful career choice, but I’ve only been doing it about 5 months while hoping I could push through if I really enjoyed it. That isn’t working well…

  • Tammy Rome author
    2 years ago

    youkayn00b,

    The study referenced in this article states that the response rate to medication withdrawal is 28%. That still leaves 72% of us for whom such treatment is ineffective. Obviously, research on chronic migraine still has a long way to go. MOH does contribute, but it’s not the answer for everyone.

  • 2 years ago

    I wish there was an easy answer for chronic headaches, Kayn. I don’t know what the percentage was – of patients who responded well to medication withdrawal therapy. I’ve done the therapy and it did not work for me.

  • youkayn00b
    2 years ago

    Hi, thanks for your reply. I am a Canadian living in the UK on a temporary visa, so disability is not an option for me for the foreseeable future, unfortunately. I have to work

  • DonnaFA moderator
    2 years ago

    Hi Youkayn00b, Have you applied for disability and be denied? You may also be interested in reading some of the articles we have on appealing disability.

    I hope something there proves helpful. Thanks for being part of the community -All Best, Donna (Migraine.com team)

  • migrainestl
    2 years ago

    My migraines didn’t necessarily improve after quitting work (it took me 2.5yrs to get approved for disability). However, my ability to manage them improved. If I have a rough night & need to sleep in vs get up to be at work at 8am, I can. If I start to feel ill & need to lie down, get food, go to quiet room, I can. My options are greater now I guess. When I was at work & got a migraine it was a much more stressful experience.

  • Kate
    2 years ago

    My pain levels for my constant headache (NDPH) are always significantly higher at work. I also tend to get migraines on weeknights (after work) way more than any other time. I’m guessing it is some underlying low level stress, even though I wouldn’t by any means call my job stressful. I think the major “stress” for me is knowing that I have to show up and be there and functional the whole day.

    If I didn’t have to work, my medication requirements would be much lower. I’ve always wondered if quitting could actually keep my pain levels low for the long term though, as I haven’t even had more than a few weeks off at a time, and I could see how it may be a short term thing (although from this article maybe not?). Too bad quitting my job isn’t really an option unless I literally just couldn’t do it anymore. I have a long term disability policy through work and of course there is federal disability, but neither is a sure thing to receive, requires an unknown wait time with no income, and if you receive benefits, its a huge income drop. Disability at 30 is just something I don’t want to think about. I’ve definitely tried to plan for it somewhat though, saving as much money as I can as a rainy day fund.

    Every day is a struggle for me to make it through the work day, and unfortunately requires a ton of medications. Currently for preventatives I’m doing Botox and Verapamil. For pain management, I have daily & as needed opioids. Then as needed I have Ketamine capsules (from a compounding pharmacy), Lorzone (a great non sedating muscle relaxer), Diclofenac (NSAID), and Imitrex. I’m really lucky to be getting as good of care as I get and having insurance to cover most everything. It took 10 years to get to this point of feeling stable more days than not though, and I still get days or weeks on end of uncontrolled pain at times. Best wishes.

  • Kate
    2 years ago

    Tammy – Thanks! Yes, I’m familiar with FMLA including that it can be used intermittently, but haven’t needed it yet. I think employers usually want you to be out of sick days first. So, when you have combined sick & vacation days (PTO), I’d guess it would be annoying as with intermittent FMLA you can’t really plan a vacation.

    My pain levels are pretty constant (as I primarily have NDPH, vs. someone who gets more frequent episodic migraines). So far I’ve managed fine with just sick days as needed. I take way more sick days than anyone else at the office, but I haven’t ever run out. I’m more likely to take a sick day for gastro issues than severe pain, but thats probably as I have a good arsenal of as needed pain meds. That and I’ll often get severe pain midway or more through the work day, and just tough it out. Its way more difficult to gather the courage to ask to leave early vs. just sending an e-mail that I’m out sick! Somehow I’ve actually been able to hide this all from work. I imagine they might think I’m a bit of a flake since I take a lot of sick days and often leave early for appointments (then stay later other days to make it up), but I’ve always done well on performance reviews as I put in a good effort when I’m there.

    A few times over the years I’ve ended up taking up to a week off when I was having a procedure or a rough med switch though. Its more that continuing to work is a daily struggle and wears on me. I end up not being able to manage much of anything on nights & weekends. I’ll definitely keep that in mind if I start missing more days of work. At the end of the day I’m thankful to be able to keep working though, as I know a lot of folks just don’t have the option. If I was getting level 10 migraines with vomiting or something there was no way I could manage. best wishes.

  • Tammy Rome author
    2 years ago

    Have you considered (or do you use) FMLA? I wish I had known it could be used intermittently when I was working. That would have helped a great deal. If you haven’t already, maybe that is something worth looking in to.

    https://migraine.com/blog/ada-accommodations-migraine-triggers-making-the-workplace-work-for-you/
    https://migraine.com/migraine-basics/ada-accommodations-the-workplace/
    https://migraine.com/blog/migraines-and-unexcused-absences-from-work/

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