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.
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.
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.
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.
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.
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?