Imagine your head pounding. And when you try to move, a door slams, or curtains are drawn it gets much worse. Ideally, you would like to crawl under your blanket in a dark and quiet room.

This is how it may feel for people suffering from migraine or frequent tension headaches. Untreated, a migraine attack may last for 4-72 hours, and tension headaches may potentially last for a week. In Denmark, it is estimated that approximately 770,000 people suffer from migraine or frequent tension headaches.

Now, for the first time, a new study from the University of Copenhagen shows specifically how migraine or frequent tension headaches affect the ability to work.

“It is especially the ability to remember, make quick decisions and do hard physical work that cause difficulties for people with these headache disorders,” says Project Manager and author of the study Kirsten Nabe-Nielsen.

She hopes that the study will help to focus on the consequences which headaches may have for working life.

“Migraine is the leading cause of functional impairment among people under the age of 50. And headaches have negative effects on sick leave and productivity. So, it would benefit workplaces to open their eyes to the untapped potential that you find here,” says Kirsten Nabe-Nielsen, adding:

“Indeed, we cannot afford not to take it seriously.”

If you ask the Danish working population, 24% of women and 10% of men suffer from migraines or frequent tension headaches.

The possibilities of adapting the work during headache attacks depend on the type of work you have, says Kirsten Nabe-Nielsen, stressing:

“So also in this context, there is a significant inequality in health.”

While people with academic jobs will often be able to go home a little earlier, work from home or choose to postpone the tasks that demand the highest concentration, other people, such as cleaning staff or nursing staff in old people’s homes, do not have the same opportunities to adjust the working hours or postpone the tasks to be solved. Instead, they may have to call in sick.

According to Kirsten Nabe-Nielsen, it takes creativity on the part of the manager and the employees to find out which solutions may be helpful:

“It is about having a good overview of the tasks that need to be solved, and then having a talk as to the best way to arrange a work day. For example, there may be tasks that can be performed later in the day, or that can be solved at a leisurely pace or in a quiet space until the pain has gone.”

“I am going to lay down”

Kirsten Nabe-Nielsen believes that headache disorders such as migraine and frequent headaches are an overlooked epidemic.

“We are stuck with the idea of the character Maude from the Danish TV series Matador saying ‘I am going to lay down’ whenever she is a bit stressed,” she says, explaining:

“Most people have experienced headaches. Therefore, it may be difficult to understand how debilitating migraine and frequent headaches may be for a colleague, friend or family member. People still have the notion that it will be sufficient to swallow a pill.”

Kirsten Nabe-Nielsen believes that there is a lack of knowledge in the general population about the importance of headache disorders. The same applies to the fact that taking too many painkillers to soothe the headache may actually lead to more headaches.

“Some studies show that headaches are the second-most common cause of sick leave – surpassed only by infectious diseases. Therefore, headache disorders carry large personal and socio-economic costs,” says Kirsten Nabe-Nielsen.

Associated with depressive symptoms and muscular pain

The researchers have used self-reported information from more than 5,000 active Danes with different educational backgrounds – from people with long academic educations to unskilled workers.

“It is new that we combine information about migraine and frequent headaches with the participants’ use of painkillers and with their description of the ability to cope with seven different, specific requirements at work,” says Kirsten Nabe-Nielsen.

The participants also answered questions about their health, depressive symptoms and pain in muscles and joints.

Here, the researchers found that depressive symptoms and pain in muscles and joints play an important role for the context between headache disorders and the ability to work.

“Our results indicate that the handling of depressive symptoms and pain in the musculoskeletal system may be an important factor in improving the ability to work among people with headache disorders,” says Kirsten Nabe-Nielsen.

Previous studies support the finding that headaches, muscle and joint pain coincide with depressive symptoms. Among other things, you may see mood changes, and neck pain may be a warning sign of a migraine attack, just as frequent headache attacks may affect the mood negatively.

Under- and overmedication

The researchers find the lowest ability to work in the group of headache sufferers who do not use painkillers at all and the group who use painkillers on a daily basis.

“This raises the question whether these two groups are undertreated and overtreated, respectively,” says Kirsten Nabe-Nielsen.

According to Kirsten Nabe-Nielsen, it seems to indicate that the group taking painkillers on a daily basis may not receive a treatment that works as intended – and they might even suffer from medication overuse headaches.

“On the other hand, when you look at the group who does not take medication at all, it seems to indicate that they are undermedicated. And maybe it has to do with the fact that they do not consider their illness to be severe enough to seek medical attention – but that is just our guess,” says Kirsten Nabe-Nielsen.

Facts: What are migraines and frequent headaches?

The two most common forms of headaches are migraine and tension headache.

Migraine is characterised by bouts of moderate or severe pulsating headache accompanied by nausea, vomiting and sensitivity to light and sound. Chronic migraine occurs more than 14 days a month.

Tension headache is characterised by mild to severe pain on both sides of the head. Nausea and vomiting are usually absent. Chronic headache occurs more than 14 days a month.

Facts: Three recommendations

Based on the study, and seen in the light of other research, the researchers are making three recommendations:

• People with headaches should see their doctor for advice and possible medical treatment.
• Managers and employees should discuss the possibilities for adapting work during attacks, in order to reduce absenteeism, such as the opportunity to work in a room with less noise or outdoors, the opportunity to perform less physically demanding tasks or the opportunity to perform tasks that are not emotionally or cognitively demanding.
• We need to think about the handling of other pain disorders (e.g., neck-shoulder pain) and mental health in order to improve the overall health-related quality of life among people with headache disorders.