How to manage migraine at work

Working with a migraine can feel like trying to do your job in a dim room. Your words get scrambled, lights seem too bright, and nausea can be a constant companion. You may start the day with good plans. You want to be useful. You want to finish your work. You want to show that you can be trusted. Then the warning signs begin.

The screen feels too bright. Noise becomes harder to tolerate. Your thinking slows down and your concentration slips. You may feel dizzy, tired, nauseous, tearful, or irritable. Some people experience pressure behind one eye, while others notice brain fog, visual changes, or increasing sensitivity to light and sound.

Tasks that would normally feel straightforward can suddenly require far more effort than usual.

Why migraine at work can feel so difficult

That was one of Ms TMA’s fears.

*Ms TMA is an anonymised name used to protect confidentiality.

She had started a new role after time away from work due to migraine attacks. In her old workplace, she had kept her migraine quiet. The culture had taught her not to speak when she was in pain. One day, she heard her manager and colleagues mock another worker for going home with a headache. Ms TMA felt bad for that person, yet she said nothing. She was afraid the same judgement would come for her.

Over time, she pushed through attacks, but her work suffered. Sometimes she would take time off when she felt an attack coming. In the end, the pressure became too much, and she left the role.

Now she was in a new job. She wanted to stay, to do well and to be seen as reliable. Her main question in coaching was whether she should tell her employer about her migraine.

A second fear sat underneath that question.

“What do I actually do if a migraine attack starts while I am at work?”

That is the part many people do not see.

They see the sick note, the missed meeting, or the person leaving early. What they do not see is the internal conversation that often starts long before that.

Is this the beginning of a migraine attack? Should I take medication now or wait? Can I finish this task first? Will people think I am unreliable? Should I tell someone? Can I get home safely? What if it gets worse?

Migraines at work are not just a health issue. It can affect confidence, finances, professional relationships, and how you see yourself. For many people, the challenge is not only managing the symptoms, but managing the fear, uncertainty, and judgement that can come with them.

Migraines are not just headaches

Migraine is a neurological condition that can involve much more than head pain. It can affect vision, speech, thinking, mood, balance, energy, and how you cope with light, sound, and smell.

To manage migraine at work, you need more than willpower. You need a plan. You also need to stop treating every attack as proof that you are failing.

In coaching, Ms TMA did not need shame. She needed a strategy. Shame says, “Why can’t you just cope?” Strategy asks, “What needs to be in place so you are not forced to cope at breaking point?”

That is a big difference. One makes you feel broken. The other helps you build.

Know your early migraine warning signs

The first step is to understand your warning signs. Migraine does not always arrive like thunder. Sometimes it creeps in quietly. You may notice pressure, tiredness, yawning, food cravings, neck pain, brain fog, mood change, blurred vision, light sensitivity, or trouble finding words. When you know your early signs, you can act sooner. This does not mean panic. It means informed action.

Many people with migraines wait too long. They want to finish the report, answer the email, attend the meeting, and prove they are not lazy. Then by the time they act, the migraine has unpacked, rearranged the furniture, and put its feet on the table.

Rest should not be something you earn after suffering beautifully. Breaks are part of prevention. Food, water, screen breaks, medication used as advised, and a quieter space can all form part of your plan.

Understand your migraine triggers at work

Workplaces can also carry many migraine triggers. These may include stress, long hours, screen use, bright lights, noise, strong smells, missed meals, poor sleep, dehydration, shift work, and changes in routine.

This does not mean every attack is your fault. Migraines are complex. Sometimes there is no clear reason. Yet tracking patterns can help you spot what adds pressure to your system.

You may notice that symptoms get worse after long video calls. You may find that skipping lunch is a problem. You may realise that bright office lights make attacks more likely. You may see that your migraine is not caused by a single factor, but by the overall load on your body.

This is useful information. It gives you choices.

Create a migraine flare-day plan

Ms TMA and I worked on a flare-day plan. This is a simple plan for what to do when migraine symptoms start during work.

It included:

• her early warning signs,
• what treatment she had been advised to use and when,
• keeping water and food available,
• reducing screen brightness,
• moving away from harsh light where possible,
• knowing who to contact if she needed to leave.
• Most importantly, it also included how she would get home safely if migraine affected her vision, balance, thinking, or ability to drive.

A flare-day plan is not dramatic. It is not a 'cancel your life and move into a dark cave' plan. It is practical. It answers questions before pain starts shouting.

Make your workspace kinder to your brain

You may also need to make your workspace kinder to your brain. This might mean lower screen brightness, bigger font size, less glare, fewer notifications, regular eye breaks, quieter work time, or a desk away from bright lights.

These changes are not “being difficult”. They are functional. A chair is not a luxury for someone who needs to sit. In the same way, light control and breaks are not luxuries for someone with migraines.

Talk about migraine without oversharing

You may also need to think about communication. You do not have to tell everyone at work about your migraine. Disclosure is personal. Yet if migraine affects your work, selective communication may help you get support.

You could say:

“I live with migraines. It can affect my concentration, vision, light tolerance, and ability to work during attacks. I am committed to my role, and I would like to agree on a practical plan so I can manage symptoms safely and work as consistently as possible.”

This keeps the conversation calm. You are not oversharing, you are explaining the impact and asking for a sensible plan.

Ask for reasonable adjustments when needed

In the UK, migraines may count as a disability under the Equality Act 2010 if it has a substantial and long-term impact on daily life. In that case, reasonable adjustments may be needed. These might include:

• flexible working
• regular breaks
• adjusted lighting
• home working
• changes to absence procedures
• a quiet space
• occupational health support

Know when migraine symptoms need urgent help

You also need to know when symptoms are urgent. Get medical help right away for a sudden severe headache, confusion, weakness, speech issues, seizures, fever with a stiff neck, vision loss, or new aura symptoms that last longer than usual.

You are not failing

Ms TMA’s breakthrough was not just learning what to do during an attack. It was learning to stop seeing migraines at work as a personal failure.

She did not need to choose between being professional and being honest about her limits. She needed to become professional about her limits. There is a difference. One says, “I cannot cope.” The other says, “Here is how I manage this responsibly.”

Managing migraine at work is not about pretending you are fine. It is about having a plan that protects your health, supports your work, and removes unnecessary shame.

You are not failing. You are learning how to lead your life and career with a real condition that deserves a real strategy.

References

1. NHS. Migraine [Internet]. London: NHS; [cited 2026 May 5]. Available from: https://www.nhs.uk/conditions/migraine/
2. The Migraine Trust. Managing migraine at work [Internet]. London: The Migraine Trust; [cited 2026 May 5]. Available from: https://migrainetrust.org/live-with-migraine/migraineandwork/managing-migraine-at-work/
3. The Migraine Trust. Getting support for migraine at work [Internet]. London: The Migraine Trust; [cited 2026 May 5]. Available from: https://migrainetrust.org/live-with-migraine/migraineandwork/getting-support-for-migraine-at-work/
4. Acas. Reasonable adjustments at work [Internet]. London: Acas; [cited 2026 May 5]. Available from: https://www.acas.org.uk/reasonable-adjustments