S3 E8: Headache and Work

A National Migraine Centre Heads Up Podcast transcript

Headache and Work

Series 3, episode 8

Heads Up is the award-winning podcast series on all things headache, brought to you by the National Migraine Centre.  Produced by leading headache doctors, it’s the trusted source of information and support for all those affected by migraine and headache.

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[00:00:00]  Did you know when your migraine attacks are coming frequently with high impact on your ability to do normal daily activities, migraine is considered to be a disability and the law protects you at work. Welcome to the Head’s Up podcast brought to you by the National Migraine Centre, the only UK charity treating migraine and headache.


Dr Jessica Briscoe [00:00:30] Hello and welcome to this fortnight’s episode of our Heads Up podcast. I’m Dr Jessica Briscoe and I’m joined by Dr Katy Munro.


Dr Katy Munro [00:00:41] Hello.


Dr Jessica Briscoe [00:00:42] We’re back together.


Dr Katy Munro [00:00:43] Finally, too many changes with this lockdown. It’s very tricky.


Dr Jessica Briscoe [00:00:49] And actually this fortnight we’re talking about a really important topic and something that we both see a lot of. We’re talking about migraine in work. And it’s actually not just about migraine we’re going to touch on some other headache types, particularly cluster headache, obviously, they’re the two most common types of headache disorder. And a lot of this information is applicable to any headache type if it’s significantly affecting your life. But we’re just going to talk a little bit about how migraine and headache can affect your workplace. And Katy will be talking to some people from the migraine trust later about how they can support people and what advice they can give as well. So let’s start off by actually talking about the fact that- we talked about it quite a lot, but migraine is incredibly common. I think that’s probably the most common thing that we say. It does affect one in seven people and it does actually have- the affect of it on the working population does actually have quite a big economic impact, doesn’t it, Katy?


Dr Katy Munro [00:01:56] It does. It has a huge impact. And a lot of people who get migraine particularly, are in that sort of working age population. So the Work Foundation did a study in 2018 that they published, which is kind of summarising the impact, and It’s a bit shocking really, because they ended up saying that if you add together the cost of people being absent from work or people going to work (presenteeism)


Dr Jessica Briscoe [00:02:26] Your favourite word.


Dr Katy Munro [00:02:27] Which is our favourite. It’s when you go to work, but you’re actually not functioning properly. And then you add in the direct costs of health care, people having to go and get treatment for their migraine. That comes to a massive 9.7 Billion pounds for the UK economy. I mean, that’s huge, isn’t it?


Dr Jessica Briscoe [00:02:45] Staggering.


Dr Katy Munro [00:02:45] Really extraordinary. And then, of course, there’s also the financial impact on people, which is harder to measure, which is, you know, what the cost to them is in terms of missed opportunities or, you know, missed promotions and things like that, which may have a financial impact as well on them or their families- and their families really.


Dr Jessica Briscoe [00:03:08] Yeah. And I think also, as you said, this whole missed opportunities thing, I think people- so with the presenteeism people do- if you turn up to work and are in the midst of migraine attack, we’ve discussed how it affects people cognitively. You can get cognitive slowing, you do get reduced concentration and that brain fog. even if it’s just pain that’s one of your main symptoms, trying to actually function and be and have a significant neurological deficit of some sort is really difficult. And you it will really impact your ability to function correctly. And if you’re if you are being seen as someone who’s not necessarily functioning at 100 percent, possibly you could miss out on a promotion or people will, sort of, not think that you’re dependable and I think that’s what people worry about, being seen as being unreliable if they have to miss work or if they’re not always hitting the mark properly. I think that is a real problem for people.


Dr Katy Munro [00:04:03] Yeah, I think you’re right. And I think people often really shy away from being honest and kind and volunteering the information. When you’re offered a job, your potential employer is allowed to ask you about your health and sickness records. And so that’s really the time when people should be saying, well, actually, I do get migraine and it may impact me. But of course, if you only get one or two a year, which some lucky people do, they might think, well, it’s not worth mentioning, I’m not going to bother. But it is more when it’s kind of building up in frequency and people are finding that they’re having to have sometimes one day or two days off and then it starts to creep in as a difficult thing. And I always think it’s better to kind of try and talk about that in advance rather than trying to explain things after they’ve happened.


Dr Jessica Briscoe [00:04:58] Yeah, I completely agree with that. I mean, actually, from personal experience, I know I’ve disclosed it before to work probably because I’ve been working for the National Migraine Centre and I’ve been a bit more pro that. And I have had a call from occupational health before just saying ‘is there anything that you need us to do, sort of, you know, change your screen, you know, are you light sensitive’. And actually that felt quite supportive from my point of view. Actually, there wasn’t anything at that point that I needed. But because it’s a really good opportunity to have that that conversation, if work has an Occupational Health Department or has access to occupational health actually seeing whether screen filters or, you know, making sure that your desk set up properly, ergonomics is really important because we’ve talked before about how neck and back pain can filter into migraine. You know, I mean, the ergonomic assessments are very- we’re supposed to do them ourselves in a lot of workplaces and I know I do a lot of corporate work in my general practise job. They’re always doing workplace assessments where people have to follow a programme and make sure that computers set up properly. And actually, you can easily- you know, it’s one of those mandatory training things and peple just skip through it and actually don’t do it properly. If you have migraine, it’s quite important. I only know this from having done it myself and realising, you know, how much less neck pain you can get from having your computer at the right height or your chair set up probably or maybe having a foot rest if you need it. And you know, these little things can make a big impact. And actually maybe starting off from that point, instead of developing lots of problems with migraine and then having to- you end up starting off on the back foot, don’t you? If you’re not sort of set up from the offset. But it can be a bit scary, disclosing it.


Dr Katy Munro [00:06:33]  I actually was talking to a patient the other day and she was saying that, you know, with all the changes of working that have happened in lockdown and lots more people working from home. And I was reminding her about that very thing, saying, you know, do you sit at home with a laptop on your lap or are you having a desktop computer? And she was really happy to report that actually her work has been quite on it with advising their employees to get into a good work space situation at home as well. So just sitting on the sofa and putting your laptop on your lap is is not the best posture. And so I think sometimes, you know, that can aggravate and people have definitely had a change in their migraines, haven’t they, when they’re working from home as opposed to going in and out of their offices or wherever they normally are working.


Dr Jessica Briscoe [00:07:28] I think also working from home, I mean, it so depends on your home set up. But lots of people are used to having lots of fancy screens at home. And I’m sure my sister’s going to be really cross with me for bringing this up, but she, for example, used to have three screens in the office. And when she was first working from home, everyone thought it was just going to be a short time so they thought I won’t bother getting it. But actually, it was, again, a case of actually requesting it from work and getting things that were like being in the office set up at home. And you can do that. But I think that that knock on effect from thinking that it was going to be three weeks of lockdown initially and here we are months later, causing, you know, a bit of a delay in that sort of thing.


Dr Jessica Briscoe [00:08:07] You I know, get aura, Jess, so you were telling me earlier about aura affecting you at work as well. And I certainly used to work with somebody who got aura as a GP, and that was quite tricky in a consultation sometimes.


Dr Jessica Briscoe [00:08:22] Really tricky. Yeah. I mean, I’ve had it. I’ve certainly had it in the middle of a consultation. And, you know, there are lots of things, I’m sure people think that being a GP is really easy and I’m one of the main people to bang the drum about how it really isn’t. And because you’re doing lots of things, you’re not just sat there listening to the person, you’re also assessing what’s going on with them, typing things on your computer at the same time, working out lots of things that are going on in your head whilst also looking interested and trying to engage with the person about what they’re telling you about at that time. And actually, if you suddenly get a big, you know, block of vision, you know, I get that typical central scotoma of a big white, mine’s actually green, light in the middle of my visual field. If you’re nodding away, you know, I’m typically bad at recognising my prodromal symptoms as well. You’ll suddenly not be able to see someone’s face or be able to see half their face. And it’s very difficult to concentrate and really engage and do your job properly. If you’re in the middle of a consultation, you can’t really sort of go, ‘oh, I’m so sorry, I can’t see you’ just because it’s really difficult to do that. And actually, if you’re in the middle of a busy surgery, it’s really hard to stop, actually, and say ‘I can’t do anymore’. And I think that’s completely extrapolatable? You can extrapolate that (that’s probably a better way of saying it) to other jobs as well. And I actually think this is a really good point to bring up aura if you need to drive for work as well. And I know you have mentioned aura and driving in our migraine and men podcast, which I couldn’t come to. But, you know, aura if you’re driving- you shouldn’t drive if you are having visual aura. So when you have aura, you should stop the car and make sure that everything is safe, because obviously it’s something that’s affecting your ability to function properly. And if you’re getting recurrent aura and you’re driving, it’s really important to speak to your work about it because it may affect your ability to do your job. And if there is something else that you can do instead so if you can change to sort of more office based environment until your aura’s sorted out, it is actually really important to disclose that. And I think it’s something that we possibly haven’t highlighted particularly well in the past.


Dr Katy Munro [00:10:45] It might also be another reason to go and talk to your doctor again about having preventative medication. If aura’s coming frequently enough, even if it’s not, you know, sometimes people say, ‘well, I don’t get that many attacks’, but if it’s impacting on your work, stopping you doing what you have to do, then I think thinking about prevention earlier is a good idea. We’re sometimes a bit too slow, I think, to talk to patients about preventative medications and we need to get that discussion out there quickly.


Dr Jessica Briscoe [00:11:17] I agree with you on that front, actually. While we’re talking about preventative medication, there are some issues where- I was talking to one of our colleagues about this the other day where actually the person’s work impacted which preventative we were thinking about. Actually, I think this kind of brings us a bit onto shift work. It seems a bit of a random segue, but I’m just thinking about the fact that some of the medications you take at night like amitriptyline, and actually, if you’re changing your sleep pattern in your shift pattern, sometimes it is worth thinking about whether the type of preventative you’re using is suitable for that. But also, is your shift work causing problems with your migraine? Are you sensitive to changes in sleep pattern? And Katy you actually brought my attention to something from the BMJ, which has some really, really useful information about sleeping and shift work, doesn’t it?


Dr Katy Munro [00:12:15] Yes, the British Medical Journal has a website, and if you type in on their website ‘infographics’, there’s a beautiful one about how to optimise your sleep around shiftwork, because shiftwork is really not ideal for people with migraine. But sometimes it’s unavoidable really, isn’t it, for people like nurses and doctors and other people in industries where you have to do night shifts, you know, I’ve had patients who work on London transport and things like that, and they just have to do shifts and unless you want to actually change your whole job you need to work out how you can manage your sleep around shifts to try and minimise the impact. And there are ways of doing that. So, yeah, I think have a look at that. Infographics on the BMJ.com website, it’s really worth having a look at. So the other place, of course, that is impacted is not just work, it’s schools, isn’t it? And we haven’t talked very much in this series about kids. But of course, kids get migraine, too, and the impact on their schooling and attendance and, of course, you know, education can suffer, their emotional health can suffer. They’ve got an awful lot of things going on, especially our teenage children who’ve got maybe growth spurts, maybe peer group pressures, maybe the wonder if they’re going to do exams this year or are they going to be cancelled, all this kind of thing is really combining to irritate their brains.


Dr Jessica Briscoe [00:13:51] It’s so stressful.


Dr Katy Munro [00:13:51] And so I’ve had some children in clinic who have said that the lockdown initially was great. I’d somebody say ‘it was like a circuit break for his migraine’.


Dr Jessica Briscoe [00:14:04] Very topical.


Dr Katy Munro [00:14:04] It was a very topical phrase. And It just switched them off because he didn’t have to get up in the morning and rush off to school. And we were talking a bit about sleeping patterns that are changing through the week and then at the weekend and you know, getting up for school at seven o’clock in the morning and then at the weekend having a long lie in is another change that can impact. But then of course going back to school with all that attendant worry about, you know, infection controls and washing hands and wearing face masks and all of that, I think has added another level of stress for kids in education as well. So yeah, it’s a tricky one, isn’t it? But again, talking to your school in advance and saying ‘my child’ or ‘I am getting migraine’. It may be up to the child to find their head of year or somebody helpful and just to really explore the reasonable adjustments and that can be so, so helpful if only to reduce the stress? Just knowing that somebody else knows and is there to give you a hand is sometimes all you need.


Dr Jessica Briscoe [00:15:17]  I think sometimes it’s that sort of ‘oh gosh, I’m going to tell them and will they believe me and what do I do if I have an attack in class or something like that’? And actually, if you know that there’s someone where you can just raise your hand and say, ‘oh you know’, and they’ll be able to usher you out or get you to a- because, you know, some of the reasonable adjustments, sometimes are having dark rooms and things like that, which is applicable to work or school. Or actually things like sometimes people feel a bit better if they have migraine in the morning and knowing that it’s OK to go in a bit later to school as long as they can get to school and actually not having that worry of having to explain it when you get there, because the school knows that that’s something that can be effective or have an effect for you. This kind of brings me onto- I remember having- I’ve had a few children have had a fair amount of time off school because their migraines had been chronic and very badly controlled. And actually they worked really well with their school. I mean, this is before coronavirus, before this kind of situation, but they worked really well with their school about how to return to school. And they actually had what we call a phased return, which I use a lot with migraine patients and patients who are out for other reasons. The phased return is essentially where you’ll go back for a short amount of time. And I think this is really useful for children and adults with work. So if you’ve been off for a long time and, you know, if you’ve been ill and had to have, you know, quite a significant period of time off of work or school, actually sort of pacing your return, pacing is another thing we talk about a lot at the moment, quite topical. Making sure that you’re sort of going back in small, manageable chunks so that you’re not suddenly going from having no school or not being in work for a period of time to sort of being there all the time. So, you know, you can just sort of you kind of gradually increase the amount of time. So some people just go back for a short period of time. So maybe, for example, so that you’re not having to go in from 9am till 3.30pm for school, but going in at 10am till lunchtime or something. So you’re just doing a few hours and then coming out and then you’re avoiding the rush hour, that sort of commuting time for school but also not overwhelming yourself. And then you just build it up over time. And sometimes people just go in Monday, Wednesday, Friday, or they go in every day, but for a short period of time. So it’s really worth talking to your doctor and to your head of year or your manager about if you’ve been off work or school for a period of time, about whether a phased return would be a more manageable way of getting back to normal life.


Dr Katy Munro [00:17:55] Of course there are some people and I’ve certainly got patients who it’s gone really to the extreme where they’ve lost their jobs or they’ve just decided they can’t carry on with that particular career anymore. And so they’ve had to step back and have a period of time where they’re not employed and they might need to claim benefits or they might just need to reassess the way that their working. I’ve certainly heard from quite a number of people that they’ve said, ‘well, that particular environment’- I seem to remember somebody who was working in a very hot, very noisy, busy kitchen and it was a very pressurised job. And she said, ‘I just decided that wasn’t for me’. And she changed, took a step back and looked around for another way of having a career that would suit her. Somebody else I can think of was, you know, the pressure and the sort of corporate environment that she was in was making her migraines really worse and she decided that she would stop and retrain completely. So there are ways of doing that but it’s quite hard, especially if it takes you a while for your migraine to settle down or, you know, sometimes people say, ‘well, I’ve given up my work to have a sabbatical to see if that fixes my migraine’. I had somebody the other day who said, ‘oh, I think I’ll take six months off and see if that fixes my migraine’. And sometimes it really helps and sometimes it doesn’t immediately, it can take a while, but it gives them a bit more reflection time to decide what’s the best way for what’s the next step.


Dr Jessica Briscoe [00:19:25] Yeah, a bit of space to sort of work out what’s going on.


Dr Katy Munro [00:19:27] Yeah, yeah, I think so. Yeah, definitely.


Dr Jessica Briscoe [00:19:30] I think that was everything that we wanted to cover pretty much, Katy. And now you’re speaking to- who is it that you’re speaking to you from the Migraine Trust.


Dr Katy Munro [00:19:37] So yeah. So I was very delighted to speak to Helen and Gemma, who are both part of the support services of the Migraine Trust and we’ll be listening to what they had to say a bit later in the podcast.


Dr Jessica Briscoe [00:19:51] Well, I hope you’ve enjoyed this episode of the podcast. It’s really important for us as we’re a charity that, if you have enjoyed it, that you can give us a donation via our giving page and the link is in the blurb below. It is also on our social media websites. It also would be really helpful for us if you’d rate and leave us a review on whichever podcast platform you’re listening on. This is because it really helps other people to find and to discover the podcast and also gives people a flavour of what wonderful wisdom we have to impart. So I’d be really grateful if you could do that. Thank you.


Dr Katy Munro [00:20:54] Well, now I’m going to be talking to Gemma and Helen from the Migraine Trust, they are two of the support services officers and they have very kindly come on the podcast to help explain the kind of support that they can give to you if you’re struggling with migraine at work. So would you like to introduce yourselves? So, first of all, Gemma would you say a few words about how you got into this and what the Migraine Trust is?


Gemma Jolly [00:21:18] Lovely. Thanks, Katy, and thank you for inviting us. I’m a big fan of the podcast. It’s quite exciting to be on it. My name’s Gemma Jolly and I am the information and support services manager at the Migraine Trust. I started with the trust in January 2020, so just before lockdown, unfortunately. And before that I worked with people with dementia for 10 years. But my interest in migraine comes that I am quite fortunate now in that I don’t have them. But I used to have them a lot when I was younger and my mum gets them quite bad and had them very badly when she was pregnant with me, sort of a lasting legacy, I think. So I’ve always had an interest in migraine, but I’ve definitely learn a lot in the last 10 months or so. So it’s been really interesting.


Dr Katy Munro [00:21:56] That’s great. And what about you, Helen, tell us a bit about you?


Helen Balami [00:21:58] Ok so my name is Helen Balami. I am the advocacy officer. My role is to provide information and guidance for people who are having problems with work issues in- people who suffer from migraine and are having problems at work. I joined the Migraine Trust about six years ago. I came in from a mental health charity background. I worked with a mental health charity for about six years and I’ve been doing this job now for about six years and it’s quite exciting for me.


Dr Katy Munro [00:22:30] Excellent. That’s great. So the Migraine Trust I know does great work in supporting people with migraine and supporting research into migraine as well, doesn’t it? But one of the things, Gemma, you were saying to me was that you have phone support lines for people and they are open, not every day, but which days are they open?


Gemma Jolly [00:22:48] Yep. So we have the telephone lines open currently on Tuesdays and Thursdays, 10am to 4pm and the number you can find on the website, because I can’t remember off the top of my head.


Dr Katy Munro [00:22:59] We’ll put it in the blurb, don’t worry.


Gemma Jolly [00:23:03] Thank you. Yeah, but people can contact us 24/7 via the website or via email if they want to. So we have the email enquiries open all the time and we tend to find more people are comfortable emailing than phoning. But we have the phone lines there if people want them.


Dr Katy Munro [00:23:16] Have you noticed, Helen, a change in the amount of demand for your help since the covid lockdown? Because obviously, you know, so many more people are working from home now. And I don’t know about you, but I’ve found that that has a mixed effect on people. So some people have found that it’s really helpful not having to go into work environments that might be noisy or stressful, whereas other people have found that the kind of stress and worry of having to work from home and rearrange everything and sitting in a maybe not ideal situation has made their migraine worse. Is there any change in the amount of calls you’re getting?


Helen Balami [00:23:52] That’s very true actually. There’s a mixed response with what has happened during the coronavirus. More people working from- everybody working from home. Some people have responded well because they don’t have to travel to work and they can work in the comfort of their home after adjusting from travelling from work. Because, as we know, migraine likes the consistency, migraine does not like the change in patterns. But when the lockdown rules was eased off and more people began to go back into work, we saw a big change. We started to see more enquiries again with regards to people going back to work and having issues because of the change in pattern, again, in leaving home and going back to work. And people were more stressed as well. So, yes, we saw a change in pattern. There was a dip in the beginning, and then towards the end of the lockdown and people began to go back to work, we saw more enquiries come in.


Dr Katy Munro [00:24:57] That’s really interesting, actually, isn’t it? Because I think it’s been such a weird year, hasn’t it? So unpredictable. And then you think, you know, getting through the the covid virus and then suddenly it’s kicking off again. And I know it’s taken- you were saying about working for a mental health charity, and I’m sure mental health charities are really noticing that with people contacting them as well. It’s a huge impact on people.


Gemma Jolly [00:25:24] It is. We ran the survey at the beginning, well, in the spring, just after lockdown started and we had over 2000 people respond and 58% of people said that migraines had got worse since the beginning of lockdown. We think mainly attributed to stress, but also change in routine and just not really being sure what the rules were. I think it’s that uncertainty and anxiety. So, yeah, and as Helen said, it has increased. Also more widely, you know, anxiety around not being able to access treatments perhaps and all that kind of thing.


Dr Katy Munro [00:25:55] Of course, it has really impacted on people who have injection therapy like Botox, and I know right at the beginning of lockdown that was really difficult and right the way through to the summer. And we from the National Migraine Centre, we normally would be offering Botox as part of our services, but we haven’t been able to do that very easily or we have managed some alternative venues. But yes, it’s a big challenge. So would you say there’s anything that sort of stands out as the most common question that people are asking you about work and migraine? Is there anything that jumps to mind?


Helen Balami [00:26:33] I think the most common question that people ask is whether migraine is a disability. People are not sure that migraine is a disability and they want to know whether they are covered under a certain law or under the Equality Act. Some people know about the Equality Act and some people are not aware of it. So people- the most common question I receive is, is migraine a disability? Am I covered under the Equality Act? So is there some kind of- what are my rights? These are the kind of questions we receive. And yes, we know that migraine is covered under the Equality Act, it is classified under the episodic conditions which are covered under the Equality Act. So a person with migraine would be covered under the Equality Act if their condition satisfies the definition of what is a disability. Now, the Equality Act defines disability as something that has- if a person would be disabled for the purposes of the act, if they have a physical or mental impairment, and if that impairment has a substantial and long term adverse effect on their ability to perform their daily activities. Sometimes people with migraine have one or two attacks in a year, and it may not impact on their day to day activities. But sometimes people have frequent attacks and the frequent attacks could be having an attack two or three times a week or once a week but actually it’s impact heavily on the person’s ability to carry out their normal day to day activities. So it all depends on the individual circumstance. So if the person’s migraine is more frequent and can impact on them, then the person may be covered under the Equality Act. Usually the person who is best able to advise the individual is their health professional. So their GP, headache nurse, occupational health practitioner or a neurologist will be able to advise the individual and their employer whether this person is likely to be covered under the Equality Act and the health professional can also recommend suitable adjustments that an employer can also make for the person so that the individual receives support from their employer and is able to carry on with their work without much impact of the migraine on their work.


Dr Katy Munro [00:28:57] That’s a really important point, isn’t it? Because the one thing we also know about migraine is that it fluctuates. So it varies in severity throughout people’s lives, but also it can vary in severity over the course of a year and sometimes will go through phases where it’s gone away for a while. And then other times it comes relentlessly, seems to be thick and fast. So I think that’s really tricky, isn’t it? And the definition of disability is really prone to interpretation. But the Equality Act I know replaced the Disability Discrimination Act, which is an older act that was aiming to still protect people with disabling conditions. And do you think many people think of, especially in people who don’t get migraines- do you think they would think of it as a disabling condition?


Gemma Jolly [00:29:49] No, I think is from I mean, from my personal experience but also the people we speak to regularly, you know, it’s just a headache is the most common retort that people get. And I think one thing that we’ve noticed as well as people almost feel guilty for trying to- not everyone, but some people there’s a sense of guilt for trying to use the Equality Act sometimes because they feel because I think as much as society has pushed them to feel that they should just get on with it because it’s not seen as a serious condition. And there’s a big piece of work and something we’re looking into to raise awareness of just how disabling migraine can be and what having migraine actually means.


Dr Katy Munro [00:30:26] There was a big survey, wasn’t there? The Global Burden of Diseases. It’s got much longer name than that I can’t remember all the title. And they did that in 2016. And it’s a worldwide survey of the impact of diseases and migraine came second.


Gemma Jolly [00:30:42] Yeah.


Dr Katy Munro [00:30:43] As the second most disabling thing that people can have. And I think, you know, a lot of people would be quite shocked to hear that when they don’t really understand that migraine isn’t just a headache. It’s about so much more with the, you know, the auras or the brain fog or the general- all the other conditions that can come along with migraine. And also the length of time that an attack can last for, it can roll on for several days, can’t it?


Gemma Jolly [00:31:14] Yeah, I think not understanding the premonitory and the sort of postdrome phases as well. So, you know, that stage before the main attack happens, people don’t really understand it or it’s not very well understood. It’s becoming better now. But there’s a lot of work there, I think, to raise awareness, but also, you know, feeling wiped out, hung over, not quite right. We hear that a lot. And people get quite concerned because that can go on for several days and they’re like, ‘is this normal? What’s wrong? Should I be worried?’ and it’s hard when you feel you should be back at work to try and you end up pushing through or not maybe listening because you feel, you know, you should be at work or there’s an expectation from employers, if they don’t understand that even if they do know what a migraine is, perhaps they think it only lasts four hours. So why are you off for a week or more?


Dr Katy Munro [00:32:04]  I was going to say the other things about pushing through is that often because of that kind of sense that we should just put up with it. People go to work when they’ve got a migraine and they’re not actually functioning at their best because they’re trying either to creep- I’ve certainly done this myself, creeping around work with a headache or sitting really still when I see patients. I don’t do too often these days, but it is that sort of presenteeism which is under recognised as well.


Helen Balami [00:32:38] Yeah, I think also people don’t know that migraine is so prevalent, like research says that one in seven people get migraine in the UK. So it’s so prevalent that people are not even aware of it. And again, we’ve talked about people misunderstanding it as a headache. So people just excuse you that it’s just a headache so come on, get on with life. It’s one of the enquiries I get, complaints from individuals who contact us with their enquiries. Some of the things they said is that ‘my colleagues don’t understand. My employer does not understand. My employer tells me it’s just a headache. Come on, take paracetamol. I get headaches as well and I take paracetamol and I’m fine. I take ibuprofen and I’m fine’. So they expect people, everybody’s condition to be the same. They expect the headaches to be the same. Expect a headache is the same with migraine. So there is that lack of understanding. Again, the fear of the fact that you could be stigmatised because you said you have headache so people see you as lazy, you only have a headache and you don’t want to work. So that creates a kind of stigma. So with that also, it’s stops people who actually have migraine to be able to come out and ask for support in the workplace. So for that reason, some people continue to suffer with migraine and don’t actually ask their employers to put in the reasonable adjustment in place for them.


Dr Katy Munro [00:33:59] Yeah, yeah. I’ve also heard of employers making comments like, ‘well, haven’t you got a cure for that yet? Or haven’t you sorted yourself out?’ And sort of things like that, which are very hard aren’t they?


Gemma Jolly [00:34:10] They are.


Dr Katy Munro [00:34:13] Migraine isn’t a curable condition, because it’s a lifelong condition. But the vulnerability to getting attacks can vary. But that genetic predisposition is always there. So we’re always saying to people, we’re not working towards trying to cure you, we’re trying to manage your migraine. And often that is a lot more realistic. And if people can begin to understand that, that’s helpful, I think.


Gemma Jolly [00:34:39] Yeah. And I think this is where the toolkit that you mentioned that we have. So the help at work toolkit comes in because it aims to sort of educate employers about what migraine is and also employees about their rights so it brings in the definition that Helen gave around the Disability Act, but it also touches on reasonable adjustments and complaints procedures, grievance processes. And Helen can talk about this more. But one of the biggest issues is when people contact us, it’s almost too late. It’s at the point where they’ve lost their job or they’re about to lose their job. And at that point, there’s very little we can offer and we need to signpost on. And I mean, you’ve got more information on that.


Helen Balami [00:35:15] Yeah. The help at work toolkit provides basically information on employment rights where the individual can use the tool kit to seek for help in work. It also provides detailed information on the types of adjustments that an employer can put in place. Examples of this can include having flexible working hours, also adjusting the sickness policy where the individual’s migraine days sicknesses are not counted as like other sicknesses. So basically to be counted as a disability sickness, which means that they can’t discount it and it will not count towards their disciplinary or trigger a disciplinary. It can also be that the individual will be given more frequent breaks so that the person can get up from their desk and have walkabouts so that they relax their muscles and just make themselves more relaxed. So generally they are just different types of adjustment where this can be implemented by the employer. But again, like I said, it’s not one that fits or each individual will require something that fits their specific circumstance.


Dr Katy Munro [00:36:53] I had an example of that, I had a a patient a while ago who had to go, every week, she had to go to a meeting where there was a briefing and it was on a PowerPoint presentation. And they put it up on a great big screen that was really bright and it was in this sort of stuffy room and a crowd of people in there having the briefing and she would get a migraine every single week. So she had a chat to her employer and said, look, this is a bag trigger for me. And so they said, well, you need to have the briefing information so we’ll print it out for you on paper copies and you can be looking at the paper copies so you don’t have to look up at the slides on the screen, which is so helpful, and so that really made a difference to her life. It was really helpful.


Helen Balami [00:37:39] Usually the adjustments are just sometimes small things that an employer can make for the individual and it makes a very big difference. Sometimes it can be just access to water for the individual and the individual is rehydrated and also that reduces the impact of the migraine. We all know that dehydration is one of the triggers for migraine. So if an individual can stay rehydrated, that can help a lot. Sometimes it can be simple things like putting a screen cover on the computer and that can reduce the the flicker on the computer and that can help the individual. So little little things the employer can do and sometimes also they are not very costly. So it’s just working with the individual. Sometimes also the individual and the employer will need to get the health professionals to help them reach an agreement on what is more suitable for the person. Because the health professional knows the person’s symptoms and has the medical history for the individual, they will be able to advise the employer and the individual well on what is best for them. I think Gemma mentioned earlier the common things we see with people coming to us is that when people come to us most of the time, they’re already possibly at the highest stage where they are about to be sacked or they have lost their job. And like she said, most of the time it’s hard for us to provide the support that we could help the person basically to be put in place. And so what we have to do at points like that is to signpost them to where they can get more support, either through solicitor, where they can get legal advice, or to other organisations where they can provide them with more support. If an individual is struggling with migraine in the workplace usually we would suggest from the beginning, either from the beginning of the employment when they’ve been offered a job, they can ask for reasonable adjustments to be put in place or just alert the employer that ‘I suffer from this condition and sometimes it can be debilitating for me and I may need help’. So the employer is aware of it. So when the right time is around the corner, they can sit down again and have that chat and then support can be put in place. If there is a misunderstanding with between the employer and the employee, the employer can also speak to their union representative. The union representative can also support the employee, talk with the employer and also come to an agreement on what kind of adjustments should be put in place for the individual.


Gemma Jolly [00:40:17] I think it’s always worth finding out what support you have, even if you’re not part of a union, because some organisations have employee assistance schemes, occupational health, there are options. I mean, sometimes people are like, ‘oh, we don’t have a union, I’m not a member of the union’, but it’s always good to I mean, with anything in life, regardless of whether you have migraine, it’s good to know your rights. And that’s definitely the case when you have migraines. It’s important in your job that you know sort of what your sickness policy is, what the equality policy is, what occupational health set up is. Find out how it works and then ask questions if you’re not sure.


Dr Katy Munro [00:40:48] That’s a really good point actually. I was reading about a survey that the European Migraine Headache Alliance did, and they did a huge survey with a questionnaire postals survey of all over Europe and one of the things came out from that was that people just didn’t know what was going on with their employers, access to health services, policies and things like that. You do need to take a bit of responsibility for looking at your own contract and finding out what’s available for you? I think also taking responsibility, it just occurred to me what you were saying, Helen. I was thinking back to the days when I used to get really bad migraines in a general practise situation. And one of the reasons was because I didn’t bother taking lunch because I was so busy I would just plough on through the morning and then have a cup of tea and a biscuit and then go on and of course I realised, eventually, that I needed to take lunch and stop and eat my lunch. You know, we do have to also look after ourselves,.


Helen Balami [00:41:54] It’s very important.


Gemma Jolly [00:41:54] The other thing is that we are always happy to talk to employers if they want guidance or talks. We’ve done some over the year remotely. So, you know, we’re more than happy to come and talk through sort of what migraine is and what adjustments are and all that kind of thing, and just give people some information if they need it. They’re always quite enlightening.


Dr Katy Munro [00:42:12] So you’ve done a lot of work with the civil service, I think, haven’t you?


Gemma Jolly [00:42:16] Yes, we have. We’ve been really lucky. So it was actually inspired by an employee of the civil service who wrote a blog about her experience of migraine. And that then led to lots of people getting in touch and saying ‘thank you so much, you know, for raising awareness and explaining what migraine is, I have migraine and I didn’t know anyone else at work had it’, and then they reached out and sort of teamed up with us to deliver sort of a programme of activities and to look at becoming an inclusive employer. So it was really beneficial and it’s still ongoing. So we’ve got workshops planned sort of into next year with them.


Dr Katy Munro [00:42:46] That’s really good. I did a webinar a while ago with a quite a big insurance company, and when they asked me to do it, they said, oh, probably, you know, we’ll probably get about ten or a dozen people. And the room was absolutely packed when I did it. And the person who’d organised it was like, ‘oh, my goodness, I didn’t realise all these people had migraine, they all came out of the woodwork’. So I think we need to encourage people to encourage their employers to have wellbeing services to value their employees, because if you have happy, healthy employees, you also have a happy, healthy business. So it’s a win win, really, isn’t it?


Gemma Jolly [00:43:28] It really is. And it’s like Helen said earlier, it doesn’t have to be expensive. I think people panic when they think they’ve got to make reasonable adjustments because I think they think they’ve got to change the entire design of the building, back when we were in buildings obviously less of an issue now, or, you know, spend thousands of pounds on really snazzy equipment for people, but a lot of the time it’s not that. It’s very simple things, even something like a workstation assessment or showing someone how to set up their workstation at home, you know, it doesn’t really cost anything, but it can have a huge impact. So it’s just getting- and it’s like you say, if you’re looking after your staff, it looks after your business. So actually, it’s a good investment if you do need to spend the money.


Dr Katy Munro [00:44:02] So if people are really struggling and they end up, you know, either getting disciplinary meetings or even losing their jobs, you know, the financial impact is quite scary for them, isn’t it, and so I wanted to just come on a little bit to talking just broadly about benefits. There’s also, I think on the Migraine Trust website, there’s a little bit of information about benefits, but maybe we need to be signposting people to the government websites to get more detailed information about that.


Gemma Jolly [00:44:34] Yeah. So we don’t do benefits advice because obviously benefits advice is very specialised so we can give a broad overview and let people know that they might be entitled to apply. We speak to some people who do successfully apply for things like PIP, so personal independence payment or disability living allowance, if that’s what it’s still called. But we also speak to a lot of people that don’t have a lot of success with that. So we would sign post them on to other organisations like Turn To Us sometimes Citizens Advice Bureau, it depends. But basically your local area should have a benefits advice service so you can always contact them, but Turn to Us have a lot of information about that.


Dr Katy Munro [00:45:10] Yeah, I think Citizens Advice has a good website with information and I think the gov what is it .gov.uk website. There’s a lot of- if you just type in benefits then you will get all the different ones. They seem to change and they are quite confusing I think, aren’t they. So it might be as well if people are thinking about applying for benefits, that they go and talk to more specialist adviser,.


Gemma Jolly [00:45:37] I think with Universal Credit roll out as well. So, you know, it’s a minefield. We struggle with it, don’t we Helen. And, you know, so it’s really important to get that specialised advice as well. And also if you’re claiming other benefits. So, for example, if you were claiming carer’s allowance or something, it may be impacted if you were to claim others. So it’s really important to get that specialist advice.


Dr Katy Munro [00:45:58] The other thing I just wanted to mention, we’ve talked all about migraine and obviously the Migraine Trust and the National Migraine Centre. It sounds as if our emphasis is always about migraine. But of course, we also hear from people with cluster headache. And so I just want to flag up the excellent organisation called OUCH UK, the Organisation for the Understanding of Cluster Headache, because I think the same kind of things apply for people who are struggling with cluster headache at work, and they may need to have their oxygen or able to go and have their injections and all the slightly different treatments that people with cluster headache need. So we’ll put the link to the OUCH UK in the blurb as well. Anything else that you would like to add about migraine and work or about what you think people should be considering?


Helen Balami [00:46:54] I think just one thing. We talk about reasonable adjustments and we expect the employer to put in adjustments in the workplace for the individual. But one thing also that the employee should note is that there is also a limitation to how much the employer can do. So the person must be aware of that. So an employer is only expected to implement what is reasonable. If something is beyond the employer’s capacity to do, then they will not be able to do it. And that’s exactly what the law says so one should be aware of that. The employer should do their bit but again, we must also be conscious of the fact that there is a limitation, the Equality Act says that what is reasonable is usually determined by factors such as the size of the employer, the role and the size of workforce, as well as the financial and logistical implication for the employer. So those things must be taken into consideration as well. I think that’s important to note.


Dr Katy Munro [00:47:56] I think that’s a really important point. The reasonableness has to be on both parts, doesn’t it? So I guess it’s really about having that discussion. And the earlier you can have that discussion with your employer, the better, because the more likely then you can work together to make life at work much more happy, much more healthy, much more productive, rather than kind of keeping it secret, pushing through and struggling. And then it all kind of gets a bit stressful for everybody concerned. So, yeah. Really important topic!


Gemma Jolly [00:48:31] Yeah. And I’d just add, you know, if you don’t know, if you’re not sure, ask, you know, the Migraine Trust is here, ask your employer. You won’t be alone, you won’t be the only person in your workplace unless you’re in a very, very small workplace, but even then probably not, with migraines or other headache disorders, as Katy mentioned. You know, it’s not just migraine it’s the other headache disorders as well. So I think our advice would always be ask, come to us, you know, speak to your employer, find out what your rights are at work.


Dr Katy Munro [00:49:01] OK, that’s lovely. Thank you so much for that. I think that’s really useful and helpful. And we’re going to spread the word widely about heading to the Migraine Trust website, looking for that tool kit, and maybe picking up the phone and speaking to you. So once again, thank you very much.


Helen Balami [00:49:18] Thank you.


Gemma Jolly [00:49:18] Thanks, Katy.


Swati [00:49:23] Hi, everyone. Welcome to the Heads Up podcast. Today I have been joined here by my colleague and friend Valentina.


Valentina [00:49:30] Hello, Swati.


Swati [00:49:32] So Valentina and I today sort of decided that since this episode is about work and since both of us happen to get migraines, we thought to talk about how I had to transition during this time from working in an office environment to working from home full time. Valentina, who joined us in April, was it? She had a transition from her student life because she was doing her masters before and then she started to work, but her work started off from working from a home environment. So we just going to have a chat about it and discuss how migraine has sort of changed while these transitions have happened in our lives. What do you have to say, Valentina, I mean from student to work?


Valentina [00:50:18] Yeah, I think from my perspective probably it was a little bit easier to work from home because as a student I was already used to studying from home and because I was used to going for lectures but of course a big part of your master is to study and it’s a lot of individual studying. So I would say the part of working from home, I was already used to it. For me, the hardest part was having to collaborate with people remotely because of course, before I could actually meet people if I had to, I would say this was like the biggest challenge of having to work remotely. I would say that I actually enjoy from working from home not having to commute as it has saved me a lot of time.


Swati [00:51:02] Sorry to interrupt, commuting is a big one isn’t it because I think most of my migraines used to actually start thinking ‘I am going to commute’ and I still remember on my journey along the central line (which is probably the worst line to be on) to reach the office, I used to dread it because I would just have this back log of headaches somewhere sort of hovering around my head. I wouldn’t really have a migraine migraine but it would become a migraine, it would become a full blown attack the moment I entered the central line, so I used to be always trembling. Travel used to be like my major trigger and cause for getting a migraine sometimes. So, yeah, I relate to that.


Valentina [00:51:44] I completely agree, I think with the commuting, if you take the tube on non peak hours, the experience is completely different, but when you finish a long day and you have to step on the tube and it’s full of people, there’s little oxygen, for me was a definite trigger that I’m definitely enjoying not having anymore. But on the other side, I don’t know why, but I feel like I spend more time in front of a screen like I feel that lately my life has become me and the screen,.


Swati [00:52:16] Yeah absolutely.


Valentina [00:52:17] Which I didn’t really have this problem before. I would say I work sort of the same hours, but I’m seeing it a lot more and I think what has helped me a lot is to don’t wake up and start working immediately, but wake up a little bit earlier, as anyway like I would have woken up at that time if I had to commute, and go for a walk and maybe like at lunchtime try to go for a little walk and after work again, put my phone away, not look at my phone just to have that break. But I definitely had to learn during the pandemic as my eyes were burning and I was getting migraine every day, so.


Swati [00:52:58] No, absolutely, I mean, all of those things that you just said, I think I can totally relate to. I mean, going from an office environment to working from home for me was just like one the part of the commute, as I mentioned, that sort of changed and I kind of had that- that was a bit of a relief. And to be honest, initially, when the whole work from home situation happened, I personally sort of felt like my migraines were getting better. I was sleeping better, I was having much more relaxed time in that sense because I was not rushing up in the morning to go because it’s usually like an hour long journey from home to office and I didn’t have that panic in the morning that I had to run and I had to rush and i had to do this and had to do that. I just have to get up, take a shower.


Valentina [00:53:49] I think just the stress to get ready as well, to leave the house on time.


Swati [00:53:54]  Exactly so all of those things, while that happened. I know that there was a phase probably where I was like, wow, I’ve not had a migraine for the longest time, a good three or four weeks. No headaches, no migraines, nothing at all. No symptoms at all. And then all of a sudden, you know, when the pressures built up with the whole work from home situation. Work actually increased and subtly sort of increased so you wouldn’t know, so instead of starting at 9am, because you are up and ready by 8 o’clock, you’re like, oh, let me check that email at 8.30am and let me just look at that thing and let me just do this. And by the time it’s 5 o’clock whilst I would be all out of office, I would still by 6 o’clock, I would still be like, oh, I think I should probably close it’s almost 6pm but let me just have a look at that last e-mail and send this and send that. So I think for me, there were expansion’s in terms of the way work was happening on both ends. Both morning and evening and that as rightly you said, the time we are spending in front of screens, because everything literally is happening on a screen, isn’t it?


Valentina [00:55:01] Yeah.


Swati [00:55:02] You’re talking to people on screens, you’re watching something on screens, you’re reading something on screens because everything I mean, there was a time when every single thing was happening on screens then I probably had that phase where I was getting more and more migraines, because I think that whole pattern where there was a bit of a relaxation i had just sort of settled into. Different triggers, different things sort of triggering the migraine rather than the ones that were relevant to working from office space. And I think that’s probably the transition that happened. I am pretty sure a lot of people who have gone from working in an office to working from home must have had that relax period and then all of a sudden an increase in migraine. Everybody must have had that pattern, which is sort of expected. Even with walks and stuff. I mean, luckily when it happened, we were sort of nearing summer. Now it’s dreadful winter so i don’t know if i can continue that whole thing ‘let’s go out and have a walk’ because maybe not, the weather’s terrible.


Valentina [00:56:06] I’m still forcing myself to go. But it’s honestly like some mornings, like, why am I doing this? And when I don’t do it, I actually then feel the difference. But yeah, when it pours down it is actually challenging just to go out of the house. When, I think, when you go out for work, you have to go out and then you actually breathe some fresh air in between the tube and the office, let’s say. I think probably the main difference has been that with work before you were at the office and you were working. While you were at home, unless it was an emergency, nobody was even considering to disturb you. Well, now personal life and work life has merged together completely, which is something I would say that by studying I was more used to it because studying is, like, nobody cares how many hours you’re spending studying that you have to be ready. So I was more used to this, but I can understand that for somebody who was probably working and used to work. There’s no more personal life.


Swati [00:57:10] And I just want to extend on that and just say the fact that migraine itself is such an isolating condition, it really isolates you and impacts your social life. When COVID happened, I felt like all of a sudden the term social just vanished, like it just wasn’t there anymore. So you could not socialise anymore because there were rules around it and it took time before you could meet people because of the lockdown and then you could meet three people and two people, there were rules in that situation and we are back again into a lockdown. And I think sometimes actually meeting people and being able to get out and be able to see people, which probably when you go to your work, you end up seeing people and meeting people, also somehow helps because it just helps you to rejuvenate, to not think too much, to not sort of be in that space.


Valentina [00:58:08] To distract as well.


Swati [00:58:10] Exactly. Exactly. So and otherwise, you just consumed in work for the entire day. I’m constantly in front of a screen just thinking about work. Whereas in the office I would just get up and pop in and have a cup of tea with a colleague and just chat about other things. You could do those things and you had an element of socialising there as well and while I don’t know how much impact any of this has on migraine, but I do feel that the fact that you get to move around, you get to sort of talk to people, see people, that does sometimes, you know, take you out of that mental space and it helps you sort of breathe a bit and sort of step back a bit, which probably isn’t or wasn’t happening when the whole situation happened with lockdown. And that is probably one of the major transitions I felt quite hard when I moved from an office to work from home thing. It does always sound fantastic working from home, it’s like a dream thing isn’t it?  We were all sort of before the pandemic everyone was just like, oh my god!


Valentina [00:59:19] Sounded like a dream yeah.


Swati [00:59:19] Exactly. And then I think three months down the line, we are all just like ok a dream? Maybe not. Like give me a bit of an element where we see people, we can actually see human beings.


Valentina [00:59:32] I think a middle between like working from the office and working from home would be ideal. Of course, at the moment we’re not able to but yeah, there are positive and negative aspects with this.


Swati [00:59:46] True, no, absolutely. Is there something you would, as you said, going out, taking walks, is there anything else you think might help? Because I know if there is anything that has happened is a lot of people have graduated and come out of universities, are probably getting into jobs or are trying to get into jobs and trying to get into a work mode. Is there anything you would suggest for the transition that you had?


Valentina [01:00:13] Yeah, I would say that on one side, starting from work from home for me, felt almost safer because when I graduated, I was scared that my migraines could impact on my work. Because, of course, like when you study, as I was saying before, if you have a migraine, it’s you managing your own time and you can just take a break and maybe then work harder another day. Well, with work, you have to be there, you have to collaborate with people at certain hours. When I think this thing of working from home on that side really helps because it’s like a sort of transition. You’re still at home so if you do not feel well, you don’t have to think ‘I’ve got a terrible headache I have to commute all the way home’. You can think, ‘oh, I just finished work and I can just lie down and relax’. I can imagine that is a lot harder to find a job itself because companies are not hiring as they used to, and it’s a lot harder to get in contact with your colleagues. I would probably say, try to focus on the positive side and on the communication that you were also talking about, I think sometimes you have to be brave and call your colleague just for a chat, even if you know that they’re working, like I think that it will help you to build actually a personal relationship when you have to collaborate. And then I would suggest when you start working, in the morning especially, don’t rush to look at your emails, don’t rush to your computer, but try to probably take some time off to get some fresh air, get some movement, as you will probably not move during the rest of your day. I don’t know if you’ve got any other tips that you found helped you with working from home?


Swati [01:02:06] Well, the ones that I would actually recommend to anybody that sort of worked for me is to sort of try and have non screen distractions. So I got a lot into things like expressive writing. So I started to sort of do that a lot or even pick up a topic and start writing on it or think of something or maybe write it in a book


Valentina [01:02:36] On a piece of paper right?


Swati [01:02:38] Exactly. So paper or a book so that way it didn’t involve a screen. And I was trying to sort of get away and have less screen time in that sense. Also, I think from a mental health point of view, because I know that a lot of people, especially if their suffering from migraine or chronic illnesses, for that matter, in these common times, might be feeling much more isolated, might be feeling much more depressed and lonely. And I think it is very, very important to sort of remember that while the way things are right now, you can’t actually go out and about and meet people, but there are still ways to connect. So whether it’s your work colleagues, you want to connect with and have a chat with, whether it’s your friends, whether it’s some mate from school, whoever you feel you can have a chat with, do give them a call. Do have those conversations. Do flex your time when you’re working. Make sure that you’re moving around. You’re not sitting in one place in one spot for a long time because that, again, is going to sort of build up and give you a migraine or a headache. And I think those elements are important. Looking after yourself is very important. The one thing that I noticed, which probably I don’t know why it happened at all, it sort of automatically happened is you know when you’re at home, I was less likely to eat on time. So breakfast sort of moves to like 9ish, 10ish and then it kind of goes to 11ish. And because now you’ve had breakfast at 11, you end up having your lunch at 3 and then everything’s so erratic. So my eating initially became extremely erratic. And I think slowly and steadily I worked on it to make sure that I’m having my meals on time because it’s very important if you suffer from migraine that you have your meals on time. It is not important to have massive meals, but it is very important to have short meals in shorter duration so that the sugar levels don’t differ. And I think that’s one of the protest that our doctors always talk about, make sure you’re eating regularly and keeping sugar levels balanced. I think that is something I would say that it’s very easy to go haywire when you’re sort of working from home. Caffeine is very easy to have an absolute massive intake. I started off with, I don’t know, like four, five, six cups of coffee and I’ve deliberately now I’ve tried to sort of have some seeds or some sort of dry foods and things like that around me to sort of munch on so that I don’t have that thing that I need to get myself a cup of coffee. I just became a coffee addict. I was not when I was at the office, to be honest, but I became one because at home it’s very easy and I was having all these different flavours of tea, different ways of making coffee and I got this really nice way of making cappuccinos and lattes and mochas. I was making all of that and not realising how much caffeine, even in different forms I was taking it.


Valentina [01:05:37] Yeah, it’s excuse. You’re like, ‘oh, if I make a coffee then I don’t have to look at the screen for like what is it, three, five minutes’ and you end up drinking the coffee to have the break, not for the caffeine itself. And then you end up drinking a lot of caffeine. And on the other side, I don’t know if you had that as well, but I noticed that I was drinking a lot less water.


Swati [01:06:02] Yeah absolutely.


Valentina [01:06:02] I think, because I was used to bringing my bottle of water if I was going to university. So I actually had next to me like the amount of water that I was drinking. When at home, I will have the glass and then the glass finishes and you have to move to fill it up and I never end up filling it up. And that was a big, I think, a big trigger for my migraines and I ended up drinking one glass of water in an entire day while I was used to maybe drinking like two litre’s.


Swati [01:06:33] Yeah, please, drinking water is very, very important, and especially now in winter, it gets even worse because you are not inclined to have more water. We are inclined to have less water in winter, not feel very thirsty. So keep yourself hydrated, because again, that’s one of the reasons why one can get a migraine. But that is all I can sort of think of from my end, I really didn’t do much. Does not sound like a big list of things I had to do. I think it is all about the small things?  Like the small changes in your life to sort of make things better? And I’ll be honest, it is not always going to be good. I had a massive migraine a couple of weeks back and it is always the case. You will always have it because it’s not a condition that can completely go off but if managed well, you’ve got control of it rather than the other way around. So I think that is probably where I’m going to sort of conclude the whole thing. But thank you, Valentina for talking today.


Valentina [01:07:35] Thank you for having me.


Swati [01:07:37] Lovely  to chat with you about it.


Valentina [01:07:39] Yeah. Thank you very much. And I hope you will enjoy listening to it.


[01:07:46] You’ve been listening to the Heads Up podcast, if you want more information or have any comments, email us on info@NationalMigraineCentre.org.uk, till next time.


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