Some words are far too mild for the violence of what they describe. Migraine is one of them. For many people, it evokes a simple headache—an inconvenience solved with an aspirin (or Tylenol) and a glass of water. For those who’ve never experienced it, migraine is almost a cliché: a lame excuse to stay in bed or avoid a meeting.
But for millions of people—and I’m one of them—migraine is anything but benign. It is a debilitating neurological disease that can force life to grind to a halt for days at a time. It is an invisible disability that millions are expected to simply “push through.”
The Mild Version Everyone Sees—and the Severe One No One Understands
I often compare migraine to carrying a 60-pound bag everywhere you go. On “mild” days, you still walk, work, answer emails—but you do it while pushing through a fog of pain that absorbs all your energy. Many migraine sufferers perform normal life while their brain fights a private war.
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Ironically, this “functional” version of migraine contributes to the disbelief faced by people who cannot work during severe attacks. They hear, “But I know someone with migraines and she still works—why can’t you?”
Because not all migraines are the same. Some are annoying. Some are so ferocious you can’t imagine enduring another minute of it.
A Neurological Reality That Hijacks the Entire Body
When a severe migraine hits, everything stops. I find myself in bed, motionless, in the dark. I shuttle back and forth to the bathroom to vomit. I can’t read. I can’t watch a show. I can’t think clearly. My brain is overwhelmed by pain and sensory overload. The outside world simply disappears.
More than one billion people worldwide experience migraines. One in seven adults. And yet . . . it remains an astonishingly misunderstood disease.
It disproportionately affects women—roughly 80% of migraine sufferers—largely because of hormonal fluctuations that influence the sensitivity of the nervous system. It’s driven by an abnormal excitability of brainstem neurons that triggers a cascade: CGRP molecules flood the system, blood vessels dilate, nerves ignite with pain signals, and the body spirals into nausea, hypersensitivity to light and sound, vomiting, word-finding difficulties, and exhaustion. Some people experience visual disturbances—“aura”—before the pain even hits. But whether with or without aura, the result can be incapacitating.
The Monastic Life Migraine Demands
Migraine forces me into a kind of monastic discipline. I don’t drink alcohol anymore—it’s an instant trigger. I’ve cut out lactose completely, because even a small amount can set off a crisis. I follow a tightly controlled diet. I guard my sleep like it’s sacred, because one night that’s too short or too long can derail an entire day. I limit screen time as much as I can. I monitor my stress levels (not easy in the world we live in). I avoid harsh light, loud spaces, sensory overload.
And even with all that, I still can’t fully prevent the attacks.
For some, it’s chronic. A migraine that never really leaves, a pain that becomes the background noise of existence. I honestly cannot imagine living like that. I don’t know how people with chronic migraine keep going—their resilience is extraordinary.
A Workplace Blind Spot With Enormous Costs
The gap between lived experience and workplace perception is enormous. Migraine is still not widely recognized as a disabling condition at work. Many employees fear being judged as unreliable or weak. And too many managers still respond with skepticism or impatience.
Yet migraine is one of the world’s leading causes of productivity loss. The economic cost—through absenteeism, presenteeism, and cognitive impairment—runs into the hundreds of billions globally each year. And behind those numbers are real people who spend days each month barely able to function.
Treatment Exists—But Access, Awareness, and Understanding Lag Behind
Traditional preventive medications (like beta blockers) help some patients, but only a fraction of them. Acute treatments like triptans can work—until they trigger rebound headaches that are worse than the original pain. Many of us know that spiral all too well.
Newer therapies, especially those targeting CGRP, are genuinely promising. Some patients describe them as life-changing. But they remain expensive, inaccessible for many, and often unknown.
And because migraine is still not taken seriously, an astonishing number of people never even seek medical help. They just live with it. They sometimes mention it in passing—“oh, and I get migraines”—if they mention it at all. For a condition that can derail entire lives, the gap between the severity of the disease and the lack of treatment is staggering.
Despite how common migraine is, very few workplaces have policies that address it.
The Question We Avoid: What If Migraine Affected Mostly Men?
History gives us a pretty clear answer. Across medicine, conditions that disproportionately affect women—migraine, endometriosis, autoimmune diseases—have been minimized, dismissed, or psychologized for decades. When women describe pain, it is more likely to be labeled as stress, anxiety, “sensitivity,” or “overreaction.” When men describe pain, it is more likely to be investigated.
Migraine sits squarely in this long lineage of medical bias. For generations, it has been seen as a women’s complaint, something vaguely emotional rather than neurological. In the mid-20th century, many doctors literally described migraine as a manifestation of female hysteria. The stereotype still lingers today: the fragile woman with “her headaches.”
If a condition that disables one in seven adults were perceived as a “men’s disease,” it would almost certainly have received more research funding, more public awareness, more employer adaptations, and far earlier recognition as a legitimate disability.
Instead, millions of women have been told for decades to “push through it,” “take something,” or “manage stress,” as if willpower could override a neurological storm.
What Can Employers Actually Do? More Than They Think.
Migraine shouldn’t be a private burden. Workplaces can make a profound difference by recognizing it, adapting to it, and supporting those who live with it.
1. Give people autonomy over how they work: Flexibility in location and schedule is the single most important accommodation. Many of us can avert a severe attack if we rest at the earliest warning signs—but only if work allows it.
2. Accept sick leave for migraines without suspicion: No eye-rolling. No raised eyebrows. No unspoken judgment. If someone says, “I can’t work today,” believe them. Trust goes a long way toward reducing stigma.
3. Reduce sensory triggers in workplaces:
- reduce harsh lighting,
- limit strong fragrances,
- manage noise levels,
- provide quiet rooms when possible.
These changes don’t just help migraine sufferers—they benefit everyone!
4. Train managers and HR teams: A simple awareness session can avoid years of misunderstanding. Managers need to know what migraine is (and isn’t), how it affects cognition, and why flexibility is not indulgence.
5. Normalize disclosure without forcing it: People should feel safe sharing information about their condition without fear of bias. A culture of psychological safety helps enormously.
6. Support access to treatment: Health insurance plans should cover modern migraine treatments, including newly approved CGRP-targeting medications. These therapies can prevent attacks entirely or significantly reduce their severity. Supporting access is cost-effective compared to the productivity losses of unmanaged migraine.
We Are Many—and We Deserve to Be Believed
Millions of people navigate migraines in silence. We endure the pain itself, and then the second burden: the disbelief, the minimization, the cultural shrug.
Migraine is not an excuse to avoid work. It is a neurological disease that destroys days and derails careers.
We deserve to be heard and supported. We deserve autonomy, flexibility, empathy, and access to effective treatment. And above all, we deserve to be believed.
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