How to Support an Employee With Migraines

Someone on your team gets migraines. They’ve told you, or you’ve worked it out from the pattern of sick days, and you’d like to handle it well without making it a thing.

Most guidance here is written for the employee. This is the manager’s version.

Start by getting the scale right

Migraine is a neurological condition, not a bad headache. Attacks can involve nausea, vomiting, visual disturbance, difficulty speaking, and a recovery day afterwards where concentration is genuinely impaired. Some attacks last three days.

This matters practically, because it explains two things that otherwise look like inconsistency: why someone can be at full capacity on Monday and unable to read a spreadsheet on Tuesday, and why they might come back looking fine but working at seventy percent.

The adjustments that are actually worth making

Most cost nothing.

Lighting. Overhead fluorescents and flickering LEDs are the most common workplace trigger, and the fix is a desk lamp and permission to switch the strip light above their desk off. The Migraine Trust specifically suggests avoiding flickering lights, using desk lamps over overhead lighting, and anti-glare screens. If they sit under a buzzing tube, move them or change the fitting.

Screens. Anti-glare filter, blue-light reduction, and a seat that isn’t facing a bright window. Let them turn the brightness down without a discussion.

A place to go. A quiet, dark-ish room they can use for twenty minutes without booking it or explaining. This one is disproportionately valuable: catching an attack early somewhere quiet sometimes means finishing the day instead of losing it.

Flexible hours. Being able to start late after a bad night, or make time up later in the week, prevents the specific spiral where someone drags themselves in, has a worse attack, and loses two days instead of two hours.

Meetings. Camera-optional as a standing rule, not a favour requested each time. Agendas in writing so a missed meeting isn’t a missed decision.

Scent. If your office does plug-in air fresheners or someone’s diffuser sits near their desk, that’s worth quietly resolving.

How to have the conversation

Ask once, privately, and make it about logistics rather than health.

Something like: “I want to make sure work isn’t making this worse. Is there anything about your setup, hours, or meetings that would help?” That’s answerable. “How are your headaches?” is not, and it puts them in the position of performing wellness for their manager.

Then write down what you agreed and act on it without them chasing. An adjustment promised and not delivered is worse than one declined.

Don’t ask for a diagnosis, don’t ask what medication they take, and don’t ask them to prove it. If you need medical input for a formal process, go through occupational health rather than asking directly.

What not to say

The workplace versions of the usual mistakes:

• “Have you tried…” — they have. All of it.
• “I get headaches too.” It resets the scale downward.
• “You seem to get a lot of these.” Said neutrally, heard as a warning.
• “Just let me know if you need anything.” Well-meant and useless, because it makes them do the asking. Offer something specific instead.
• Announcing it to the team. Whether colleagues know is their call, not yours.

What not to say to someone with chronic migraines covers why the kind-sounding ones land badly.

Absence, handled sensibly

Migraine absence is often short and frequent rather than long and continuous, which is exactly the shape that trips automated absence triggers.

In the UK, migraine can fall under the Equality Act 2010 where it meets the definition of a disability, which depends on frequency and impact — and where it does, employers have obligations including reasonable adjustments. The Migraine Trust covers this in detail on its migraine, disability and legal rights page, and adjustments can extend to how absence is counted. Get HR involved early rather than after a trigger point has been hit, and take actual advice rather than mine.

The practical version: if someone’s absence pattern is about to trigger a review purely because of a recognised health condition you’ve already agreed adjustments for, that’s a system problem to solve in advance.

Judge output over hours

The single most useful thing a manager can do is measure the work rather than the presence.

Someone who loses four days a month to attacks and delivers well is not a performance problem. Treating them as one guarantees they’ll start hiding attacks, working through them badly, and eventually leaving.

Help them arrive at their appointment prepared

If someone is working out what’s going on, the most useful thing you can offer beyond adjustments is time: an hour for a neurology appointment without it costing annual leave.

Those appointments go much better with records. Three months of dates, severity, medication days, and a disability score turns a vague conversation into a specific one, and what to bring to a neurologist appointment sets out what’s needed. Tools like Migraine Journal exist to make that record take under a minute a day, and a paper diary works fine too.

None of this is medical or legal advice, and specifics will depend on your jurisdiction and your organisation’s policies.