Professor Adam Hyde Explains Economic Impact of Chronic Illnesses

Migraines, other chronic illnesses, create balancing act for employers

Winston-Salem Journal | by Richard Craver

Valerie Koeval wakes up most days not sure if she will be able to go to work.

Koeval, an environmental studies teacher at West Forsyth High School, has suffered from migraines most of her adult life — the pain often bothersome, but sometimes excruciating. They typically are brought on by high levels of stress, she said.

Koeval said she has a migraine two to three times a month. She missed work four days during the 2011-12 school year because migraines caused her to either become too lightheaded to drive or she experienced blind spots or auras.

Another time, Koeval had to leave work just before a class began because "the migraine got so bad I couldn't see half the room."

"You don't plan on having a migraine," Koeval said. "I just wake up some mornings and go, 'Oh, no.' I do a quick triage on what's going on, try to eat, dress and take medication and hope for the best.

"But some mornings, I just know it's just not possible, and I have to call in at the last minute, knowing how challenging that is for the school to find a replacement."

Even though Koeval said her migraines can linger three to four days, "my goal is to find a way to force myself to go the next day. The biggest part of me wants to do my job to the best of my ability because my students are counting on me."

Koeval is not alone in struggling with going to work when a migraine comes on.

About 60 million Americans — or about one in five — will experience some form of migraine this year, according to a February report to Congress by the Alliance for Headache Disorders Advocacy.

A migraine headache can cause intense pain and throbbing, typically in one area of the head, according to the Mayo Clinic. It's often accompanied by nausea, vomiting and extreme sensitivity to light and sound. It might be preceded by warning signals, such as flashes of light or tingling.

Women are affected by migraines at a 3-1 rate compared with men. About half of migraine sufferers require bed rest with each episode.

Getting the work done

There's always been a balancing act – and a level of tension – in the workplace when it comes to employees experiencing a chronic illness, whether it involves migraines or back ailments, or recovering from cancer, heart disease or an organ transplant.

Most employers want to do right by their employees, but they also need to get the work done, analysts said.

Every day, about 430,000 people are unable to work because of migraines, equaling about 157 million workdays lost annually, according to the National Headache Foundation.

According to the American Migraine Study II, which appeared in the publication Headache 2001, about 31 percent of migraine sufferers missed at least one day of work or school in the previous three months because of a migraine. About 51 percent reported work or school productivity was reduced by at least half.

That tension often compels employees with chronic illnesses to show up at work, mainly to protect their job and benefits, even when it is detrimental to their health.

Those with migraines often come with deep bags under their eyes from lack of sleep, squinting as they try to readjust to light after spending hours, if not days, in darkness to rest their brains.

"Someone with chronic migraines is no different than someone with another chronic illness," said Cathy Glaser, president of the Migraine Research Foundation, who has a daughter who has experienced migraines most of her life.

Glaser defined someone with chronic migraine illness as having more than 15 migraine days a month.

"It's the humane thing to do as a society to protect people who suffer from chronic illness," Glaser said. "They didn't bring these migraines upon themselves."

Glaser and Koeval acknowledge part of the challenge of experiencing chronic migraines is that it is not an easily detectable illness, just like someone with chronic back pain.

Making accommodations for workers with a chronic illness "has been an issue in good and bad economies," Glaser said.

"Some people don't think of migraines as a debilitating illness. They just think of it as a bad headache that you just take some medicine and solider on."

According to the Migraine Research Foundation, less than half of migraine sufferers get the proper diagnosis; therefore, they often go without proper treatment.

Koeval said she was in that category, being diagnosed with migraines at age 23. She thought she had a neurological issue, but her main symptom was nerve pain that hurt her head like a bad case of sunburn.

"It was a relief to find out that I didn't have a brain tumor or some exotic illness," Koeval said.

Legal obligations

Meanwhile, more employers are dealing with the stress of replacing production or services in an already do-more-with-fewer-workers economic reality.

Most employers understand their legal obligations, primarily related to the Family Medical Leave Act.

The act provides certain employees with up to 12 weeks of unpaid, job-protected leave per year, as well as secured group health benefits during any leave. It initially was geared toward women who had given birth and needed several weeks to recover before returning to work.

The act, at its essence, applies to all public agencies, all public and private elementary and secondary schools, and companies with 50 or more employees.

Because the onset of migraines is unpredictable for most sufferers, their time off tends to be more sporadic than taking a set week or two off.

"As a rule, employers have the staffing they need, which means they have no slack," said Andrew Brod, a senior research fellow for UNC Greensboro's Center for Business and Economic Research.

"The FMLA creates a need for workers to double up on tasks or for the employer to hire a temporary replacement. To be sure, the employer can often plan on the leave and make necessary adjustments.

"In an economy this weak, it's possible that some employers would look at the prospect of losing Joe X for a 12-week FMLA leave and say, well, that's not such a bad thing."

Adam Hyde, a visiting professor at Wake Forest Schools of Business, said the challenge to employers is making up the ill employee's production or services within their workforce.

"Depending on the size of the firm and the nature of the work, employers should theoretically be able to pay co-workers extra to pick up extra hours or hire temps to fill in," Hyde said.

"In practice, that is not likely to be possible, though, because the absences are so difficult to plan for. In terms of actually measuring the cost of lost production, that gets very difficult very quickly."

Hyde said studies have shown migraine sufferers tend to have lower-paying jobs.

"I'm not sure which way the causality runs in that relationship, but one survey put migraine sufferers about twice as likely to be earning less than $22,500 as they are to be earning more than $90,000," Hyde said.

"This could be a result of them missing work, choosing — or being forced into — lower paying occupations, or likely some combination of all three."

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