Assessing the Impacts of Migraine, Tension-Type Headache on Employees’ Work Ability

Migraineurs and those with tension-type headaches reported poorer physical and cognitive work ability compared with their headache-free counterparts.

In a new paper published in the International Journal of Industrial Ergonomics, researchers assessed how migraine or frequent tension headaches affects individuals’ ability to work using self-reported information from over 5000 Danish study participants.

Among the findings reported, data showed individuals with a headache disorder have poorer physical and cognitive work ability, and that no medical treatment or medication overuse were associated with poor work ability.

Migraine and tension-type headaches (TTH) are the 2 most common primary headaches, while both conditions are more common among women. In addition, “migraine and TTH co-occur with emotional problems and poor mental and physical health, and these disorders have substantial consequences in terms of disability,” authors wrote.

Although previous studies have investigated generic measures of work ability associated with migraine, there is a lack of knowledge when it comes to specific work-related activities affected by headache disorders.

To fill this gap, researchers gleaned information from the Copenhagen Aging and Midlife Biobank, collected between 2009 and 2011.

All participants (n = 5551) were between the ages 49 and 61 and were occupationally active. Of the individuals who filled out the questionnaire, 4028 also completed a clinic examination.

Of the 5551 participants, 10.7% previously had migraine/ frequent headache and 9.2% currently had migraine/frequent headache; the percentage of full-time employees did not differ between groups, although holding a part-time job was more common among migraineurs/those with frequent headaches.

Adjusted analyses revealed that those with past or current migraine/frequent headache had higher odds of poorer work ability across all outcomes including:

  • The ability to handle physical demands (Odds Ratio [OR] 1.98; 95% CI, 1.58–2.47)
  • The ability to handle cognitive demands such as remembering things (OR 1.66; 95% CI, 1.40–1.98) and making quick decisions (OR 1.43; 95% CI, 1.19–1.71)

However, adjusting for depression and musculoskeletal pain reduced these associations and explained most of the symptoms observed, researchers said, noting both depression and musculoskeletal pain are ranked high in terms of years living with disability.

In subgroup analyses of patients who underwent examinations, “we found the poorest work ability among participants with migraine/frequent headache and no or daily use of medication,” authors wrote. “The strongest associations were found in relation to difficulties handling the physical demands and cognitive demands related to memory and decision-making, and additionally to the pace of work and to client-work among those not using medication.”

After adjusting for depression symptoms and musculoskeletal pain in this cohort, among those with current migraine/frequent headache and daily use of medication, “only the odds of difficulties handling physical demands were significantly higher than among participants without migraine/frequent headache (OR 3.70; 95% CI, 2.61–5.23).”

The overall finding that patients had poorer work ability than those without migraine is in accordance with previous studies that used sickness absence, productivity, and effectiveness as work ability indicators.

Because past research has shown changes in mood and neck discomfort may serve as warning signals of a migraine attack, authors hypothesized depressive symptoms and musculoskeletal pain could serve as mediators of the migraine/headache-work ability link observed in the current study.

“These insights open new avenues for treatment and improvement of quality of life and work ability among employees with headache disorders,” they wrote.

In the current study, those suffering the most severe headaches may have been out of employment, thus excluding them from the sample and marking a limitation. In addition, researchers were unable to assess frequency or severity of attacks. Clustering of headache disorders may also occur alongside other health-related factors.

Overall, “Current headache, combined with either no medical treatment or overuse of medication—both signaling suboptimal treatment and medical counselling—were associated with poorer demand-specific work ability,” authors said.

“Efforts aiming at improving work ability and thereby a sustainable attachment to the labor market should preferably adopt a multi-faceted approach taking both neurological, mental and physical health conditions into account, i.e., by managing co-occurring pain or mood conditions or introducing non-medical treatment options such as supervised physical activity,” they concluded.


Steenberg JL, Thielen K, Hansen JM, Hansen AM, Rueskov V, and Nabe-Neilsen K. Demand-specific work ability among employees with migraine or frequent headache. Int J Ind Ergon. Published online December 13, 2021. doi:10.1016/j.ergon.2021.103250

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