By Alejandro de la Garza
June 27, 2019

Work can be a drag sometimes no matter how much you love your job. But for those who experience migraines, trying to make it through a workday in the midst of an episode can be downright excruciating.

Migraines aren’t just a big deal to those who directly suffer from them, either. According to the National Headache Foundation, missed workdays and reduced productivity due to migraines cost the American economy more than $20 billion annually. That may seem like an overly hefty price, but it makes sense if you understand how hard it is to get almost anything done in the midst of a migraine, and consider the millions of American workers who regularly have to stick out their symptoms in the office or on the factory floor.

To get advice for those who struggle with migraines at work, TIME spoke to Dr. Merle Diamond, director of the Diamond Headache Clinic in Chicago, to learn how to manage migraine symptoms during the workday—or avoid them altogether.

How to avoid migraines at work

More important than treating migraines once they come on is avoiding episodes to begin with, says Diamond. That means taking steps to adjust your work routine and office environment as much as possible in order to mitigate the specific factors that prompt episodes.

“Ultimately lifestyle plays a role, and so we talk about the migraine brain being more irritable,” says Diamond. “It doesn’t like change.” Establishing solid routines and sticking to them can be an important factor in avoiding migraines, she says. That means waking up and going to sleep at a regular time every night, staying hydrated, keeping daytime naps relatively short and not skipping meals.

Some people who experience migraines may want to avoid fluorescent lighting, as bright light can trigger their headaches. So can strong odors for some patients—so if a colleague uses strong-smelling perfume or aftershave that triggers your symptoms, that might call for a respectful conversation between co-workers.

You might not be able to change everything about your work environment to avoid migraines, but it’s important to adjust what you can control to make episodes less likely to occur.

What to do if you get a migraine at work

Even the best preventative measures don’t work all the time. If you experience regular migraines, chances are you’ll find yourself riding one out at work. If that happens, Diamond recommends trying to take 20 minutes to a half hour in a quiet spot away from your desk to rest and take whatever acute migraine medicine you use, if any. Once the migraine (hopefully) clears, or at least subsides, you can return to work.

Some people who have migraines use caffeine to treat their symptoms, but Diamond stresses that this only works if you don’t overuse it. “If you’re slamming four lattes a day, then you may have some headaches just because of your excessive use of caffeine,” says Diamond. “But if you generally don’t use caffeine a lot, then it certainly can be used as a medication.” Diamond recommends limiting your normal caffeine intake to less than 80-100mg per day, or about one cup of coffee.

When should you head home?

Migraines don’t always resolve quickly, and sometimes it can be important to know when to call it quits on a work day if an episode isn’t getting any better. Some people can tell when a migraine is here to stay based on the level of pain, or other factors, like nausea or light sensitivity. In those cases it’s important to go home get a quick nap and rest to get ready for the next day, instead of sticking around and making things worse. That is, of course, assuming you’ll be able to get home safely in a car or on public transportation. Otherwise, you might have to see about calling in a favor to get a ride from a friend or family member. If you suffer from regular episodes, try to have a talk with your employer ahead of time so they know you might have to leave work early unexpectedly sometimes.

And when you do get back to work, Diamond stresses that it’s equally important not to overload yourself right away. “When a patient misses a day because of a migraine or they’re behind because of a migraine, they get more anxious and concerned about finishing what they need to finish, and that doesn’t help the whole process,” she says. Instead, try to ease back into your work and keep from getting too anxious, as excessive stress could trigger another episode.

How should you talk to your boss or co-workers about your migraines?

Conversations with bosses or co-workers can be difficult, especially if they are under the false impression that you’re trying to get special treatment.

Diamond says it may make sense to tell your boss or HR representative about your triggers, while making sure they realize you’re still committed to being a team player and pulling your weight. That might also involve pushing back sometimes, and learning to advocate for yourself for the sake of your health.

When should you consider getting treatment?

Diamond’s research group at the Diamond Headache Clinic suspects that around 40 million Americans experience migraines, and she says that only about 55% of them have actually discussed their symptoms with a doctor. Over-the-counter medications can work for some, but for those with chronic migraines—which the International Classification of Headache Disorders defines as “headache occurring on 15 or more days per month for more than three months, which, on at least eight days per month, has the features of migraine headache”—Diamond says it may be worth visiting a specialist.

Write to Alejandro de la Garza at alejandro.delagarza@time.com.

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