Including Migraines in Wellness Programs May Reduce Workplace Injuries

Migraine headaches are very common and can lead to injuries at work.  Before puberty, boys have them more often than girls but after puberty the women catch up and pass, affecting 18% of woman and 6% of men.  Many migraine suffers are unaware their headaches are migraine, and many never seek medical treatment.  People may have more than one kind of headache, so it is important to sort out which symptoms are associated with which kind of headache. They are so common, your wellness program should incorporate migraine information.  

Common misconceptions about migraine include:
1. The idea that all migraine headaches are associated with visual disturbances, called an aura.
2. The belief that only headaches lasting several days and forcing the sufferer to remain in a dark, quiet room are migraines.
3. The idea that migraines are like tension headaches, just a little more severe.

Criteria for diagnosing migraine without aura. A.  At least five lifetime headaches lasting between 4 and 72 hours without treatment or between 3 and 72 hours if always treated.  B.  Any two of the following:

1. Moderate to severe  intensity (Moderate intensity interferes with normal activity and limits efficiency, severe intensity prohibits normal activity.)
2. One-sided  (Pain is limited to or notably worse on one side.)
3. Aggravated  by activity such as climbing stairs.
4. Pounding,  pulsating, or throbbing characteristic more than rarely.

C.  At least one of the following:

1. Nausea or vomiting more than rarely

2. Both

a. Sensitivity  to light (Photophobia) and. b. Sensitivity to sound (Phonophobia).

D.  At least one of the following:

1. History, physical, and neurological examination suggest no organic disorder;
2. One or more  of the following history, physical, or neurological examination suggest an organic disorder that is later ruled out;
3. Organic disorder  is present, but migraine attack doesn't occur for the first time in close temporal relation to the disorder.

If you have an aura, criteria for diagnosing migraine with aura are:

A.   At least 2 attacks fulfilling criteria B through D, below. B.   Aura consisting of at least one of the following, but no motor weakness:

1. Fully reversible  visual symptoms including positive features (e.g., flickering lights, spots or lines) and/or negative features (e.g., loss of vision)
2. Fully reversible  sensory symptoms including positive features (e.g., pins and needles) and/or negative features (e.g., numbness)
3. Fully reversible  dysphasic speech disturbance

C. At least two of the following:

1. Homonymous visual  symptoms and/or unilateral sensory symptoms
2. At least one aura  symptom develops gradually over 5 minutes and/or different aura symptoms occur in succession over 5 minutes
3. Each symptom  lasts more than 5 and less than 60 minutes

D. Headache fulfilling criteria B through D (above) Migraine without aura begins during the aura or follows aura within 60 minutes E. Not attributed to another disorder.

Author: Sanford S. Leffingwell, M.D., MPH, FACOEM  is a board certified specialist in occupational medicine, with degrees from Harvard University, University of Colorado School of Medicine and The Johns Hopkins School of Hygiene and Public Health. He can be reached at ssl@hlmconsultants.com. www.HLMConsultants.com