From the Guidelines
Return to work planning for a field worker with complex migraines should prioritize a gradual and structured approach, focusing on modified duties, workplace accommodations, and medication management to minimize the risk of exacerbating migraine symptoms and improve quality of life. When considering return to work planning, it's essential to take into account the physical demands of field work and the need to manage complex migraine symptoms.
Key Considerations
- Gradual reintegration into the workplace with modified duties to prevent relapse and allow the worker to maintain productivity
- Workplace accommodations such as reduced exposure to migraine triggers like bright lights, loud noises, and strong odors
- Access to a quiet rest area for acute episodes and flexible scheduling to accommodate medical appointments
- Medication management with acute treatments like sumatriptan (50-100mg as needed), NSAIDs such as naproxen (500mg twice daily as needed), or combination medications like Excedrin Migraine
- Prevention strategies including propranolol (40-160mg daily), topiramate (25-100mg daily), or monthly CGRP antagonist injections like erenumab (70-140mg)
Evidence-Based Recommendations
The most recent and highest quality study, 1, published in 2021 in Nature Reviews Neurology, emphasizes the importance of providing patients with a full explanation of migraine as a disease and its management principles. Additionally, the study recommends considering predisposing and trigger factors, and adhering to the principles of stepped care to achieve optimal individualized therapy. While the study 1 from 2015 provides valuable insights into the management of chronic migraines, including the use of headache diaries, non-pharmacological treatments, and patient empowerment, the more recent study 1 takes precedence in guiding return to work planning.
Implementation
To implement these recommendations, healthcare providers should work closely with the field worker to develop a personalized return to work plan, taking into account their specific needs and workplace requirements. Regular follow-up appointments and open communication with the worker's employer can help ensure a smooth transition back to work and minimize the risk of migraine exacerbation. By prioritizing a gradual and structured approach to return to work planning, healthcare providers can help field workers with complex migraines achieve a better quality of life and maintain productivity in their jobs.
From the Research
Return to Work Planning for Field Workers with Complex Migraines
- The return to work (RTW) planning for a field worker with complex migraines should consider the worker's medical ability and physical capability to perform job tasks 2.
- A medical RTW assessment is commonly required to assure that the worker is medically able to and physically capable of performing the job tasks, and valid functional capacity evaluations can provide objective measurements of work-related strength capabilities 2.
- Migraine is a prevalent and disabling condition that can significantly impact a person's professional life, work productivity, and interpersonal relationships at work, and most of the migraine-related productivity loss is due to presenteeism 3.
- Strategies to support people with migraine in the workplace and increase their productivity include workplace migraine education programs, workplace migraine education and management programs, migraine-friendly work environment, and migraine treatment optimization and advocacy 3.
Factors Affecting Return to Work
- Factors associated with positive return-to-work outcomes include higher education and socioeconomic status, higher self-efficacy and optimistic expectations for recovery and return-to-work, lower severity of the injury/illness, return-to-work coordination, and multidisciplinary interventions that include the workplace and stakeholders 4.
- Factors associated with negative return-to-work outcomes include older age, being female, higher pain or disability, depression, higher physical work demands, previous sick leave and unemployment, and activity limitations 4.
- Gradually returning to work may improve time to sustainable work after a work-acquired musculoskeletal disorder, especially for women, workers with soft-tissue injuries, and workers in the manufacturing or trades sector 5.
Considerations for Field Workers with Migraines
- Shift work and night work may play a key function in the pathogenesis of migraine, and further studies are necessary to better understand the exposure-disease association and define risk assessment and management strategies to protect the health of susceptible and/or migraine-affected workers 6.
- Employers, healthcare providers, and other stakeholders can use the information on factors associated with return-to-work outcomes to facilitate return-to-work for injured/ill workers, regardless of the specific injury or illness 4.