Neurological diseases involve any disorder that affects the central or peripheral nervous system, which is composed of the brain and spinal cord, and all the other nerves in the body.
Neurological diseases are common and can result in an extremely wide range of symptoms, depending on the specific disorder and, especially where the brain is concerned, on the specific areas involved.
Neurological conditions such as Parkinson’s disease, motor neuron disease, and epilepsy result from damage to the brain, spinal column or peripheral nerves. Some neurological conditions are life threatening, with many severely affecting an individual’s quality of life. It is not always easy coping with the pressures of work when a person is affected by a neurological condition, and many employers are unaware of the ways in which their condition
might affect their work.
There are over 600 types of neurological conditions, which are broadly categorized (according also to a recent report of NHS UK) into:
- Sudden onset conditions (e.g. acquired brain injury or spinal cord injury),
- Intermittent and unpredictable conditions (e.g. epilepsy, certain types of headache, or the early stages of multiple sclerosis),
- Progressive conditions (e.g. motor neuron disease, Parkinson’s disease, or later stages of multiple sclerosis),
- Stable neurological conditions (e.g. post-polio syndrome, or cerebral palsy in adults).
In this section, we describe three neurological conditions: migraine, multiple sclerosis and stroke that are very frequent in working age.
The case of migraine
Age: 30 years old
Job: Employee in a multinational company
The case of Anna who suffers from migraines
Almost every month Anna suffers from severe migraine attacks, which prevent her from concentrating and force her to rest and stay at home in bed as movement is almost impossible for at least a day. She suffers the symptoms of severe pain, nausea, vomiting, and photophobia. Anna is worried about her absences from work; therefore, if the pain is not too strong, she takes painkillers and with much difficulty, goes into work or remains in the office instead of staying home so as to keep on working. When she is well again and free from migraine attacks, she overworks constantly and gets very good results in her very competitive working environment. Performing so well despite her disease is very stressful for Anna, but she refuses to talk with her manager and colleagues for fear of being judged as lazy or even of losing her job, as she does not have a permanent contract but one that is renewable on an annual basis.
1 What is it
Migraine is classified among the three main types of headache; however, migraine is not only a headache. It is a complex, common, and disabling disorder of the nervous system, whose mechanisms have only recently begun to be understood.
Migraine is a chronic disorder with episodic attacks characterized by sensory symptoms: severe throbbing pain or a pulsing sensation and sensitivity to normal afferent information, such as light, sound, and head movements.
At least 10% of the world population is affected by the disorder that, after puberty, is 3 times more common in women, with peaks reaching 25%. Most of the sufferers have their first attack before the age of 20, and attacks may decrease after middle age.
Those who have regular attacks may recognize some factors that trigger them, such as stress, lack of sleep, weather, fasting, certain food or drinks, alcohol, hormonal factors.
- Migraine appears in the form of periodic attacks separated by intervals of wellness.
- Migraine varies in its intensity: some attacks may be mild, others very severe.
- Attacks can last from 4 to 72 hours (sometimes longer) and tend to affect only one side of the head.
- Migraine is often accompanied by nausea or vomiting, and extreme sensitivity to light and sound, and it worsens with normal physical activity.
Migraine with aura is a headache that is combined with, or preceded by temporary visual and sensory disturbances called “aura”: these can include flashes of light, blind spots, tingling or numbness in a part of the body or problems in speaking clearly.
Migraine aura usually occurs within an hour before head pain begins and generally lasts less than 60 minutes.
Sometimes migraine aura occurs with little or no headache, especially in people age 50 and older.
Migraine occurring without aura is more common totaling 80% of migraines.
Migraine treatment can help stop symptoms and prevent future attacks. Since migraine pain is the result of neuro-vascular mechanisms inducing vasodilatation and the activation of the trigeminal pain system, symptomatic treatment for migraine may be classified as:
- specific: aiming at contrasting vasodilatation; it includes triptans and ergotamine
- nonspecific: analgesics, which include painkillers such as paracetamol, NSAIDS, opioids
Unfortunately, the frequent use of symptomatic treatments may cause migraine to become chronic due to sensitization of the pain system and patients overusing symptomatic treatments may be asked to limit their use and let the headache take its course untreated.
Preventive treatments are used to reduce migraine severity in terms of frequency, headache intensity and the need to use symptomatic drugs. All currently available preventive medication therapies for migraine were initially developed for other diseases and were later adopted as treatments for migraine (anti-hypertensive drugs such as beta-blockers, antiepileptic drugs, anti-depressants, Botox, etc.).
Adverse side effects are common for most of the preventive therapies and adherence to treatment programs could be a serious issue. Lifestyle modifications, including the avoidance of trigger factors, stress management and an exercise program, may be effective.
4 Psychosocial issues and impact of the disease on employment
Migraine is among the most widespread diseases in the world and the most frequent disease during working age, with considerable economic repercussions. The World Health Organization places migraine in the top 10-20 most disabling diseases on the planet. In fact, a migraine headache is characterized not only by pain but also by severe disability. Despite these data, migraine continues to be underestimated, under-recognized and under-treated throughout the world. Migraine creates social as well as economic problems for those who are affected.
- The repeated attacks and the constant fear of subsequent ones, affects family, social and work life. The constant avoidance of possible triggers as per clinical advice and strategies to prevent migraine often lead to negative consequences such as stress, anxiety and depression. The fear of a new attack can lead to isolation and avoidance of many activities, especially when they take place in social contexts.
- Moreover, the frequent use of medication to alleviate and prevent migraine can lead to medication overuse.
To manage workers with migraine and help them continue working or returning to work, employers can promote some interventions.
In the workplace, employer and colleagues in fact have an important role to play in helping and accommodating people with migraine
- CREATING AN UNDERSTANDING AND INCLUSIVE ENVIRONMENT
One of the most frequent problems related to migraine concerns the attitude of colleagues in relation to the person with the disease: the pain that the person experiences is not perceptible from the outside (“invisible illness”); thus, workers with migraines are often labeled as whining, lazy and their suffering is belittled. Therefore, all staff should be informed of the issue and be made more aware of the seriousness of the disease. To avoid and prevent stigmatizing behavior and to create an inclusive and collaborative team is essential to make the employee feel better.
- PLANNING FOR FLEXIBILITY OF WORKING TIME DURING A MIGRAINE ATTACK
When an attack occurs, depending on its severity, people may have reduced performance or be completely unable to work, may need rest, to go home or stay at home, to relax in a quiet darkened room. When the attacks are frequent and severe (in severe cases they can reach 15/20 days /month), migraine can be very disabling. Thus, it is crucial to respond suitably to people’s needs, in order to prevent absenteeism and presenteeism. It can be useful to plan in advance, together with the employee and colleagues, what to do in case of an attack and how to manage sudden or prolonged absences (e.g. by organizing collaboration, substitutions, task sharing, etc..)
- MINIMISING EXPOSURE TO TRIGGER AND EXACERBATING FACTORS
Even though triggers can be very personal, some common work conditions, like bright lights, loud noise, stress and overworking are possible triggers for people suffering from migraine. Talking to employees with migraine about their triggers and what exacerbates their attacks and then being flexible and accommodating in trying to reduce their exposure to these conditions, or limiting their impact, will make the employees feel and work better.
For further information, see:
European Academy of Neurology (EAN) – https://www.ean.org/EAN-Scientific-Panel-Headache.2796.0.html
European Headache and Migraine Alliance (EMHA) – https://www.emhalliance.org/
European Federation of Neurological Associations (EFNA) – https://www.efna.net/