Migraines

Don D · May 2002

[font size="1" color="#FF0000"]LAST EDITED ON 05-01-02 AT 12:57PM (CST)[/font][p]Any of you have experience with migraines as an FMLA qualifier? What can I expect to encounter? If approved, it seems it would be a free ticket for the employee to miss 60 days annually (5 day week x 12 wks). I don't know frankly if this is a 'serious medical condition' or not.

System · May 2002

I'm not very familiar with migraines (my specialty is being a pain in the neck). Are they incapacitated for three days? Or would it last three days if they didn't get treatment? (Something in the back of my mind makes me think that's important.) If you're a member of the Mississippi Employment Law Center, you can check the Special Report called "FMLA Leave: A Walk Through the Legal Labyrinth."
[url]http://www.hrhero.com/special.shtml[/url]

James Sokolowski
Senior Editor
M. Lee Smith Publishers

Don D · May 2002

The thing is they probably won't have to be incapacitated 3 days if the doctor indicates ongoing, unpredictable, debilitating migraines serious enough to render them incapable of coming to work. If they bring in that statement, I assume they'll qualify for intermittent. then I'm probably looking at 60 migraines (for the employee) per 12 month period. (?) Thought somebody out there might have had this situation already.

franfields · May 2002

I am responding to your comment about a "free ticket." Please try to be more sensitive to the fact that migraines are not something a person wants, unless there is something about this individual you know but did not say.

Some suffers will vomit and not be able to stand light. How would you like to work feeling that way? For that matter, how would you like to be at home in bed feeling that way? As a migraine sufferer myself, I would tell you they can be debilitating. I have had them last as long as 7 days and have felt so bad I thought I would do anything to be put out of my misery. I have never missed work but understand how someone might.

I don't know about qualifying for FMLA although I doubt it would but, if you believe this person has a performance issue, address that as the issue.

Nat · May 2002

Unfortunately, intermittent leave does seem to provide the employee with a lot of time to be out of work. I think migraines would be considered a "serious medical condition" because of the following wording in the law:

"The FMLA is not designed to cover minor illnesses or routine outpatient surgical procedures. Thus, abset complications, common illnesses such as headaches other than migraines, the common cold, upset stomachs, or other routine problems ordinarily will not qualify as "serious health conditions"."

The fact that it says "other than migraines" leads me to believe that the law is intended to cover them. I would and have covered them. You still need to get certification from a physician stating that the employee may have episodic periods of incapacity that will not allow them to work.

Good luck!
Nat

Rockie · May 2002

Don: This would probably fall under the case of a "chronic medical condition". I believe your concern may be that any employee that has a headache will say "I have a migraine" and will want to be out for FMLA. In order to qualify for this, I would think the employee should have a certification from their physician stating they do, in fact, suffer from migraines.

mschneider · May 2002

[font size="1" color="#FF0000"]LAST EDITED ON 05-07-02 AT 09:40AM (CST)[/font][p]A diagnosis of chronic migraines usually requires visiting a neurologist and extensive medical testing, often including a CT scan or MRI. (Mostly to rule out other conditions.) Requiring doctor's certification seems to be a good way to discourage abuse of the term "migraine" as an excuse to miss work.

As a migraine sufferer myself, I can say that a severe migraine can make even driving to work impossible, let alone being productive once there. Classsic migraines often include visual impairment of varying degrees. The good news is that new medications can prevent or provide relief from migraines for many people... so, by requiring doctor's certification, you may actually do your employees a favor by encouraging them to get medical attention for their migraines.

For more info on migraines, try this link:
[[url]http://content.health.msn.com/condition_center/mig][/url]

Don D · May 2002

Thanks for the replies guys. As I told one of you in a private email, the frustration evident in my posting was not a result of insensitivity to the problem of migraines, quite the contrary. The Ee in question does have a doctor's diagnosis of migraines but, strangely, only has them on Fridays, so far 5 Fridays. Additionally, this Ee asked for excused absences Friday and Monday over spring break weekend so his band could play on the Gulf Coast and that was not granted per policy. However, a migraine did develop, coincidentally I'm sure, and he was out for that reason on the Friday and Monday he had requested originally. He has since requested excused time off to go to another state to pick someone up. When I told him that didn't fall within the attendance policy guidelines, he played the migraine card and said, "Who knows, maybe I'll have another migraine". This is the 'free ticket' I referred to.

franfields · May 2002

As I said in my first response, if it is a performance issue, which I suspected, you need treat it as such. Make sure you have documentation and then deal with the real issue.

That's someone who gives real migraine sufferers a bad image.

Rockie · May 2002

This is just TOOO coincidental to be real. Migraines come in all variations from very mild to debilitating. (I have them myself). I would just have a heart to heart with the employee (and present documentation) that the migraines are occurring only on Fridays and/or Mondays and also when he doesn't get his way. I would specify the next time that one occurred in one of these instances, that the employee be required to bring in a doctor's excuse or he would be subject to discipline. This employee, indeed, is taking you for a ride.

Margaret Morford · May 2002

I would also suggest adding language to your attendance policy that permits you to address a "pattern of absenteeism" regardless of leave status or available PTO. I'll be glad to send you some language to include in your attendance policy.

Margaret Morford
theHRedge
615-371-8200
[email]mmorford@mleesmith.com[/email]
[url]http://www.thehredge.net[/url]

memiller · May 2002

We have an employee who has been on intermittent leave for migraines for the last 3 years. She has been hospitalized, tried botox injections, had to be detoxed from all the medication she has been on over the years...the whole gambit. Nothing is helping her or us, for that matter. She usually uses around 250 hours/year of FMLA and it just continues year after year. We are really in a bind because of it. We also have noted that a lot of days off are on Mondays, however, we can't prove anything else. She is a great employee, does a wonderful job when she's here but we can't count on her when the going gets tough. She is in a higher salary range so to give her a different position at the same pay would not be beneficial to us. FMLA is great for the employee (and I understand and sympathize with her condition) but from an employer's stand point, our hands are tied.

dolores · August 2002

One reason an employee who suffers from migraines might miss a lot of Mondays is because the body realizes on weekends that it doesn't have to go to work, hence, the stress that it was storing up all week is unconciously released bringing on headaches. I'm not saying that your employee who suffers many migraines on Mondays falls into this category, just pointing out a legitimate reason why they occur on that day of the week.

dianeo2001 · May 2002

Be careful making the "Friday/Monday" assumption of guilt. A few years ago, when I was first promoted to Manager of HR with a company in Chicago, I reviewed time cards and pulled all those of employees showing a Friday/Monday absence pattern. There was one card that really jumped out at me and I set it aside, figuring I had a problem on my hands. When I later turned the card over and looked at the name, I had quite an eye opener. The card was mine.

It certainly sounds like Don D's employee is faking it, but not everyone is. Just be cautious before passing judgment.

Terri B · August 2002

I know I am viewing all of this quite a bit after the fact based on the dates of the items posted. But, we are definately struggling with this one too. I am also a migraine sufferer and know how bad they can get. But, it also seems that we have a sudden influx of employees with migraines. I don't see a way around the use of intermittent leave for this, though. I was hoping for clarification as time went on but none has appeared. Have there been any court cases with this subject yet?

Gillian · August 2002

[font size="1" color="#FF0000"]LAST EDITED ON 08-14-02 AT 11:51AM (CST)[/font][p]At least one because I testified in it as an expert witness for the plaintiff. The case was a wrongful termination case. The employee was terminated for violating attendance policies, most of which were for migraine headaches. There is some fine print in the Family Leave regs which states that migraines are not the normal run of the mill headache. It was a little more complicated than this because there were allegations of sexual harassment and a botched investigation as I recall. The case is Grant v. St. Jude Medical Center, Orange County Superior Court (CA) case #79-25-06. The case went to trial in 1999 and the plaintiff prevailed.

One case, however, doesn't mean much. It is necessary to see trends before we can safely say that we should write policy in reaction to court cases.

nellyhrmendez · September 2002

I have the same problem with a direct report now, that is to say Friday and Mondays are usually migraine days. I am extremely sympathetic to sufferers of this having personally experienced it however, this just stresses the importance of medical documentation to proceed when faced with this type of situation.

I'd like to know what you end up doing with this employee. Thanks.

Sunny · August 2002

>[font size="1" color="#FF0000"]LAST EDITED ON 05-01-02 AT
>12:57 PM (CST)[/font]
>
>Any of you have experience with migraines as an FMLA qualifier? What
>can I expect to encounter? If approved, it seems it would be a free
>ticket for the employee to miss 60 days annually (5 day week x 12
>wks). I don't know frankly if this is a 'serious medical condition' or
>not.

Don D. - I have quite a bit of experience with migraines as an FMLA qualifier. When I took over HR at my non-union facility, I found 4 people who had "FMLA" absences due to migraine headaches. Since there was no paperwork, I started over, obtained medical documentation and started the clock. Three of the individuals brought back the paperwork - one apparently decided that her migraines weren't that bad - or couldn't get her doctor to sign off. During the first three months one individual took several days off. Since then there have been very occasional and truly intermittent absences from all three but no abuses. And there was nothing like 60 days - ever. I found that migraines were FMLA qualified and that the sufferers did not abuse. Maybe I was just lucky.

System · August 2002

We too have abusers with "migraines." We also have employees with legitimate migraines. We require medical certifications for most everything except inpatient care and childbirth. We require recertification for migraines every 3-4 months, to assure they are under a doctor's care. We also require use of up to 1/2 of earned vacation for intermittent leave. And still we have abusers. I just got off the phone with the Dept of Labor. Have you noticed on the notification the area requiring "fitness for duty certificate?" The DOL said we can use that for migraines. We are going to. At least they then have to go to the doctor each time they have a migraine. That way medication can be adjusted if it is a real migraine, and the issue can be addressed if not. We are also going to use the 2nd opinion option for migraines and make sure the employee is seeing a specialist instead of just their family doc, who seem around here to approve everything. (Big union town.) Everyone should benefit, legitimate migraines will get the attention and help they deserve and it will help us idenfify abusers, even if it is at our cost.

dolores · August 2002

No good solution to this problem. As someone who suffered frequently in the past from headaches that made me throw up, the last thing I want to do when I have a headache is visit a doctor and have to suffer through the wait. Several months ago, while waiting with my sister in a hospital emergency room, a woman was there suffering from a migraine. She was in such bad shape she had to sit in a wheelchair. Her moaning tugged at my heart because I know how sick you can be with a headache. She, or perhaps her family, could no longer stand the pain and the wait and elected to take her home. I know that employees who abuse FMLA by claiming migraines can be a real pain to employers, but unless you've suffered through one, you have no clue as to how employees suffering from legitimate headaches will suffer if you mandate that they go to a doctor everytime they have one. Many migraine suffers treat their headaches with prescription medicines, hence, there would be no reason to see a doctor, who is already treating them, and the medicine just needs time to kick in.

Joan · October 2002

I saw your comment on requiring "fitness for duty certificates" after each use of an intermittent leave. I was unaware that an employer may require that. Please comment.

benefits · August 2002

I share your feelings. I have a large number of employees using "intermittent" FMLA for migraines, hypertension, depression and chronic ear infections. We require that employees update their medical certification every 6 months. But it opens a door for abuse. I do not doubt that some employees legitimately use intermittent for chronic health conditions. I had a doctor call me and complain because so many of his patients were coming and asking him to complete FMLA papers for intermittent leave.

TALLEY · August 2002

I've been reading these posts for several weeks now and have been tempted to respond but have refrained thinking I was being overly senstive because I can sympathize with the migraine folks.

As a migraine sufferer, I can only tell you that my worst day at work is better than any day spent at home with a migraine! I usually try to make it through at least part of the day to take care of essentials even when I have a migraine. I'm fortunate, most of the time I can take medication and get through a few hours. But on those occasions when I can't, you wouldn't want me on duty (if my work was hazardous or required critical decisions) with the accompanying nausea, vomiting, blurred vision, loss of concentration and my general rotten attitude and personality. After two or more days of the meds, the "hangover" effect makes me feel as if I'm in a haze somewhere. Fortunately as the HRM I'm not too dangerous. But, it's a one-person office, so my attendance is often times critical.

I wish my physician and I could find something to treat the cause and prevent the headaches from happening; the best we can do now, as for most people, is to treat the symptoms. But he would think I'm a nut if I showed up in his office everytime I have a migraine. We discuss the situation everytime I'm in his office anyway, so if anything new develops, we have regular discussions about new treatments, medications, therapies, etc. I doubt I would be able to get a same day appointment everytime anyway. Have you considered what these frequent office visits will do to your health insurance rates?

After reading these posts and a recent post from Don D (Paperwork? Sorry Charlie) I guess I better understand why some health care providers are charging a fee to fill out paperwork.

Mentel · August 2002

I also suffer from Migraines and I am also the HR Director. You are correct in your assessment of their severity and debilitating effect. I have been lucky to have only one in the last two years where I had to stay in bed (because I couldn't get up and walk!). The following are what I have done to keep them at bay: 1. Get off of sugar. A drop in blood sugar will bring on a migraine. You may be suffering from hypoglycemia and this is bringing on the migraines. 2. Take feverfew every day for a couple of months. 3. I am assuming that you take Imitrix. Be sure you get a large enough dosage. I went from 25mg to 50mg. Also, take the Imitrix at the onset so it doesn't get out of hand. 4. Get plenty of exersize. Hope this helps.

franfields · August 2002

I had read about B2 (Riboflavin) as a help for those who have environmentally triggered migraines. (I could feel every severe weather front before it came through the area and had a much better track record at predicting rain than our local weatherman.) The article said to take 400 mg/day. I take 250 mg and it has made a difference. It hasn't eliminated them but it has helped. I have told others who have also seen a decrease in their migraines. :DD

There is an article on WebMD at [url]http://my.webmd.com/content/article/1668.50057[/url]. This may be linked to a cookie on my computer. If so, go to htttp://www.webmd.com and do a search on that sight for "B2 Migraine". A link to the article should be the result.

Debra F · September 2002

Have you tried the anticonvulsants such as Depakote or Topamax? I'm getting excellent results with Topamax and it's suppose to be a good one for losing weight as well. That combined with the triptans for the ones that get by have done wonders for my migraines. If you are not seeing a headache specialist (not just a general neurologist), you might want to look for one in your area. Check out the American Council on Headache Education's website at [url]http://www.achenet.org[/url]
I have been lucky since i've started on this regimen that my lost days due to migraines have decreased tremendously. Now it's just a couple of hours every couple of months. There were times when I'd be hospitalized for several days until we could get them tamed.
Migraines are serious health conditions and can lead to strokes. I know of several people who have suffered strokes as a result of migraines. There have been several studies done recently to show that migraines are comorbid (co-exist) with other medical conditions as well such as depression and some others. Although we don't have anyone currently on FMLA for migraines, if someone did come in and ask about it, you can bet I'd be very sympathetic to them if they did. Sympathetic, yes; pushover, NO!

Don D · August 2002

This one has gone from North to South to East to West since it was posted. It was never meant as a harsh criticism or insult to anyone who suffers legitimately from migraines. My original post was because of a guy who had Friday migraines and 'situational migraines' depending on his needs to be off work. God gave HR people enough to deal with.....Wonder why he also gave some of them migraines???

System · August 2002

I did not mean to offend anybody truly suffering from migraines. I am trying to find ways to prevent abuse of FMLA. We have a union environment and it seems they've encouraged FMLA to cover any absenteeism. Like the guy who called in with a migraine whenever he had to go to his other job. Luckily he quit (just when we had the proof we needed), saved me from an HR "migraine" anyway.

njjel · September 2002

What an interesting post on a subject that I, ironically, had fall on my plate to deal with just minutes ago! Again, the Forum has proven to be extremely helpful.

Pork · September 2002

Don, It is when you get one of those "blinding and up-chucking" kind that it hits and your job is a driver of a school bus, or a receptionist greeting and meeting the customers, or a Wal-Mart cash register operater that performance issues and risk and the essential functions of the positions get caught up in the FMLA concerns. If the physician labels it as a serious health condition in concert with a copy of the job description, I believe I would support the employee's application certified by his/her physician's signature. There is no way to program or schedule an appropriate time off. The issue only hits one when the attack is on-going. The individual needs to assess whether the job or stress or environment is condusive to his/her health and the headaches. Just maybe, the individual needs to get another position somewhere else. I believe the intent of the congress was to protect the employee with a need to get major medical attention on an interm but generally scheduled bases. Migraines on an unscheduled bases would not appear to reach the physician certified care threshole, but then the physician may have attented that other school in North MS but located in Central MS and they would certify whatever the brother and sisters from the other side of the campus wanted. Hope this helps! Pork

Don D · September 2002

Migraines on an unscheduled bases would not appear to reach the physician certified care threshole, but then the physician may have attented that other
>school in North MS but located in Central MS and they would certify
>whatever the brother and sisters from the other side of the campus
>wanted. Hope this helps! Pork

Pork: What in the devil are you talking about? Did you have a liquid lunch or what? I want you to accept this assignment for the weekend, then come back on Monday and explain to us what you consider a 'scheduled migraine' and an 'unscheduled migraine' and who has the ability to schedule one and how they developed that art. The people I come into contact with rarely if ever schedule an illness and never a migraine. Migraines, as we have been shown in many of the above posts, are specifically laid out in the FMLA language as event qualifying.

Migraines

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