Canadian HR Reporter

CANADIAN HR REPORTER October 30, 2017 2 NEWS Recent stories posted on www.hrreporter.com. Check the website daily for quick news hits from across Canada and around the world. WEB O N T H E ACROSS CANADA Feds ditch memo calling for controversial employee discount tax, pending review 'Let me be blunt: We are not going to tax anyone's employee discounts': PM Toronto District School Board to remove 'chief ' from all job titles Word being replaced with terms like 'manager,' 'executive officer' Sears Canada seeks court approval to liquidate assets Company says it received no viable transaction to keep it afloat U.S. tech workers more likely to job hunt in Canada: Study Job searches spiked near presidential election, inauguration Actions of 3 ex-railway workers caused Lac Mégantic disaster: Crown Says trio was criminally negligent; contributed to death of 47 victims Minimum wage bumps come into effect in several provinces As of Oct. 1, Alberta, Manitoba, Newfoundland and Labrador, Saskatchewan all see increases Proposed law would give paid leave to domestic and sexual violence survivors Would give people 10 days' paid leave in Ontario Court rules in favour of Suncor on random drug testing Union calls decision gross violation of workers' rights AROUND THE WORLD U.S. labour union challenges Cowboys' anthem stance Players who disrespect the flag 'will not play': Owner Two-year Brexit transition is assured, U.K. PM May tells business chiefs: Source CEOs raised concern over access to labour Japan ad agency Dentsu fined for making employees do too much overtime Scrutiny came after death of young employee from overwork Uber's U.K. boss quits as firm battles to keep London licence Appeal affects 40,000 drivers Win-win situation Manulife's director of campus recruiting and strategic sourcing discusses the benefits of student internships/co-ops for employers hrreporter.com FEATURED VIDEO LeNoury Law Proactive Advice to Management Employment Lawyer of The Year James LeNoury B.A. (Hons) M.A. LL.B 416-926-1107 • Toll Free 1-877-926-1107 • lenourylaw.com dicated they had cut back on participating in hobbies or other activities due to migraines, and they felt their family, friends or colleagues did not understand their condition. "The biggest thing to keep in mind is that people with mi- graines, they want to be able to work, they want to be able to par- ticipate in activities with family and friends and co-workers, and they want to be there for their kids," said Benson. Symptoms, diagnosis and stigma Migraine attack symptoms typi- cally experienced by respondents included head pain (91 per cent), sensitivity to light (87 per cent), sensitivity to sound (80 per cent) and difficulty concentrating (73 per cent), found the survey. Nine out of 10 respondents (92 per cent) said they experienced some form of "cognitive anxiety," meaning their ability to think can become impaired, leading to confusion, memory loss or an inability to focus due to pain and other symptoms. Migraines have been deter- mined as a neurological disease, and while the primary symptom is a headache, there are many other possibilities, according to Benson. ese can include a stiff neck, aura, hallucinations, trouble speaking, nausea, vomiting, con- fusion, dizziness and fatigue. at could last for hours or days, and once that's over, there's a migraine "hangover" that can involve fa- tigue, a minor headache or trouble concentrating. People often talk about "trig- gers" when it comes to migraines, but there's a huge distinction be- tween a trigger and a cause, she said. "A cause is something like ge- netics or a past history of concus- sion that could even bring on the disease in some people, whereas a trigger is something like maybe you eat some kind of food and that triggers a migraine for you." Triggers can run the gamut from a smell, a change in sleep schedule or travelling, she said, and it's often difficult for people to identify them. "Trigger" is a bit too strong of a word, according to Deon Louw, a neurosurgeon at Caleo Health in Calgary, who prefers to call them intensifiers. "One of these focal intensifiers could convert a mild attack to a severe one… or push you over the edge when you have an undecided migraine that's sort of hesitant — it's kind of incubating," he said. ere are about 38 million peo- ple in the U.S. with migraines, and just 500 or 600 headache special- ists, according to Amrita Bhow- mick, chief community officer at Health Union. "When you think about it as a field, it really isn't quite as devel- oped from an academic stand- point as some other fields are, and that has led to a gap in research and knowledge," she said. "Mi- graine still remains a diagnosis of exclusion, which is always much more challenging from a physi- cian's standpoint. You really have to be able to rule out many other things before you can know for sure it is migraine." Migraines are still underdiag- nosed, partly because the educa- tion of GPs on them is severely deficient, said Elizabeth Leroux, clinical associate professor of neu- rology at the University of Calgary. "To be honest, some cases are not diagnosed because they are not frequent or severe enough to seek medical attention, or because they look like tension type headaches. Others are confounded with some- thing else," she said, such as sinus headaches or neck headaches. Chronic migraines have been defined more recently, in the last 10 to 15 years, and are still severe- ly underdiagnosed, she said. "is is a bigger issue because this is a significantly disabling disease." In looking at the number of people misdiagnosed or under- diagnosed, it's like an iceberg, with only the tip representing those di- agnosed, said Louw. "Many family doctors associate migraines with women but one in 16 men get migraines as opposed to approximately one in five for women." And the criteria used to classify headaches and migraines can be quite complicated for the average physician, he said. "e various symptoms associ- ated with migraine, they're not all of equal importance, and so the family doctor may be focusing on symptoms that don't have high odds ratios or a positive predic- tive value." e actual cause of migraines is still considered unknown, which of course impacts our ability to treat them, said Bhowmick. And most triggers are very difficult to avoid because they're environ- mental or ever-changing. People with migraines often say "My life is my trigger," she said, as coffee might be fine one day, and not the next, for example. "The general public thinks, 'Why don't people just avoid that trigger?' and it's simply not that easy." Research has shown almost 70 per cent of people feel others don't understand their migraine is not just a headache, while two- thirds worry about disappointing people, and about half are embar- rassed they have migraines, said Bhowmick. "It's huge, the impact of stigma, because if you're hiding it and you're worried about how it's af- fecting your relationships and how people perceive you, then chances are you're not able to manage it effectively as well." e stigma around migraines is huge, said Leroux. "I see a lot of shame and guilt in my patients." Many migraineurs just "push through" at work, she said. "ey know they are perceived as whiners but in my practice I see a lot of extremely courageous people who do everything they can not to miss work." Workers who might ask for lights to be dimmed or for co- workers to be quiet might seem like picky individuals, said Benson. "It can be hard to know how to advocate for yourself but not seem like you're just complaining," she said, adding a migraine is largely an invisible illness, which can fur- ther the stigma. Treatment options, workplace supports When it comes medical treat- ment, more than two-thirds (67 per cent) of respondents said abortive or acute prescription migraine medications are the most commonly used, followed by over-the-counter pain medi- cations (50 per cent), preventive medications (49 per cent), and rescue medications (47 per cent). But side effects play a key role in people's avoidance or stopping use of a medication, according to Health Union. ere are a lot of different op- tions but none of them can take care of the problem 100 per cent, said Benson. "We really just need to understand better what mi- graines are so that new treatments can be more targeted." ere's a perception that there are many treatment options, but few of them were developed to treat migraines, said Bhowmick. "It's really just a cobbled together approach at this point in time, and either the side effects are unbear- able and it's not something a pa- tient is going to endure, or they just don't work… and what's more frus- trating is they might work and then it might stop working," she said. "It is constant trial and error." Migraines can affect a person's attendance, be they episodic or chronic, said Benson. ere are days when people can function OK, and days they cannot because it's not safe to drive, they're throw- ing up or the pain is too severe. "Being able to be a reliable co- worker or employee or boss can be really difficult," she said. When it comes to making the workplace more supportive or ac- commodating, there are sensory options, such as a no-perfume policy, or allowing for a quiet space, said Benson. "Sometimes, if a person can treat their attack either medically or naturally and have a space to lie down and take a quick nap, that can mean you can function the rest of day versus trying to power through it." It's also good to try and use tools that don't affect other people in the room, such as special glasses for fluorescent lights or earplugs, she said. "Not eating on time can be a trigger, so another accommoda- tion is just (about) making sure the employee has adequate breaks to even just have a quick snack if they need to." Ergonomically, comfortable chairs can help too, as can a sit- stand desk, said Bhowmick. "Sound, light and smell are the three most common we hear about in the workplace, and they're things that people without migraine probably don't think twice about… they're also very difficult to change depending on the employer — that's a challenge." People who have to work shifts also talk about the disruption in the hypothalamus, the "irritable" part of the brain that helps mobilize the headache phenomenon that's also involved in sleep, "so even sleep deprivation is an issue," said Louw. "They're complaining about scents not being aggressively en- forced necessarily at the work- force, the ergonomics — if you have neck pain, this can be one of those intensifiers for migraines, so if you don't have good ergonomics at work, like hands-free headsets and the ability to stretch and move and exercise gently, this could cer- tainly be an issue for workers." IT can also help, by providing a filter that goes over a computer screen or changing black type on a white screen to white type on a black screen to reduce glare, he said. "It's very individual. Some peo- ple say they hate it… other people said it's fantastic, so one of the big challenges for the patient and the employer and the doctor is every migraine brain is different, un- fortunately, so we're probing and testing and half the time things don't really work, and then we just keep trying something else." It's also reasonable to talk about dimming or eliminating overhead flickering fluorescent light or hav- ing a lamp on the desk that work- ers can modulate, "just to give that sense of control back to the patient or the worker," said Louw. Trying to reduce gratuitous noise is also helpful, such as re- placing an overhead paging sys- tem with personal pagers, he said. "Acoustic pollution is a horren- dous source of stress and aggrava- tion and headaches. So definitely things like that can be done." Migraineurs often 'push through' pain MIGRAINES < pg. 1 "If a person can have a space to lie down to take a quick nap, that can mean they can function for the rest of the day, versus trying to power through it."

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