“Just Keep Working” – Migraine in the Construction Industry
Migraine disease is often misunderstood as “just a headache.” In reality, it is a complex neurological disorder affecting approximately one in seven people worldwide, and is among the leading causes of disability for working-age adults. For many individuals, migraine involves far more than pain. Symptoms may include nausea, visual disturbances, sensitivity to light and sound, cognitive impairment, fatigue, and difficulty concentrating. Some attacks last for days rather than hours, and individuals living with chronic migraine experience symptoms on 15 or more days each month.
The Impact of Migraine in Construction
The impact extends beyond the individual sufferer. Research has shown that migraine contributes significantly to absenteeism, presenteeism, healthcare expenditures, and lost productivity, costing employers billions of dollars annually. While missed workdays are often visible, one of the highest organizational costs frequently goes unnoticed: employees who continue reporting to work while silently struggling with debilitating symptoms.
This challenge may be especially relevant within the construction industry. Construction workers routinely face environmental and occupational conditions that can intensify migraine symptoms. Examples include heat, bright sunlight, loud noise, physical exertion, schedule pressure, and demanding production expectations. At the same time, the industry’s culture often emphasizes toughness, resilience, and the ability to push through adversity. While these characteristics can contribute to success in demanding environments, they may also discourage employees from discussing health concerns or seeking support when needed.
As part of my doctoral research in Industrial-Organizational Psychology, I interviewed construction workers living with chronic migraine to better understand their workplace experiences. What emerged from these conversations was not simply a story about migraine. It was a story about workplace culture, stigma, disclosure, and psychological safety. One participant summarized the prevailing mindset with a statement that many construction professionals will immediately recognize:
“There’s no crying in construction.”
Another participant explained why workers often choose not to disclose their condition:
“You don’t want to be seen as weak or using it as an excuse.”
The Greatest Challenge is the Perceptions of Others
These comments reflected a recurring theme throughout the interviews. For many participants, the greatest challenge was not managing the physical symptoms of migraine but managing the perceptions of others. Several described being viewed as lazy or unmotivated when symptoms affected their performance. Others reported coworkers dismissing migraine as “just a headache” and failing to understand the severity of the condition. One participant explained that coworkers assumed he had an attitude problem because he became quiet while experiencing severe pain. Another eventually stopped trying to explain his symptoms altogether because, in his words, “People just didn’t get it.”
Perhaps most concerning were the findings related to disclosure. 86% of participants expressed concerns about disclosing their condition in the workplace. Some feared ridicule or skepticism. Others worried that disclosure would negatively affect promotion opportunities, job assignments, or supervisors’ views of their competence. One participant stated that he would never disclose his migraine condition during the hiring process because he believed employers would see him as a liability rather than an asset.
These findings suggest that employees often make decisions about their health based not solely on medical considerations but also on anticipated social and professional consequences. When workers believe they must choose between protecting their health and protecting their reputation, organizations create conditions in which important problems remain hidden until they begin to affect performance, safety, attendance, retention, or morale.
The Issue of Psychological Safety at Work
The implications extend beyond migraine. At its core, the issue is one of psychological safety. Organizations have made tremendous investments in physical safety through training programs, equipment requirements, inspections, and safety protocols. However, many organizations have not made equivalent investments in creating cultures where employees feel safe discussing invisible health conditions without fear of judgment or negative consequences. The workers in this study were not seeking special treatment. Rather, they wanted understanding. They wanted supervisors who listened, leaders who recognized that not all disabilities are visible, and workplaces where honesty about a health condition would not automatically result in stigma or diminished opportunities. (In this blog, Ben shares his experience as a coworker with migraine.)
For HR professionals, the lesson is clear: policies alone are not enough. Organizations may offer accommodation procedures, wellness programs, and employee assistance resources, but these initiatives are only effective when employees feel safe enough to use them. Culture ultimately determines whether workers choose disclosure or silence.
For organizational development practitioners, the findings raise important questions about leadership and culture. What messages do leaders send about vulnerability? How is toughness defined within the organization? What happens when an employee admits they are struggling? Does the culture reward honesty, or does it reward silence?
For construction leaders, the next frontier in workplace safety may not be physical—it may be psychological. The strongest organizations are not those where employees suffer in silence. They are organizations where people can acknowledge challenges, seek support when needed, and continue contributing at a high level without fear of stigma or judgment.
Is It Safe to Discuss Invisible Disabilities at Work?
Although this research focused specifically on construction workers living with chronic migraine, the lessons extend to employees living with chronic pain, mental health conditions, autoimmune disorders, neurological disorders, and countless other invisible disabilities. The question for leaders is not whether these challenges exist within their workforce. Rather, the question is whether employees feel safe enough to discuss them. Unfortunately, the people suffering the most are often the people saying the least.
Let Us Know
Have you seen or experienced stigma around invisible disabilities like chronic migraine at work? How does your workplace define toughness? Have you felt safe at work disclosing invisible health conditions without judgment? What can organizational leaders do to better support workers with invisible disabilities, such as migraine?
Source
- Bailey, Brian T., “Understanding Workplace Stigma and Coping Strategies Among Those Living With Chronic Migraine in the Construction Industry” (2025). Doctoral Dissertations and Projects. 7399. https://digitalcommons.liberty.edu/doctoral/7399