Mental Health, Migraine and Workplace Culture in the time of COVID-19
Sep 09, 2020
PATHw, in partnership with Novartis, Swiss Embassy Philippines, Great Place To Work, The American Chamber of Commerce Singapore, Partnership To Fight Chronic Disease and Galen Centre for Health and Social Policy, spearheaded an Asia-wide virtual roundtable, titled “Reimagining Healthier Workplaces in Asia” on 9th September 2020.
The virtual roundtable was held in support of Migraine Awareness Week and brought together key leaders from health, human resource and business industries to promote healthier workplaces and employee behaviors in the region. The discussion successfully engaged constructive dialogue on key issues that affect employees at workplaces.
The event saw a successful turnout of 134 attendees who gained meaningful insights from 13 speakers, across a spectrum of human resource and business fields. The virtual roundtable speakers for the first session were Tyler Thorpe, Great Place To Work; Dr. Eric Finkelstein, Professor of Health Services and Systems Research Program, Duke-NUS Medical School, Singapore; Associate Professor Dr Ivy Chung, Deputy Dean of Health & Wellbeing Research Cluster, University Malaya, Malaysia; Associate Professor Dr. Wan Aliaa, Neurologist & Associate Professor at Faculty of Medicine & Health Sciences, Universiti Putra Malaysia and Dr. Rosalina Picar, President, Philippine Neurological Association. This session was moderated by Julien Remond, Chief Executive Officer, Awakened Mind.
The speakers for the second session were Azrul Mohd Khalib, Chief Executive Galen Centre for Health and Social Policy, Malaysia; Dr. Ethan Lim, Head, Clinical & Wellness, Cigna Singapore; Jonathon Dixon, Head, Enterprise Business Segment, Asia Pacific & Japan, Amazon Web Services; Marla Arnall Senior Principal, Asia Consulting Leader, Mercer; Leonhard Schaetz, Global Market Access Director, Novartis. This session was moderated by Dr. Gia Sison, Occupational Health Expert and CNN Philippines host.
Workplace Culture Dimensions
During the first segment of discussion, attendees were invited to hear firsthand insights on the impact of migraine on the Singaporean and Malaysian economy through robust studies presented by health economic experts. This is the first time that an Asian study on prevalence of migraine among workers in the banking sector was reported. Results from the Singapore study showed that overall costs to the economy due to migraine was attributed to missed workdays and lost work productivity.
“The significant impact of migraine on work productivity and regular activity appears to lead to substantial monetary loss, attributed to not only absenteeism but more importantly to presenteeism,” said Associate Professor Dr Ivy Chung, Deputy Dean of Health & Wellbeing Research Cluster, University Malaya, Malaysia. “The Malaysian study presented during the roundtable event highlights the unmet needs in migraine management and the need for a call for awareness and intervention strategies at individual and organizational level.”
The first segment also tackled the response of professional societies to the challenges imposed by lockdown and the pandemic on access to care of patients needing neurological care.
“The major difficulty that faced our patients in a developing country such as The Philippines is the lack of an existing structure for telemedicine and even electronic prescriptions. Access to neurological care relied heavily on the creative responsiveness of professional societies, with the support of the private sector and acquiescence of government. The pandemic has forced us to think out-of-the-box to provide quick but safe solutions to ensure continuous access to proper neurologic care,” said Dr. Rosalina Picar, President, Philippine Neurological Association.
The roundtable also underscored key mental health issues that affect employees in the workplace, in light of new working conditions. Key presentations also outlined the importance of sensitizing employers about the burden of pain and disability in employees, as well as helping them identify trigger factors to help employees manage these impacts.
Caring for Employee Mental Health in the Face of COVID-19
Dr. Gia Grace Sison explained that the most common concerns during the COVID-19 pandemic are uncertainty about the future, barriers in accessing services, loss of loved ones, heightened emotions and adjustment to changes. Such concerns can result to isolation and loneliness. Dr. Sison underscored the importance of employees and employees in building safe spaces in the workplace.
With most of them working from home, employees should focus on determining factors such as self-awareness, acceptance of the situation, physical wellness, personal boundaries, other’s boundaries and pacing of work. If these factors are disregarded, it could lead to burnout and other negative mental health effects.
According to Dr. Sison, health includes social and psychological components, aside from physical or biological health. She enumerated key factors in ensuring a healthy working environment:
Communicate risks and plans clearly.
Inform employees of possible mental health effects of the pandemic.
Recognise early signs of mental health distress.
Make support services available.
Dr. Sison reiterated the importance of creating community care, such as structural changes and social rearrangements, which need to be done alongside the usual support, “Social distancing does not mean social isolation”.
Migraine in the Workplace and How to Help Your Employees
Dr. Martha Lu-Bolanos defined migraine as the most clinically disabling primary headache disorder, a complex neurological disorder which affects more than 10 per cent of the global population. The condition affects two to three times more women than men,, and is associated with substantial personal, family and economic burden, she explained.
According to Dr. Lu-Bolanos, common migraine symptoms include nausea, visual disturbances and photophobia, with environmental factors and family history as potential triggers. She noted that more than 54 per cent of migraine sufferers have severe impairment whose symptoms are only relieved with bed rest. The debilitating symptoms of migraine have a significant impact on quality of life, with sufferers sometimes stigmatised. Migraine also has a significant socioeconomic burden, and is a leading cause of lost productivity.
Dr. Lu-Bolanos recommended the following actions for optimal migraine management:
Establishing the diagnosis
Educating patients on their condition
Setting realistic patient goals and discussing expected benefits of therapy
Empowering patients to be actively engaged in their treatment, and tracking their progress
Developing formal management plan, individualising treatment and considering comorbidities
Encouraging patients to identify and avoid migraine triggers
Dr. Lu-Bolanos encouraged patients to keep a migraine diary where they can record possible triggers and sensitivities, such as chocolate, cheese, monosodium glutamate, alcohol and smoking. Other factors such as sleeping patterns and stress can also contribute as trigger factors.
Finally, she highlighted the Migraine Buddy App, which serves as an effective migraine diary by helping to track the frequency, intensity and triggers for each migraine attack. She also reiterated that employers can provide patient support by raising migraine awareness and accelerating patient journey to empower employees to seek better care through education and internal support.
Partnering for Healthier Workplaces
Case studies on workplace health programs were presented during the webinars. One of these was the Novartis Migraine Care Program.
“Many employees with migraine lack support, are often stigmatised, and are not able to work thus increasing work-related anxiety and discrimination. All these can impact mental health,” said Christine Fajardo.
To help address this gap, Novartis collaborated with patient groups and leading experts in neurology, telemedicine and digital medicine, to pilot Migraine Care, a program that aims to help Novartis associates living with migraine to improve their quality of life. 339 Novartis employees registered to the programme, out of which 141 consented to their data being analyzed and 79 completed the program at six months. Participants received monthly sessions of individualized tele-coaching comprised of educational modules; action plans from a specialized nurse by phone; and through a specially developed module on the Migraine Buddy smartphone application.
At the end of six months, participants reported 54% decrease in migraine-related disability and a 9% increase in the patient activation measure (PAM), a measure which assesses patient knowledge, skill, and confidence for self-management. Loss of productivity through both, absenteeism and presenteeism, were reduced by more than 50% and in addition participants report their private life being significantly less impaired by migraine.
“Novartis is exploring opportunities to work with other employers who are interested in supporting their employees and family members living with migraine through our Migraine Care Program. We look forward to partnering with HR leaders to provide migraine education and facilitate support mechanisms for migraine sufferers in workplaces,” Ms. Fajardo said.
 Headache Classification Committee of the International Headache Society (IHS). Cephalalgia 2018;38:1–211;
 Russell MB et al. Int J Epidemiol 1995;24:612–8
 Diamond S et al. Headache 2007;47:355–63
 Blumenfeld AM et al. Cephalalgia 2011;31:301–15
 Lipton RB et al. Neurology 2007;63:343–49;
 Schaetz et al. Impact of an Employer-provided Migraine Coaching Program on Patient Burden and Engagement . 6th (Virtual) Congress of the European Academy of Neurology, Paris, 23-26 May, 2020