A big workplace issue

Headaches at work is an issue that comes up surprisingly often – not surprising given that headache disorders cost the UK an estimated £5 to £7 billion per year and 25 million working days lost (and those costs are just relating to diagnosed headache disorders, there is a huge additional impact from ‘ad-hoc’ sufferers even beyond these figures).

When staff report that they have been getting headaches at work, this is a headache itself for Facilities Managers, Human Resources or Safety Managers who want to help, but are understandably not always sure where to start. After all there are so many reasons why someone might be getting headaches how do you even begin to sort through them?

This article sets out the main reasons why – in my experience of dealing with this issue from a consultancy and advice point of view – people are likely to be experiencing headaches at work. To be totally honest, in my experience there’s not much alternative other than to work through these reasons, ruling things out, striking them off the list. Once you have done that, you need to focus on reasonably practicable adjustments that can be made to deal with what is left on that list – the things that are still possible causes.

Medical

The first thing to say is that if someone is experiencing severe headaches and / or repeated headaches, they should discuss it with their GP if they haven’t already done so. Although headaches are generally transitory and not a sign of a serious underlying condition, in some cases they do signify medical conditions that need urgent attention. It is always best to try to rule this out in the first instance.

Signs that someone should definitely see their GP are: headaches present despite taking painkillers, headaches getting worse over time, headaches that started after a knock on the head, severe and sudden onset (a ‘blinding’ headache), associated symptoms such as numbness, weakness, tremors, seizures or nausea. For more information on types of headache visit:

https://www.nhs.uk/conditions/Headache/Pages/Introduction.aspx

Headaches can also be a side effect of medication – particularly if someone is still adjusting to new medication. They can also indicate Hypoglycemia which is indicative of possible diabetes – so it is definitely worth checking out repeated headaches that disappear after eating.

But putting all these worst-case scenarios aside – We’ll look now at headache-related issues that are within the control and remit of HR / facilities management.

Lighting

There are two key aspects of lighting that are linked with headaches: flicker frequencies and blue light intensity.

Frequencies

Older style fluorescents, CFL and new LED bulbs flicker at 100Hz (on a UK AC supply) unless they are fitted with a high-frequency modulator (which most are not – although modern fluorescents are typically fitted with electronic ballast which). This is not a flicker that we can consciously see or detect, but it is a frequency which is related to headaches and visual discomfort (frequencies up to 160Hz can have this effect on people that are susceptible).

An easy way to check if your lights are operating at 100Hz is to view them using your smartphone camera / screen. If you see strobing, it most likely means they are operating at 100Hz and there is scope to eliminate this potential issue by installing high-frequency modulators (or electronic ballast in the case of fluorescent lights).

Dimming

The flicker issues described above are likely to be increased if these types of light are dimmed (if they are operating at 100Hz). This is because dimming is achieved by cutting out periods of light in the light-dark (on-off) cycles. This will reduce the effective frequency below 100Hz which may increase the negative effects of the flicker (again – still not a ‘visible’ flicker).

If you plan on using a dimmer (which I would recommend installing) my advice is definitely make sure the lights are powered via a high-frequency modulator.

Overall brightness and blue wavelength intensity

Direct glare from unshielded or poorly shielded lights can lead to eye strain and headaches, as can direct glare from sunlight. On the other hand, if lighting is too dim it can lead to eye strain, which can result in headaches.

Light ‘whiteness’ which tends to be determined by the levels of blue light wavelengths has also been associated with headaches and visual discomfort. Generally a lower colour temperature (which is actually associated with ‘warmer’ looking lights) is less likely to lead to headaches, as long as the colour rendering qualities (how accurately the light enables colours to be seen) are not compromised. Full spectrum bulbs are also preferable to cool or white bulbs in work areas. Be aware of white or cool bulbs sold as daylight bulbs – they are not necessarily the same as full spectrum. Full spectrum are typically favoured for workplaces where high visual acuity is needed, because they have a high colour rendering quality (CRI), but there are ‘warmer’ lights which also provide high CRI. My general rule of thumb – don’t go too white or too bright!

Research also indicates that tinted lenses can help to reduce photosensitivity, and are particularly useful for migraine sufferers if lighting is white and bright. If a staff member experiences migraines and has photosensitivity during an episode, they should definitely discuss this with their optician. See link for more details: https://irlen.com/headaches-and-migraine-research/

The recommended luminance level for a typical office is 500lx (average). Higher luminance levels are – anecdotally at least – associated with headaches. Interestingly, older generations tend to find higher light levels more tolerable, whereas younger generations prefer more subdued lighting.

Dutyholders may find lighting issues come to the fore towards the middle and end of the winter – during the long months of shorter daylight hours where peoples’ daily light ‘intake’ has had a higher artificial content for some months, over which time any sensitivity may have become more noticeable. Interestingly Seasonal Affective Disorder which may increase sensitivity to / awareness of headaches, tends to reach its peak in January / February – i.e. as daylight hours are actually just starting to increase again – (which can seem a little bit counterintuitive).

Screen settings

People who are sensitive to blue light wavelengths will also benefit from adjusting their screen settings to reduce those wavelengths. Apps like f.lux are popular and some newer screens have an ‘eye-saver’ mode which allows users to switch their screen to a warmer and generally less white and intense setting. Staff should be made aware of how to make these screen-setting changes when they are given their DSE risk assessments, or as part of the DSE information and training provided to them.

Screen positioning

Glare – reflections on screen – can also be a trigger for headaches. Most modern LCD screens are unreflective, so there is less likelihood of reflections. However some screens such as those on larger Macs have a highly reflective gloss surface. Anti-glare screens can help reduce these reflections, if repositioning the screen and / or light source are not possible. Click here to see some examples.

Poor posture

Poor posture at our desks – hunching forward or bending our heads down or up excessively to look at our screens – can lead to chronic muscle tightness in the shoulder and neck, which can lead to tension headaches.

Make sure your staff have had a DSE (Display Screen Equipment) assessment to identify any postural issues for the neck in particular that could lead to muscle strain. Also make sure that your staff have the equipment they need to sit in a comfortable neutral posture (i.e. a comfortable supportive chair, external monitor(s) on a stand or arm).

Using a laptop directly on a table (or worse still, your lap) inevitably leads to poor neck posture for most people because the screen is too low. Using a smartphone or tablet for sustained periods also typically means our heads are bent forward and down, putting a strain on the neck and shoulders, which can lead to headaches.

For more information and help on mobile device ergonomics visit our partner company Mobile Office (www.mobileoffice.guru).

Dehydration

This is a classic source of headaches that is likely to be worse in (but certainly not exclusive to) the summer or in air-conditioned areas. Dehydration can not only bring on headaches but it can affect cognitive processes and overall productivity levels.

Make sure there is plenty of drinking water available to staff as well as a means of drinking it (as required by Regulation 22 of the Workplace Health Safety and Welfare Regulations 1992!). Also make sure people are actually able to either drink while they work or can take regular breaks in order to drink.

Lack of air-flow

If air in the workplace is not replenished at a suitable rate, toxins such as VOCs, ozone and CO2 can build up that can cause general feelings of tiredness, malaise and headaches. This can be a particular issue for large but heavily used spaces with limited total percentage air transfers, or equally it can be significant in smaller spaces with limited or no air transfers other than doors opening and closing.

Check the air refresh situation in your office. Is air actually replaced rather than just re-circulated? Are the volumes of fresh air suitable for the number of users and the type of use?

Further useful advice on recommended air refresh volumes can be found in Building Regulation part F – Means of ventilation. Bear in mind that in offices where printers are in heavy use, the recommended air refresh volumes are double those in a normal office.

Cold drafts

Cold air or drafts is (anecdotally at least) linked with headaches. It is likely if this is an issue it will be fairly quickly identifiable. Poorly sited or over-active air conditioning units, or badly fitting windows are the main causes.

Uncorrected vision

Eyestrain is strongly associated with headaches. One of the first questions to ask anyone experiencing headaches at work, is whether they have had an eye test recently. Even if they have had one in the last two years, it is surprising how eyesight can change quite suddenly, so I would always recommend a trip to the optician to rule out eyestrain due to uncorrected vision. As part of a DSE assessment always check that the user is within the 2 year recommended test period, and is aware of company policy on eye tests.

Tiredness

Sleep deprivation is a key cause of headaches. This can be work-related if for example someone is having to work particularly long hours, or their work-related stressors are causing them loss of sleep. This comes down to the need for honest discussions about stress and work intensity, and effective work planning. There are also many domestic reasons why someone may be sleep deprived – for example if someone has just had a new baby, there is almost inevitably going to be fairly severe sleep loss for a period of time. Employers should be sensitive to this and certainly consider it / rule it in or out as an underlying factor.

Putting it all together

We have put together a downloadable investigation and action form – it’s a Word document so you can add to it and work on it electronically. Click here to download. The form is a starting point and provides a way of keeping a clear record of the steps being taken to address any complaints of headaches. As we said at the start – there are many possible causes and they need ruling out one-by-one, starting with the quickest, least disruptive and lowest cost (e.g. eye-tests and seeing GP). Good luck, and please do get in touch to share your experiences of managing these issues or to discuss ways we can provide support.

Resources and further information

BS12464 Light and lighting – Lighting of work places. Part 1: Indoor work places. BSI.

The Building Regulations (2006 ed.) – Part F – Means of ventilation.

McCrone, P et al (2011)Service use and costs for people with headache: a UK primary care study. Journal of Headache Pain 12(6).

Headache Services in England – A report of the All-Party Parliamentary Group on Primary Headache Disorders (2014). 

LED Lighting Flicker and Potential Health Concerns: IEEE Standard PAR1789 Update. 

HSG38 Lighting at Work. HSE Books.

Zumtobel – The lighting handbook.

Air quality link – https://www.ccohs.ca/oshanswers/chemicals/iaq_intro.html