Headaches among nursing and care staff: a growing problem

A demanding job with a lot at stake

Whether in a hospital, nursing home or other care setting, nursing staff face demanding physical and emotional challenges every day. Under these circumstances, it’s hardly surprising that headaches are a common problem in the profession. When nursing staff are constantly at breaking point while trying to do their job, recurring tension-type headaches and migraine attacks become yet another burden to cope with.

What does the research tell us?

Researchers have been drawing attention to the considerable pressures on nursing staff for some time. One finding stands out: nursing staff are especially likely to experience the three most common types of headache – migraine, tension-type headache and medication-overuse headache – and their symptoms may be more severe. One possible explanation for the high rate of medication-overuse headache is the widespread use of painkillers. Medication-overuse headache, or MOH for short, is a particular problem in nursing. There can be enormous pressure to turn up for work and remain fit for duty no matter what (we have looked at this phenomenon, known as “presenteeism”, in a separate article). This kind of pressure may result in people taking painkillers ‘just in case’, hoping to stop a headache or migraine attack before it starts. What they may not realise is that overuse of these medicines can itself cause headaches (you can read more about MOH here).

Shift work is another important reason why headaches are so common in nursing. In fact, a growing body of research suggests that working shifts can actually trigger headache attacks. We will take a closer look at some of those studies below.

Shift work in the spotlight

One study from Spain looked at 24-hour on-call shifts, which are common in the health sector. The results were striking. People with an existing diagnosis of migraine reported that their symptoms had become noticeably worse just six months after they first started working these shifts. The researchers used the MIDAS questionnaire to measure the impact of migraine. MIDAS is a well-established tool for assessing how severely migraine interferes with everyday life. MIDAS scores were significantly higher in these migraine patients, indicating a clear link between migraines and shift work.

The same study also found higher rates of depression and anxiety among people working shifts. Similar results have emerged from many other studies, including research involving nursing staff in Danish intensive care units. This study from Denmark produced another interesting finding. During periods of shift work, participants said they paid less attention to eating regularly and maintaining a healthy diet. For people with migraine, this is particularly concerning. Going too long without enough food or energy can make a migraine attack much more likely. The study also shows how the different pressures of shift work can affect each other. The most commonly reported issues due to shift work were mood changes, headaches and difficulty falling asleep. These three problems have long been known to be closely connected. Each one of them can make the others worse.

A key factor: night shifts and sleep problems

Sleep may be one of the most important pieces of the headache puzzle. The Danish study we mentioned earlier found that night shifts had a particularly heavy impact – and an Italian study involving 1,000 female hospital employees also found that working at night made the symptoms worse.

More recently, researchers in Kyoto, Japan, reported significant sleep problems among hospital employees with migraine as well as among those who frequently experienced tension-type headaches. The authors argue that the way work is organised needs to be part of the solution. Changes to working arrangements could help reduce excessive stress and its effects, they say.

Several studies from China have reached similar conclusions, identifying frequent sleep problems as one possible reason why shift work can lead to headaches. The researchers link these problems to the body’s circadian rhythm (“circadian” means “about a day”). The circadian rhythm governs processes such as when we feel sleepy and when we naturally wake up. Shift work can disrupt this rhythm, moving our usual sleep and waking times away from the pattern our bodies are used to.

This is problematic because regularity is an important part of headache prevention, particularly for migraine. Ideally, people with migraine should go to bed and get up at roughly the same time every day. Shift work disrupts this regularity, making headaches and migraine attacks more likely. You can find out more about sleep and headaches in this article).

Does the impact increase the longer you work in nursing?

Two of the studies we have discussed produced another interesting finding: the people most affected by headaches were often those who had already spent many years working in nursing. The Italian study found particularly severe symptoms among women over 40 who had worked in nursing for more than 15 years.

The Chinese research teams reached a similarly clear conclusion. They found that a history of working in nursing for more than five years was a risk factor for migraine. Taken together with findings from other studies, this suggests that the headache burden increases the longer someone works in nursing.

Possible answers and ideas for prevention

So, what can be done, both at the level of the workplace and by individual nursing staff? The authors of the Italian study focus particularly on workplace stress. They recommend looking closely at all the factors that contribute to stress and finding ways to reduce them. Their overall message is that both organisational changes and measures tailored to individual employees are needed if workplace stress is to be reduced in the long term.

For many nursing staff, avoiding shift work altogether simply isn’t an option. Nevertheless, there are things that can help to make shift work easier on the body and reduce the risk of headaches. One recommendation from researchers is to use forward-rotating shifts where possible: early shift, then late shift, then night shift. This pattern is thought to put less strain on the circadian rhythm.

For people with migraine, lighting can also make a difference. Bright lights should be avoided where possible. It’s better to use several smaller light sources instead. When working outdoors, sunglasses or a peaked cap can provide useful protection from bright sunlight. And don’t forget: breaks are crucial. Regular breaks give your body a chance to recover and can help prevent sensory overload. A few quiet minutes away from all the noise and activity can make a difference. Relaxation techniques, such as Jacobson’s progressive muscle relaxation, can also be an effective way to prevent stress from becoming overwhelming. You can find more recommendations for coping with shift work in this article).

We offer resources specifically designed to help prevent headaches, which we also recommend for people working in nursing and care. Our websites and medically certified apps provide reliable information about headaches, along with practical advice, tips and strategies that can help you prevent headaches – at work and off duty as well!