Presenteeism: taking your headache to work

Presenteeism in the narrower sense used in this article means when employees show up for work despite being ill. How widespread is this phenomenon? Why do people choose work over rest and recovery? And what does presenteeism look like in a university setting?

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A 2023 survey by a large German health insurance company found that over a quarter of employees often work while sick, either at their workplace or from home. Even among those in leadership roles, 16% admitted to it. Presenteeism has been on the rise in industrial societies for over two decades. People working from home are particularly susceptible, with nearly half reporting that they carry on working despite feeling unwell. In fact, more than one in ten say they keep working despite having a doctor’s note. And people working from home are particularly likely to use medication to stay productive despite illness.

Headaches: the presenteeism classic

In countries like the USA, Denmark, and Sweden, presenteeism has long been recognized as a problem. Studies often focus on headaches, along with allergies and orthopedic issues. Research from Norrköping University in Sweden looked at employees from two very different settings: a high-tech company (Saab Aerospace) and a public hospital. They found that 64% of high-tech workers and a whopping 78% of hospital staff experienced headaches due to stress in the past three months. The self-report on presenteeism asked how many employees regularly show up for work despite acute headaches. Half of the respondents in both groups said they did so. When asked to estimate their loss of productivity – the second research objective – respondents in both groups put it at over 20%, equivalent to losing more than six workdays per person per quarter.

Presenteeism in nursing: exceptionally high prevalence

The nursing professions are rife with presenteeism and its impacts, as various studies have shown. A study in Lisbon polled nursing professionals from various disciplines in a hospital deemed to be representative. Questions included how they manage their workload despite feeling unwell, their levels of stress, and how well they cope with their workload in spite of the impairment. Employees who went to work despite being ill cited perceived stress levels and anxiety as the most significant psychological burdens. Alongside back pain and respiratory issues, migraine was high on the list of self-reported physical disorders.

Anxiety and presenteeism go together

A 2018 study also found a definite trend toward presenteeism in employees with tension headaches. Using specific models to distinguish between mental and physical health, the study revealed that many of those who worked through tension headaches felt anxious about doing so. The conclusion is that people who show up to work despite suffering from acute tension headaches are likely to experience performance anxiety about their ability to do their job effectively, properly and to their employers’ satisfaction.

An article in the "Harvard Business Review" titled "At Work – But Out of It" highlighted another critical factor: when someone doesn’t show up for work because they’re sick, the work either piles up or has to be done by someone else. But you often can’t tell when – or how much – illness or a medical condition is hindering someone’s (or your own) performance. Working while sick leads to more mistakes. Not only that: they also tend to be more serious. If these errors go unnoticed due to poor concentration or lack of focus, the consequences can be dire.

Presenteeism in care work

Work is work, even if it’s unpaid. Care work is work too, and staying away because you’re sick is even less of an option for care workers – not just because someone else would have to do it, or because the work would pile up – but because care work often simply cannot be delegated or postponed. Caring for children and other relatives means doing whatever work comes up, when it comes up. The pressure may be exceptionally high because of the additional burden and heavy responsibility of another person's well-being. The concept of presenteeism should therefore be expanded to include unpaid work in order to highlight the serious implications for all parties concerned.

Presenteeism at university: powering through pain

Presenteeism among university students often stems from the fear that skipping a class due to illness will make you miss important material. Because lectures and seminars often build on previous content and cover increasingly complex topics throughout the semester, students worry about missing important material for exams or falling behind and not being able to catch up. As a result, they feel compelled to show up for class even when sick. Where that option exists, some try to follow along online – but that’s not always helpful for recovery either, especially where headache disorders are involved.

A pilot project on headache and migraine prevention at universities ("KopfHoch – Kopfschmerz & Migräne an der Hochschule kompetent vorbeugen") by ZIES gGmbH found that acute headaches rarely deter students from attending university. Two-thirds of students with headaches report trying to get through their day despite the pain. Over half of students with migraine symptoms and more than two-thirds with tension headaches say they have not missed a single lecture in the past three months despite symptoms. The study also found a strong correlation between academic presenteeism and high use of pain medication, often without a prescription and without medical advice. Nearly 10% of respondents with features of migraine even said they tried using illegal drugs to cope with their headaches.

Take pain and prevention seriously

Easier said than done: if you’re sick, you should rest. Studies show that trying to get everything done despite a headache, especially a migraine, can worsen and prolong the attacks. Especially if you’re prone to morning migraines, resting properly early in the day often helps you get back on your feet by the afternoon. Dragging yourself to class with a migraine risks prolonging and intensifying the attack. What’s more, your cognitive response will be impaired during an attack. That material you didn’t want to miss? You won’t be able to retain it anyway. Every university has disability officers to help with accommodations for migraine.

By resorting too often to medication to combat headaches, you risk developing medication-overuse headaches (find out more in this article). The most sustainable approach to beating headaches is effective prevention. Knowing your headache type, your personal triggers and adopting preventing habits can help you head off the pain.