My migraine pain is constant, meaning that it never breaks, not even for a minute. Despite this pain, I need to work to support myself.

There’s no way to sugar-coat this challenge: Working in pain is a struggle and it’s never easy. It causes me to second-guess myself, feel anxious about my performance, and question whether my pain or I am to blame for mistakes.

During my many years of experience of working in constant migraine pain, I’ve uncovered some strategies that have been invaluable to me:

Start the day off right

My “working with migraine” experience doesn’t start when I get to work. It starts when I wake up.

For me, the morning is the hardest part of living with migraine pain. While waking up is hard for anyone, waking up when you have severe migraine pain — and the feeling of a 30-pound weight on your head — makes it especially tough to lift your head off the pillow. Oftentimes, it’s impossible. This means that before I even get out of bed each morning I’ve already begun coaching myself.

Every single day I question if I can do it. Am I capable of lifting my head? Am I capable of taking a shower? Getting dressed?

Sometimes the answer is no. But for the most part, I tell myself that the answer is yes.

Look good, feel good

Once I am out of bed, even when I feel miserable, I find that it’s important to put myself together for work. This means washing and drying my hair, putting on makeup, and wearing an outfit that makes me feel confident. Unfortunately, all of this takes energy and effort.

For a long time, my pain was too extreme to even allow myself to expend a moment of energy on my appearance. During this time, there were many days when I let my pain get the best of me. I’d roll into work with a greasy ponytail and a comfortable outfit, almost as if I’d given up on the day before it even started.

Today, putting effort into my appearance is part of what helps me feel ready and prepared. It means that I can truly “show up” for work each day, ready for what’s ahead. It makes a difference.

Prioritize your to-do list

Every morning I review my long to-do list and write down a shorter list on a sticky note of what I realistically need to get done that day. Then I put numbers next to each task in order of highest to lowest priority. This process removes the overwhelming feeling that I’m never going to get everything done and simplifies the day ahead.

Battling brain fog

My migraine triggers brain fog, which can slow my thinking down significantly. It’s an unavoidable symptom that I battle daily. Brain fog makes me feel dumb and say things without thinking first. If I’m being frank, it even causes me to question my intelligence. It’s hard to work through that feeling of clouded thought.

How do I handle these moments of migraine fog? I read and re-read everything an obscene number of times. I’m sure that there are a lot of neurotic people who read over their emails too many times and even re-read them after they’ve been sent — yes, it’s a thing! For me, it’s all part of working with migraine.

And while I’m sure that it’s inefficient, I’m too paranoid that I will make a mistake due to my brain fog. The extra checks lessen that anxiety — and the number of typos.

Update my colleagues

In severe instances, when it’s impossible to hide my pain, I will tell my colleagues. This most often happens when I’m experiencing nausea and I want to prepare them that I may need to abruptly leave a meeting. I’m lucky that they understand and are open to hearing about this vulnerable side of me in a work setting.

Accept when something can’t be done

I’m guilty of getting upset and angry when my brain makes me incapable of finishing my work. I know that I’m a capable person, but my migraine pain often puts a halt to my thinking. When this happens, I try my very best not to get upset or angry, and instead to accept that I can’t finish the task at that particular moment.

To combat instances like this, I rarely save anything for the last minute. I never want to be faced with a deadline and intense brain fog simultaneously. This also means that sometimes I need to close my computer and wait until the next day, when I’m thinking more clearly, to finish work — something that’s hard for me to do.

Congratulate yourself for small wins

Just as I coach myself out of bed every morning, I coach myself through the work day. Sometimes the goals are small, like “send out these three emails in the next 15 minutes.” Other times, I’ll bribe myself with a ginger tea or a bag of pretzels when I finish something on my list. Regardless of the goal or the reward, it’s important for me to congratulate myself on the small wins throughout the day.

Take advantage of low-pain moments

When my pain and brain fog are low, I CRUSH work and I don’t stop until I’ve finished everything on my list. It’s rare for me to experience days when I’m feeling strong, clear, and capable, so I need to take full advantage of those times and get as much done as possible.

Trust yourself

For years, I felt anxiety that migraine was making me slow, inefficient, and less capable. While migraine likely does all these things to some extent, I now trust that I will get everything done — even if my pain has thrown me off course for the moment.

Go home and shut down

While this is not always possible, I find that it’s important to give myself a break after an exhausting workday or workweek. Mentally shutting down after work makes me more efficient when I’m at my desk the next day because I’ve had a solid break.

The takeaway

As I’ve said, working while in constant pain is hard. However, I know that having constant pain and not working is so much harder. When I was too sick to work, I completely lost my sense of independence and I missed the fulfillment that having a job provides.

While challenging, I realize that it’s a blessing to be able to work in this circumstance. I’m grateful for every day that I can continue to move my career forward despite my pain.

For more information on how to manage migraine, reach out to your doctor or healthcare team.