Migraine sick leave on the first day: what to tell your employer, UK fit notes and US doctor's notes
Migraine and sick leave on day one: what to tell your employer, UK fit notes and self-certification, and US doctor's notes and policies.
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When a migraine hits on a workday, you ask what to tell your employer and whether to go to the doctor. The rules differ in the UK and the US. Keep your attack times, aura and symptoms on paper or in the migraine program in Sam, and take the doctor report as a PDF to your appointment.
This text is general information, not legal advice. UK rules come from GOV.UK and ACAS. A union or employment lawyer can advise on your case. In the US, the rules sit with your employer and your state. An employment lawyer or your state labour office can help. What applies to you depends on where you live and work.
Tell your employer on the first day
First, you tell your employer you cannot work today. This is your task, and it is separate from any later note. In the UK, ACAS calls this self-certification for the first 7 days. You tell your employer you are not well enough to work. Check your contract and sickness policy for what details they ask for. In the US, follow your employer's absence policy. Many workplaces set a deadline for calling in. Check your contract and staff handbook.
Fit notes and self-certification in the UK
In the UK you can self-certify for 7 calendar days. After more than 7 days off in a row, you need a fit note. A GP, hospital doctor, registered nurse, occupational therapist, pharmacist or physiotherapist can provide one. The note says you are not fit for work, or may be fit with changes. Your employer can take a copy and you keep the original.
Statutory Sick Pay in the UK
Many people also ask about pay. GOV.UK says Statutory Sick Pay is up to £123.25 a week. Your employer pays it for up to 28 weeks. Since 6 April 2026, ACAS says SSP is payable from the first day of sickness and the lower earnings threshold is removed. It is the lower of the weekly rate or 80% of your average weekly earnings. Northern Ireland has its own rules, so check nidirect there. A company scheme may pay more. Check your contract for the rules that apply to you.
Doctor's notes and policies in the US
In the US, your employer's policy sets when a note is due. Some states and cities add their own rules. If your migraine counts as a serious health condition and you meet the FMLA eligibility rules (12 months with the employer, 1,250 hours, a worksite with 50 or more employees within 75 miles), the FMLA can protect your job. That leave is unpaid. Ask your employer what they need, and ask an adviser before you worry. See FMLA and intermittent leave: what to document for the records that help.
How your entries help at the doctor
Whether you go on the first day is for you, your doctor and your employer. You can always prepare a clear description of the day. Dated details are the easiest to give. When did the attack start and end, and did an aura come with it? These sentences are quick to say and give the doctor something concrete. New to tracking attacks? Read migraine diagnosis: your first weeks. For the questions to bring, see the doctor-visit checklist for a chronic condition.
When a migraine is an emergency
The NHS says migraine attacks usually last between 4 hours and 3 days. A few signs belong with urgent care, even if you know your aura. Call your local emergency number for a headache that comes on suddenly and is extremely painful, trouble speaking, loss of vision, confusion, a seizure, or weakness on one side. The NHS says to get urgent medical advice (an urgent GP appointment or NHS 111) if an aura lasts longer than 1 hour at a time or an attack lasts longer than 72 hours. Sam does not decide this. When in doubt, call. Use 999 in the UK and 911 in the US.
Log your attacks and take a dated report to your appointment
Go to the doctor with a dated record instead of reconstructing one migraine day from memory.
- In the migraine program, each attack gets a start, end, aura and strength. For entries made today, sleep and HRV from Apple Health sit beside them.
- The doctor report counts your migraine days for the period you choose, as a PDF you can show or keep.
- When a headache is not an attack, log it in the symptom diary.
Sam records what you enter and gives no fit note or doctor's note. Only a doctor decides fitness for work. Sam gives no medical or legal advice.
Try Sam for freeSam is a wellness companion, not a medical device. The app does not diagnose, treat, cure or prevent any condition or health state. Always consult qualified professionals for medical decisions.
Related reading
- Migraine diagnosis: what now? Your first weeks
- Migraine symptoms and aura: what to note
- Doctor-visit checklist for a chronic condition
- FMLA and intermittent leave: what to document
Sources
Updated: October 2026
- GOV.UK: Taking sick leave
- GOV.UK: Statutory Sick Pay (SSP)
- ACAS: Sick leave
- US Department of Labor: Family and Medical Leave Act
- EEOC: Fact sheet: disability discrimination
More on Migraine
- See the program for Migraine
- For family members: Migraine
- With a second condition: Migraine and Epilepsy
- With a second condition: Migraine and Panic Disorder
- See the doctor report
- Keep your medication and reminders in one list
- Keep a diary of your symptoms and complaints
- Share what you record with family
- Calculate your MIDAS migraine score (free tool)
Frequently Asked Questions
Do I have to tell my employer on the first migraine day?+
In most jobs, yes, you report that you are off sick. In the UK this is your task, and ACAS says you can self-certify for the first 7 days. In the US, follow your employer's absence policy. Check your contract and sickness policy for what details your employer asks for.
When do I need a fit note in the UK?+
You can self-certify for the first 7 calendar days. After more than 7 days off in a row, you need a fit note from a registered healthcare professional. Your employer can take a copy and you keep the original.
Do I need a doctor's note in the US?+
It depends on your employer's policy and on state and local law. Many workplaces ask for a note after a set number of days. If your migraine is a serious health condition and you meet the FMLA eligibility rules (12 months with the employer, 1,250 hours, a worksite with 50 or more employees within 75 miles), the FMLA can protect your job.
What is Statutory Sick Pay in the UK?+
GOV.UK says Statutory Sick Pay is up to £123.25 a week, paid by your employer for up to 28 weeks. ACAS says that from 6 April 2026 it is payable from the first day of sickness and the lower earnings threshold is removed. It is the lower of the weekly rate or 80% of your average weekly earnings. Northern Ireland has its own rules, so check nidirect there. A company scheme may pay more; check your contract.
Does Sam issue a fit note or doctor's note?+
No. Sam is a wellness companion and records what you enter. The doctor report as a PDF supports a conversation but is not a leave certificate. Only a doctor decides fitness for work.
What do I tell the doctor if I go?+
Dated details help most. When did the attack start and end, and did an aura come with it? Short notes like these give the doctor something concrete. You can keep them on paper or in Sam.