Returning to work after long migraine sick leave: phased return, fit notes, FMLA and ADA
After long migraine sick leave: how a phased return, fit note, FMLA and ADA reasonable accommodations work in the UK and the US.
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After many migraine sick days, an invitation to talk about returning to work can feel sudden. A phased return and reasonable adjustments are normal support, and the rules differ in the UK and the US. You can note how migraines affect your days on paper or in the migraine program in Sam, a diary with a doctor report, where new entries made today also bring in last night's sleep and HRV from Apple Health.
This text is general information, not legal advice. In the UK, ACAS and Citizens Advice give free guidance. A union or employment lawyer can advise on your case. In the US, the EEOC and the DOL publish guidance. A labour lawyer can advise there too. Whether you join a conversation, and what you share, is your choice. This text covers what migraine changes; the rules for any condition are set out in phased return to work in general.
Why does your employer want to talk?
Long sick leave often starts a return-to-work conversation. GOV.UK says employees off sick for more than 4 weeks may be considered long-term sick. Before dismissing someone for long-term sickness, GOV.UK says an employer should consider whether they can return to work, for example through flexible, part-time or different work. The talk is a chance to plan support, not a demand that you return before you are ready.
Fit notes and a phased return in the UK
In the UK, a fit note says whether you are fit for work. It can say you are not fit for work. It can also say you may be fit for work with changes. Examples are different hours or tasks. Your employer should discuss these changes with you. A phased return is a gradual build-up to your old hours. A fit note can recommend one, and you agree the pace with your employer. If you are disabled under the Equality Act, a phased return can count as a reasonable adjustment. If the fit note says you may be fit for work with changes and no changes are agreed, you are treated as not fit for work.
Reasonable adjustments under the Equality Act
In England, Scotland and Wales the Equality Act 2010 protects disabled people at work. Whether migraine counts as a disability depends on whether it has a substantial and long-term effect on your normal daily activities, which GOV.UK defines as 12 months or more. Northern Ireland has its own disability discrimination law and its own Access to Work (NI) service; check nidirect or the Equality Commission for Northern Ireland there. ACAS says employers must make reasonable adjustments by law. The duty starts when they know, or should know, you are disabled. Adjustments can change how and when you work. They can include flexible hours or a phased return. What is reasonable depends on your situation and the employer. The employer pays for the adjustment. Access to Work can fund some practical support.
FMLA leave in the US
In the US, the Family and Medical Leave Act gives unpaid leave. Eligible employees get up to 12 workweeks in a 12-month period. The leave is protected, so your job stays open. It can cover a serious health condition. You need at least 12 months with your employer. You also need 1,250 hours in the 12 months before your leave. Your worksite must have at least 50 employees within 75 miles of it, and the employer must be covered. Some states have their own leave laws that may give more, so check your state labour department. Leave can be taken in blocks when medically needed. See FMLA and intermittent leave: what to document for the record-keeping.
Reasonable accommodation under the ADA
The ADA protects qualified people with disabilities. It covers employers with 15 or more workers. Employers must give reasonable accommodation. That is a change so you can do your job. Examples include a modified schedule or extra leave. The employer acts when they know you need it. The EEOC says you can ask in plain words. It is usually an informal conversation, not a form. The employer may ask for documentation when your need is not obvious.
What you can prepare before you talk
A clear record helps you decide what to ask for. You do not have to show an employer your diary. Your notes are for you and your doctor. Record when attacks happen and how long they last. In Sam the doctor report counts your migraine days as a PDF. You decide whether to take it anywhere. Talk to your doctor first, and to an adviser. If migraine affects work between attacks, keep those days in the symptom diary. New to the condition? Start with migraine diagnosis: your first weeks. More on phased returns with a chronic illness and workplace reasonable adjustments is in our other guides.
Log your migraines and bring a report to your return-to-work talk
Get into the conversation with a clear record instead of a memory you piece together.
- Each attack gets a date, strength, duration and aura in the migraine program. New entries for today add last night's sleep and HRV from Apple Health.
- The doctor report counts your migraine days for the period you choose, as a PDF you can show or keep.
- The monthly MIDAS check-in turns how migraine limits work and life into one number you can discuss with your doctor.
Sam keeps your entries together and sends nothing to your employer. You decide what, if anything, to share. 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
- Phased return to work with a chronic illness
- Workplace reasonable adjustments for a chronic condition
- FMLA and intermittent leave: what to document
Sources
Updated: October 2026
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 go back to work before I feel ready after migraine sick leave?+
Not on your own. A fit note from a healthcare professional says whether you are fit for work or may be fit with changes, and your employer should discuss those changes with you. If they cannot put them in place, you are treated as not fit for work. Talk to your GP first, and to ACAS, Citizens Advice or a union if you are unsure. This text is general information, not legal advice.
What is a phased return in the UK?+
It is a gradual build-up to your normal hours and duties after sick leave. ACAS says a fit note will usually give advice on how long it should last, and you and your employer agree the pace. It can include flexible or part-time working. If you are disabled, a phased return can count as a reasonable adjustment.
What does the FMLA give me in the US?+
The Family and Medical Leave Act gives eligible employees up to 12 workweeks of unpaid, job-protected leave in a 12-month period for a serious health condition. You need at least 12 months with your employer and 1,250 hours in the prior 12 months.
Does the ADA cover my migraine?+
The ADA covers employers with 15 or more employees; some state laws cover smaller employers. It requires reasonable accommodation for a qualified person with a disability, unless that causes an undue hardship. Whether your migraine counts is individual. An adviser can look at your case.
Must I show my migraine diary to my employer?+
No. Your own records are for you to prepare with, and Sam sends nothing on its own. What you share, if anything, is your choice.
Who can advise me before I decide?+
In the UK, ACAS, Citizens Advice and trade unions give guidance. In the US, the EEOC and the DOL publish guidance, and a labour lawyer can look at your case. This text is general information, not legal advice.