Anyone familiar with migraine will know the first signs of an impending attack. What might be a little less familiar is the precursor to the “first signs”, and what may also be unfamiliar is the thoughts that accompany those first symptoms. Today I want to talk about ways to manage this phase of a migraine – without medication.
As an aside, some people have suggested that there are ways to completely get rid of migraine, often suggesting that one of the problems could be around the numerous nerves that innervate the face, neck and scalp. One of the common suggestions is to have chiropractic or osteopathic treatment to “do something” to the nerves in this area. I put the “do something” in quotation marks because I really don’t know what the something’s are. This is not to say that I don’t think this kind of treatment works, more that I am not familiar with the purported mechanisms for how hands on treatment helps. My focus is, however, on what individuals can do for themselves to manage a migraine when or if, or even alongside, other treatments have not been completely successful. Or perhaps because of individual choice not to pursue other treatments.
One of the unique aspects of being human is our ability to think about situations in certain ways. These cognitions allow us to prepare for what might occur in light of what has happened in the past and what we predict might happen in the future. But as many of us know, the accuracy both of our memories and our ability to pull together all the relevant information is not exactly high. We’re inclined to notice only salient features, recall recent events, emotionally-laden events, unusual or novel events – and make predictions from “rules of thumb” or heuristics. These shortcuts reduce cognitive burden, but also reduce accuracy.
‘Nuff said – how we evaluate the early warning signs of migraine has an effect on at least two things: our emotions and our actions. Let me explain.
Some of the “early warning signs” for migraine can be, for me, floating sparkles that float up and across my field of vision. When I see them my first thought is “Oh no, when is it going to hit?”
What sort of emotion do you think I generate with that thought? Yes – you’re probably right, it’s fear or loathing! Dread, maybe. Whatever the name you give to this thought, the effect is to increase my heart rate, skin conductance, respiration, and probably blood pressure. There are probably other physiological changes that my body goes through because I’ve learned to associated those sparkley lights with the onset of nausea and headache. The thing is, that no matter how accurate my thought is – it’s not going to settle my headache! And the physiological changes are not going to help either.
A cognitive behavioural approach to this common situation is to take the view that I can self manage my headache because I can learn to view my situation differently – and take action to change my response. That’s the bottom line of self managing chronic pain. Nothing is quite as empowering as knowing that there are things that I can do to feel more in control, to reduce my distress, to feel more confident about managing my situation.
Often just by recognising the effect of the thought “oh no, here we go again” can interrupt the process of winding up the body’s response to migraine aura. Add to that some skills in self regulation – particularly breathing diaphragmatically and releasing muscle tension – along with a coping statement like “I can manage with this if I just take some time now”, and we have a much more positive take on what living with a migraine might be like.
In terms of actions, thoughts influence emotions, and emotions can influence actions (though not inevitably or we’d all still be like two year olds, having tantrums in the supermarket!) We do learn associations quickly, and this means that we can mistakenly associate the onset of migraine symptoms with something unassociated. In this way, triggers can be mistakenly identified, and with the usual advice being to avoid triggers, lead to a life full of restrictions. It can be quite hard to break that incorrect association because of the intermittent nature of headache.
Actions can, however, also be directed by thoughts. If I catch myself thinking “oh no, here’s another afternoon of hiding in the dark and feeling rotten”, replace that thought with a coping one “if I take a few minutes to relax, breathe deeply, and make some alternative plans”, I might be able to slightly modify what I need to do and even avert the migraine. Even if I continue to have the headache, I’m more likely to be able to keep doing things that need to be done. Even when triggers are present.
By learning to keep doing some things even when a migraine is present, the anxiety associated with being around a trigger can be reduced so at least I’m not winding my migraine up, and I may even be able to tolerate that possible trigger in the future.
I don’t want anyone to think I’m suggesting that this completely abolishes the migraine. I know only too well that it doesn’t! However in combination with medications when necessary, it does mean migraines don’t dominate completely.
Kelman L (2004). The premonitory symptoms (prodrome): a tertiary care study of 893 migraineurs. Headache, 44 (9), 865-72 PMID: 15447695
Thorn, B., Pence, L., Ward, L., Kilgo, G., Clements, K., Cross, T., Davis, A., & Tsui, P. (2007). A Randomized Clinical Trial of Targeted Cognitive Behavioral Treatment to Reduce Catastrophizing in Chronic Headache Sufferers The Journal of Pain, 8 (12), 938-949 DOI: 10.1016/j.jpain.2007.06.010