Migraines: How Relevant Is Emotional History?

28I received some criticism this week from a group of headache doctors for suggesting psychological and emotional history could have a place in chronic migraines.

Of course, knowledge of emotional impact on physiological distress isn’t new, and in fact, the idea of emotional and relational basis for physiological distress goes all the way back to the days of Freud. Though some of Freud’s theories go a bit far for some, pieces of Freud’s theories still stand as highly regarded, even in the most contemporary of therapies.

But the faulty assumption these doctors made was thinking that because migraines impact mostly women, that I must be sexist. And that because I mentioned sexual repression (among many others types of dissociation and repression), that it must mean that I’m using outdated theories and don’t know what I’m talking about. And, that because there can be underlying emotional triggers for migraines, that it must mean that I’m rejecting neuroscience. Very black-and-white, and filled with faulty logic.

Just to clarify, in the same breath that they were rejecting underlying emotional causes for migraines, they were also telling me that they don’t know what causes migraines and just don’t have the right equipment to figure it out yet. Some insisted it must only be medical, even though they still can’t prove it.

Currently, migraines are treated by “what seems to work.” And that goes for all approaches to migraine. It is a fact that there are no actual preventative migraine medications — the preventative medications that are prescribed to treat migraines are medications that were designed for other issues (anti-seizure, SSRI, SNRI, Tricyclics, etc.), but have a side benefit of sometimes helping with migraines. No one can claim to have the one answer since there is no cure, and what’s clear is that there are many different elements that can feed a migraine. It isn’t just medical and it isn’t just emotional. But treating at least both the medical and the emotional seems to do more than simply focusing on one or the other.

But back to where I was, the accusations would have almost been funny if they weren’t so alarming. (It actually was amusing in the sense that the migraine-sufferers appreciated the article, and the medical doctors, with clearly little knowledge of psychology, were the ones bashing it).

The most simple example of how the mind-body connection works — think of a moment of significant stress, nervousness, or anxiety. Do you ever feel your heart rate increase, or your stomach start to hurt, or get diarrhea, or feel nauseas? How about a stress-induced headache? Simply stated, emotions cause changes in the working order of our bodies. Chemical changes occur in the body, we become tense, etc.

Now imagine that these scenarios are with you long-term since childhood — that you’re living in an environment filled with stress and anxiety, fear, etc., since birth.

I’m not going to go further into explanations of repression and dissociation since I did that previously. But suffice to say that when we live in long-term states of stress, or closing off parts of ourselves in order to cope, these can start to manifest themselves physiologically.

Clarifying Points

As an attempt to correct some of the faulty accusations, here are some points of clarification:

• Migraines happen to men AND women. Even if the majority of migraine-sufferers are women, when I write I about migraine issues, I’m speaking to all migraine-sufferers.

• Sexual Repression and dissociation (and all other types of repression and dissociation — anger, sadness, happiness, etc.) happen to men AND women.

• Migraines are not only caused by repression and dissociation.

• There are many possible types of repression. People can repress all different types of emotions and self-states. Significant repression of any kind can play a role in physiological manifestations.

• Just because someone may hold areas of repression doesn’t automatically mean they experience migraines; and just because someone experiences migraines doesn’t automatically mean it’s caused by repression.

• Migraines usually take a team of various types of healthcare professionals to treat for most optimal results. There is generally a combination of contributing issues — underlying emotional and relational history is often a relevant part of the issue. Medical care is also necessary. It isn’t an either/or issue. (In fact, I won’t see anyone in my practice for migraines if they haven’t undergone a full medical workup with regard to the headaches first. It is important to know if there is something else going on medically before focusing more directly on migraines).

• Therapy for migraines isn’t meant to cure migraines (and at this point, there is no absolute cure, medical or non-medical). Migraine therapy is meant to help people understand their migraine picture as a whole — triggers, daily life environment (including food, sleep, stressors, et al), while simultaneously focusing on the areas of emotional history that may be relevant to each person’s individual case. It is also to help cope with the emotions of dealing with migraines, and the impact this has on various areas of life.

• The underlying cause of migraines is different from one person to the next. For optimal treatment of migraines (especially if the medical approach isn’t working on its own, which can often be the case), I’m suggesting one of the next steps – if not the next step – should be to understand personal emotional and relational history, as well as in the present. The more that is learned here, the more can be understood about each person’s migraine picture.

It’s important to note that, while some medical doctors challenge ideas that suggest other methods outside of their circle might be effective, there are also many medical professionals out there who recognize the relevance of psychoemotional impact on migraines, and the importance of treating this area, as well.

My Experience

A piece of self-disclosure: I have spent the last 20+ years working to resolve my own vicious chronic migraines. Though nothing has been perfect, with a combination of various approaches, I have been able to go from three or four episodes per week (at its worst), to one or two episodes every six months. The more I was able to learn about myself, both inside and out, past and present, the more I was able to respond to both internal and external triggers. Some triggers were more concrete, and some were more emotional and relational. The more I learned, the more I could respond, and the more the episodes decreased in frequency and severity.

So with migraine therapy, I bring not only my education and experience as a psychotherapist, I also bring what I have learned in 20+ years of active life experience in dealing with, and learning about what is relevant in the life of a person who struggles with chronic migraines. I wish I had a therapist who could have offered this combination treatment to me at the time. But I’m glad I can offer this to others who struggle now.

I’ll conclude here with what I said (in similar words) to this group of doctors: If the goal is to help migraine sufferers feel better, medical health and mental health professionals (and other healthcare professionals) should be working together on this issue. Competition only perpetuates the struggle.

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