Chronic migraines are life-changing. It is a lonely struggle that family and friends don’t tend to understand without experiencing it for themselves (and migraines are a very individual experience, so even those who have had a migraine don’t necessarily know the struggle of another). With chronic migraines, the fear of the next attack always looms. In fact, the fear itself can even become debilitating.
People have often relied on medical and alternative practices to try to relieve themselves from chronic migraine attacks. These methods can all be helpful, and it’s especially important that people have a neurologist following the progression of their migraines. However, what isn’t focused on enough is the role mental health can play in chronic migraines, and how much certain types of therapy can help with relieving migraines.
In my therapy practice, I specialize in working with people who struggle with chronic migraines and headaches. This includes people who have attacks with and/or without aura, people who get them once or twice a month, people who have chronic daily migraine for months or years, and anywhere in between.
First, I should clarify that there are many possible triggers for migraines. Each person comes in with their own migraine history, including different triggers (and triggers can often work in combination, as opposed to just one clear trigger).
While I do help people with trigger identification in their lives, I also focus more centrally on what I call the Internal Migraine Environment.
The Internal Migraine Environment is, in the most basic terms, what is happening behind the scenes in a person’s present life and history that can set the stage for chronic attacks. The Internal Migraine Environment is comprised differently for everyone, as migraines are very personal and individual. Some people seem to be generally primed at all times for an attack when the smallest of possible triggers presents, whereas others seem to have a bit more leeway for stressors and triggers before reaching the threshold of an attack.
When migraines are non-organic (meaning there isn’t a notable or identified medical basis for the attacks), people often believe that they just “get migraines.” But there are always reasons for each attack…whether the triggers are tangible — such as chocolate or hormonal shifts — or whether it’s something more difficult to identify — such as psychological and emotional life patterns that have long been present and reinforced over time.
There are many things to talk about with what comprises the Internal Migraine Environment. One of the themes that seems to be common among many migraine sufferers is a life-long pattern of caretaking for others, while their own needs are often secondary. Also, for many, a pattern of dissociating certain emotions (anger, for example) is common.
For people with patterns of attending to others’ needs while dissociating their own needs, there may be an internal frustration and anger that their needs are never met. They begin to notice that when people makes demands of them, they feel internally enraged and end up with a migraine rather than being able to deal with the situation in a healthy manner.
Another example is a person who was raised to fear their own anger — whether because they learned that they will hurt or lose others, or because they were hurt or abused in return from showing anger. This person may unconsciously avoid feeling anger, or hold it in. When a situation presents where feeling anger would be appropriate, the learned response is to disconnect from it and possibly even try to cater to others instead in order to keep them closer. This piece of emotional disconnect causes the energy from the stored anger to go elsewhere, and can result in physical symptoms over time.
Imagine a time you’ve had an intense feeling/emotion that you’ve had to hold inside, and consider what it was like to feel this. Now imagine doing this daily, since childhood, for years and years. The energy needs to go somewhere. When this happens it causes symptoms. For some people it can be gastrointestinal issues, general anxiety, depression chronic fatigue, etc. For others it can be headaches and migraines (as well as depression, anxiety, etc.).
When the Internal Migraine Environment becomes more understood for each person, it becomes more possible to make changes that can create more distance between a person and their migraine threshold. It’s also worth mentioning that recent developments in neuroscience show that certain kinds of psychotherapy can rewire neural pathways — meaning one isn’t doomed to their long-time struggles. While this isn’t meant to be a cure, as there is no cure for migraines at this point in time, I’ve seen many people able to reduce the frequency of their attacks as their migraine environment is understood, and the emotions that come with the migraine are learned to be managed in a more healthy manner.