“Migraine Brain” Part V – Emotional control

We are nearing the end of this series on “migraine brain”. I hope that you are feeling reassured that your symptoms really are legitimate.  But more than that, I hope you have gained a new sense of empowerment now that you have some new tools to cope with this particular problem.

We’ve covered the basics of executive skills, catching up after an attack, working memory deficits and project completion. Now it’s time to take a look at our emotions. As if the other deficits don’t get you flustered, coping with “migraine brain” means that often our emotions rule the day. An early prodrome symptom is irritability. The changes in our brains that bring on a migraine attack also make us grouchy and impatient. Serotonin, norepinephrine, and dopamine take a nosedive – and there goes all of our ability to feel positive, happy, and satisfied.

The good news is that when the attack subsides, our brain chemicals often return to normal. It is at this point that we can sheepishly realize we’ve been unreasonable with our loved ones. We try to apologize. We try to explain. Yet we and our loved ones know it will happen all over again at the next attack.

For patients with chronic migraine or chronic daily headache, there is no return to baseline. It seems like someone has pulled the plug and drained us of all our “feel good” neurotransmitters. No matter how hard our bodies try, the drain is open, pouring them out faster than we can replace them. It’s no wonder that depression is such a common comorbid condition. In the case of chronic pain, patients may find that antidepressants are necessary to keep brain chemistry from spinning out of control.

There are some other tools you can employ. Let’s look at a few strategies to help strengthen three specific skills:

1. Response inhibition
2. Emotional control
3. Flexibility

Response inhibition

1. When you feel strong emotions, tell yourself, “Stop!” Count to ten. Take a few cleansing breaths. It seems obvious and trite. Yet taking a moment to stop before you respond can give you just enough time to resist a destructive impulse.
2. Use the THINK strategy to slow down your impulses. Before sharing your response, stop and ask yourself if your impulse meets these criteria: true, helpful, inspiring, necessary, or kind.  If not, maybe you want to think about rephrasing your comments or refraining from speaking at all. Even if your response does not meet these criteria, at least you will have slowed yourself down enough to accept the consequences.

Emotional Control

1. Become emotionally fluent. It can be difficult to recognize what we are feeling until it suddenly comes pouring out when we least expect it. By learning to identify and communicate your emotional experiences, you gain control over your expression of those emotions.Think of emotions as falling into one of 4 categories:
   • joy
   • fear
   • hurt/shame
   • sadness

   Every emotion you can imagine will fall into one of those categories, somewhere along a range from mild to severe. For example, joy can be experienced in an infinite range of intensity from mildly amused to elation. Instead of trying to pick just the right word, all you need is to choose the most accurate category and identify the intensity. This is usually when I get two protest questions:

   What about anger?
   Anger is often a defensive reaction. It can fit into any category, depending on the primary emotion that is fueling it.  Maybe you are angry because you’re afraid and trying to avoid letting others see your fear. Maybe you’re embarrassed, or you don’t feel safe expressing your sadness. The next time you feel angry, take a quick emotional inventory. Are there other emotions present? Often when we acknowledge the primary emotion (even privately), anger is much easier to use effectively.

   Where does love fit in?
   Love isn’t actually an emotion. Attraction and lust are biological responses that can produce feelings of joy, euphoria, or even shame, sadness, and fear. Love is a very different experience that comes from a conscious choice to make a commitment.

2. Enroll in a biofeedback, meditation, yoga, or tai chi class. These disciplines slow the heart rate, increase oxygenation to the whole body, and teach progressive relaxation. When you can learn to manage your body’s response to stress, then emotional control is a natural by-product.
3. Find a good counselor, therapist, or social worker who specializes in treating clients with chronic pain disorders to help you develop healthy habits to prepare for strong emotions.

Flexibility

1. Plan for the worst! You may not do exactly what you plan, but without a plan, you will be caught off guard by situations that trigger unpredictable responses.
2. Enlist a friend to help you role play stressful or emotionally charged situations before they happen.
3. Make a pros and cons list of responses to stressful or emotionally charged situations.

Try some of these strategies at home. If you find that you struggle or
need a coach, then don’t hesitate to seek out professional help.

Emotional control is probably the most difficult of all the Executive Skills. Our brains and bodies are wired for survival. That instinct takes over when we are under stress. It takes a lot of practice to identify and respond appropriately to our emotions. Most people can’t do this alone. There is nothing wrong or weak about asking for help.

There is one more area to cover in order to complete this series. Next time, we’ll explore the ideas of metacognition, self-reflection, and self-talk.

In the meantime, take a moment to share your own best tip for emotional control in the comments below.

Read Part 6 of the "Migraine Brain" series - Self-Reflection