A Discussion - Changes in How We View Chronic Migraine

We often notice valuable discussions taking place within our community forums or Facebook page that we like to highlight as a part of our Headlines. Below is a discussion on chronic migraine that we thought our community members would find interesting. Please note that the opinions represented here are solely those of their authors.

Research on migraines, including causes, diagnosis, treatment, triggers, and more, has been going on for several decades. While much of what we know about migraines has been well established for many years, there is a constant influx of new data that affects how we view this condition. One of our community members was reading up on chronic migraine, and raised some good questions that prompted valuable discussion around how we view this condition.

Community member question/comment:

I have recently been reading Migraine by Oliver Sacks. He has a chapter on “situational migraine,” which largely refers to “habitual migraines,” a category that can include chronic daily headache (a.k.a. transformed migraine) as well as migraines following a particular pattern of occurrence (i.e. every Sunday). After listing several cases of from his patient history, he concludes “that the majority of patients who experience very frequent, severe, and unremitting migraines, for which no obvious circumstantial antecedents can be traced, are reacting to chronically difficult, intolerable, and even frightful life-situations.” Many of these patients found relief when their life situation changed (i.e. they reverted from daily migraines to their previous pattern of periodic migraines).

I am inclined to believe this thesis because it correlates with a lot of the scientific papers I have read on the subject of chronic migraines and the stories of chronic migraineurs, such as those I have read on this web site. From my personal experience, it is no coincidence that my migraines transformed from episodic to daily at the time that they did. There were some very upsetting things happening in my life at that time. These problems have not yet been resolved, and neither has my pattern of daily migraines.

It is a scary thesis for a few reasons: 1) Many people would interpret a psychosomatic illness, being purely psychological, to be a sign of emotional weakness. Who would not want to admit that their physical illness is the result of a psychological problem? 2) It implies that you have to make a courageous change in your life in order to overcome your illness. 3) It means that many people may be medicating for a physical illness rather than dealing with a potentially fixable situation in their lives that are the root cause of the frequency of their headaches.

Again, this thesis implies that the frequency of the migraines is psychosomatic, not the migraines themselves, which were already occurring on a periodic basis. Many of you on this forum currently experience chronic daily migraines or have experienced them in the past, and many of you have done a lot of research on migraines as well (I am learning a lot from you all, btw). I am curious what you all think about Sacks’ suggestion that at least in some cases the transformation from episodic to chronic migraines could be of psychological origin.

Response from Moderator, Kerrie Smyers:
Kerrie Smyres

Oliver Sacks’ Migraine was published in 1970. Migraine and headache research is substantially more sophisticated now and, while chronic migraine might be psychosomatic for some, scientists widely believe that’s not the case. There are many factors at play, one of which is medication use. Another is that the longer one goes with inadequately treated episodic migraine attacks, the more frequent the attacks tend to become.

I think where Sacks’ assertion is most seen is connected to stress. Some researchers believe stress itself is a migraine trigger, while others believe that it’s not taking care of ourselves during stressful times that triggers migraine attacks. In either case, those factors could help cause episodic migraine to become chronic and removing oneself from the stressful situation may be a helpful for some people.

Oliver Sacks’ Migraine is a great book, but, 44 years from publication, it should be considered a historical document, not a current information source.

Additional response from original posting community member:

Those are good points, Kerrie. I definitely feel like there is a stress connection for me. I think it is hard to classify a migraine as directly stress-triggered or even psychosomatic. Stress triggers changes in brain chemistry, just like anything else. Those changes could trigger migraines for some people and not for others, or stress might trigger a migraine one day and not trigger one in a similar situation days later. These things are so inconsistent, not only from person-to-person, but from day-to-day for the same person. Stress is also difficult to define. Noise and light can be defined as stressors, and they are certainly triggers for many people.

The edition of Migraine I am reading was published in the 90′s, and he did make some changes and updates to the original version. This obviously was something he decided not to change. The 90′s is still a long time ago in the field of migraine research. While I agree that parts of the book are dated, I think many points, including this one, are worth discussion. Sacks argues that migraines can be triggered by both physiological and psychological factors. The psychological side always runs the danger of leading to victim-blaming, which is never a good thing, but I like the idea of discussing it in an environment such as this, which I believe to be pretty safe from that. I really would like to hear what others have to say about their experiences with stress or other psychological factors relating to their migraines. I believe migraines to be primarily physiological, but I suspect more and more that there is a serious psychological side to mine and I imagine there are other people who feel the same.

Additional response from Kerrie:

I agree it’s an interesting topic that is often oversimplified. And it can make lots of people’s tempers flare!

It could be argued that episodes of nearly any disease could be triggered by an emotional or psychological component (a seizure, fibro flare or MS cycle, for example). No one is a body independent of emotional or cultural context. Some people find that managing those triggers reduces their symptoms, others don’t.

For migraine, cognitive-behavioral therapy, mindfulness-based stress reduction and even biofeedback are all ways of managing psychological triggers. Some find these strategies reduce the frequency or severity of their migraine attacks, others find them helpful in coping with migraine but get no pain relief from them.

I see a therapist who is also a naturopath. She told me this week that before she met me, she believed that working through an emotional trauma or sticking point would relieve most people of their migraine attacks. Having seen me for a year, she’s come to believe that migraine itself can be the instigator of emotional stress. All the work I’ve done with her over the last year has helped me cope with migraine better, but it hasn’t changed the frequency or severity of my migraine attacks.

Thanks for bringing up this complicated topic. I’m curious to see what other people have to say.

Response from another community member:

It appears to me that not everyone thinks that migraines necessarily have a physiological component. I saw a Neurologist (do not believe he is a headache specialist) who told me that the entire migraine was stress, and that with biofeedback (which he ran in his practice) and took some natural supplement (which he’d been involved in developing recently) that he’d be able to cure it in six months. (Very, very angry about that, but anyway) So I went to this appointment that he set up for biofeedback, at which they told me their machines didn’t detect undue amounts of stress, so he sent me to a psychiatrist, who I talked to for about an hour and a half, and at the end of which told me that, while my life currently had a great deal of stress, there was no evidence of stress going back as far as the migraine and therefore he didn’t believe it was the cause.
I’m not trying to discount stress as a factor for some people, just wanted to put in my two cents worth.
I saw this guy for less than two minutes and he’d already put it down to stress, and only stress, and effectively placed me in the crazy basket. Then, at the end of my last appointment, he told me to just take off the sunnies and get on with your life, and it’ll just go away.

Response from Moderator, Tammy Rome:

I don’t doubt that stress can be a mitigating factor in the triggering of migraine, much as it can for MS, fibromyalgia, some asthma, epilepsy, etc. Stress almost always makes us more vulnerable to whatever our weakness is. That doesn’t make it causal (which I don’t read that either of you are saying).

I am also of the opinion that certain behavioral-focused psychotherapies can help those with chronic pain so long as the pain is viewed as one of the stressors, not the cause of stress.

Migraine can strike me on good days and bad. Some people have accused me of “sabotaging my own success” while others tell me that I “can’t take the pressure”.

Until our society begins to accept that the mind, body, and emotions are all too intertwined to be separate disciplines, I’m afraid stigma will persist and uninformed doctors will still try to call us “crazy”. Many migraineurs have been so injured by doctors who told them they were “making it up” or “it’s all in your head” that they won’t even consider potentially beneficial psychotherapy in addition to medicine, diet, and other treatments.

Nice discussion. Thanks for bringing it up!

Have you experienced a change in your chronic migraines after a significant change in your life? Have your migraines changed from chronic to episodic after a decrease in stressors in your life? Please share your experiences with us in the comments!

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