“Migraine Brain” Part VI – Self-reflection

This is the last of a six-part series on coping with “migraine brain”. If you have missed the earlier posts, start with the basics of Executive Skills. When this series started, the plan was for only one brief article on Executive Skills. It soon became apparent that there was a lot more material than could be adequately covered in one post. So the plan changed to cover two or three skills per post and allow space to provide tips on how to improve or compensate for any deficits.

In Part I, you were introduced to the concept of Executive Skills and how they can be impacted by migraine. I encouraged you to discover your own blend of strengths and challenges by testing your skills, then shared how to overcome your challenges using the same strategies used to treat TBIs or children with ADHD. How many of you tested your Executive Skills? Do you know your strengths and challenge areas?

Let’s review. There are 11 executive skills:

  • Organization
  • Planning & prioritization
  • Task initiation
  • Working memory
  • Time management
  • Sustained attention
  • Goal-directed persistence
  • Response inhibition
  • Emotional control
  • Flexibility
  • Metacognition

In Part II, Catching up after an attack we discussed what happens after we recover from a migraine attack. That hazy fog leaves us disoriented and unable to remember what we were doing before the attack hit. It is so easy to forget what we were doing! This is where getting organized can help. By keeping a running list of ongoing priorities, making a written plan, and enlisting help to keep us accountable can really help get us started again.

In Part III, Working Memory we examined the challenges of losing words, losing our train of thought, having difficulty expressing our thoughts, and understanding others. These skills are part of the brain’s working memory – much like the RAM in a computer. Get too many things going at once, and everything will slow down.

In Part IV, Getting the job done explored the challenge of all those unfinished projects. With migraine, there is an element of unpredictability. We never know when we’re going to get interrupted. So we have a choice – we can sit around waiting for the next attack to start or we can get on with our lives. The trick is in knowing how to get things done by planning for the interruptions.

In Part V, Emotional Control we tackled the most sensitive of all the executive skills. When emotions are involved, we don’t always have control. Learning to resist the urge to respond impulsively requires us to slow down and THINK (true, helpful, inspiring, necessary, and kind) through our options.  Being able to identify our emotions and describe them to others is essential, too. Staying flexible and open to change helps us keep our emotions on an even keel. If all else fails, there’s no shame in asking for help.

Guess what we’ve just been doing? We’ve just done an exercise in the very last skill: metacognition. You’re probably wondering, “What in the world is metacognition?” In short, it is “thinking about thinking”. We all use metacognition every day. That running dialogue we all have every day within ourselves is metacognition. The question isn’t if you are using metacognition, but how you are using it.

To explain it better, let’s break it down into three categories:


We use metacognition when we learn by asking ourselves questions like,
“Did I understand that?”
“What did I just read?”
“Does that make sense?”


Metacognition is employed whenever we think,
“Now where did I put that?”
“What should I do first?”
“I should go here first, then do that.”


When it comes to migraine, this is an important way we use metacognition. It’s also where we are at our most vulnerable. We all have the tendency to think the worst when we are in pain. It’s hard to stay positive. It’s also hard to be realistic about our own motives, values, and abilities. How we evaluate ourselves and what we say internally can make a huge difference in all other areas.

How about you?

What kind of messages do you send yourself?

Are your messages encouraging?

How can you expect others to think well of you if you don’t believe you are worthy?

Migraine isn’t a character flaw. It’s a disease. Having a migraine attack isn’t some kind of punishment you deserve any more than any other medical problem. You didn’t bring it on yourself. You inherited it. The first step toward learning to live with migraine is to accept that it isn’t your fault.

This can be a very difficult habit to break. We get a lot of external messages that tell us otherwise. There’s plenty of patient-blaming to go around. You’ve heard it. You’ve probably had it done to you. The question is whether or not you are going to believe it.

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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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