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“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.

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


  • Anne
    5 years ago

    Thank you so much for this! Especially the Self Talk section – I have had a couple of weeks of other people’s opinions of how I should be handling things and it is unbelievably maddening. This is a good life lesson in never judging a person until you’ve walked a mile in their shoes. I cannot interrupt my chronic migraines, no matter what I try, and I’ve tried everything you can think of. So many people think that they’re doing something right because they don’t suffer the same way, which couldn’t be more illogical. It would be like saying, if you just did A, B or C, you’d be able to turn your blue eyes brown (as eye color is governed by genetics, just like my migraines).

    It’s hard to stay strong and not lose my shit. I’m so glad you guys are here to talk to 🙂

  • Tammy Rome author
    5 years ago

    So glad you enjoyed it! We all try to stay strong and we all “lose it” from time to time. None of us respond the same and there are so many variations of treatment. Please, come talk to us anytime! We live with migraine just like you.

  • cindyd
    5 years ago

    Having such a rough week and this is just what I needed in this article. It is getting so bad that I am thinking about going on disability because I feel like I am just sinking sometimes and that I am missing what everyone around me is “getting” as far as processing information and feeling so stupid when I know it is not my fault but my bosses, though they say they understand, I know they truly don’t “get it” and the “fogginess” is making me so frustrated . . . thank you for giving us a place to sound off and air our frustrations.

  • Jill M.
    5 years ago

    Cindyd, I can relate. Sometimes I feel as if my intelligence has actually declined over the last few years. It’s awful. I work in a secretarial position in a school system. I love my job, but sometimes I wonder that I’m not as effective as I used to be. I’ve also noticed that I have a very difficult time with spelling. I used to pride myself on being able to spell just about anything; now, I find that I constantly make mistakes. As someone who has a degree in English, it’s quite embarrassing!! I also have a terrible time with word recall. This can be quite embarrassing as well when I’m trying to have a phone conversation with someone. Sometimes I’m not sure if these things are from the migraines, from the medication, or from a combination. I’ve briefly considered applying for disability, but I’m not sure I would qualify. I also don’t think I could afford it. My husband and I have difficulty as it is with our two incomes, so I’m sure life would be very strained with only one of us working and one on disability. Lots to think about…thanks for “listening”…

  • Tammy Rome author
    5 years ago

    I never regretted going on disability. Even though the migraines didn’t get any better, my stress level changed dramatically. Now it’s my full-time job to take care of my health.

    Sound off any time. This disease is a hard one to get others to take seriously.

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