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Treating migraine brain

Treating “migraine brain”

Anyone who has ever experienced a migraine will tell you that it is nearly impossible to think clearly or communicate effectively during an attack. Many will attest to residual problems during the postdrome as well as preliminary problems during the prodrome. For patients with chronic migraine, the ability to think and speak coherently can appear to never end. I have even talked to migraineurs who are skeptical of current research that claims there are no lasting cognitive deficits resulting from white matter lesions so often found on the MRIs of long-term patients. To be fair, the research has produced conflicting results. It’s just too soon to know for sure.

What is known is that stress and pain can significantly impact our mental functioning. Our bodies go into a type of “high alert”, favoring action over manners or political correctness. Live with pain and stress long enough and it’s bound to take its toll on your brainpower. Part of the reason may be environmental. I’m not suggesting there is not a biological explanation for migraine-related cognitive impairment. Instead, I’d like to suggest that it is possible to do something to offset that “migraine brain”.

You can learn to compensate for what the mind fails to do (i.e. word loss, forgetfulness, etc.). People with irreversible cognitive damage are often taught how to use specific strategies to compensate for their disabilities. These same strategies are taught to children with ADHD to help them stay on task. They will work equally well for migraineurs.

There is one catch. The professionals who teach these skills are not medical doctors. Most are counselors, therapists, social workers, and psychologists. I realize that some patients have been referred to mental health professionals as a way to “patient-dump” or because their doctors believed their pain was psychosomatic. The topic of mental health can be a very raw subject for a lot of us. If you will indulge me, I would like to try to redeem the reputation of my profession.

The therapies employed focus on compensating for cognitive deficits called Executive Functioning Skills. These are eleven skills that govern our behavior, regulate our emotions, and set and achieve goals. Depending on genetic, organic, and environmental factors we each develop a unique blend of skill strengths and challenges. Apparently, migraines impair our ability to use these skills, too.

Take a look at the list of skills and see if you can identify with any particular skills. You can also download a brief questionnaire to help you discover your strengths. In future posts, I will introduce a variety of strategies you can use to compensate the next time “migraine brain” takes over.

Executive Functioning Skills

Response inhibition: the ability to think before you speak.
Working memory: the ability to remember lists, dates, phone numbers, and tasks.
Emotional control: the ability to prevent your emotions from interfering with a task until it is complete
Sustained attention: the ability to focus on one thing at a task until it is completed
Task initiation: the opposite of procrastination, particularly when the task is unpleasant or boring
Planning & prioritization: the ability to identify and commit to priorities when there are many competing tasks
Organization: the ability to keep things organized and neat
Time management: the ability to accurately estimate the time it takes to complete a task in order to meet a deadline
Goal-directed persistence: the ability to delay pleasure in order to achieve goals
Metacognition: the ability to be objective about oneself accurately
Flexibility: the ability to handle surprises and make adjustments ‘on the fly’.

Read Part 2 in the “Migraine Brain” series – Working Memory Deficits

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.



  • DinaMay
    2 years ago

    The brain cloud is the worst symptom for me. When I’m in too much pain I go to bed with the shades drawn and a towel over my head to block the light. I play a little Bach or Chopin very softly. And I stay like that, off in some other dimension, until it’s all over. People get used to me doing that, more or less.
    People aren’t nearly as understanding when they notice my faulty functioning. I have learned that I shouldn’t try to write anything more than a simple list. I will leave holes in sentences where I couldn’t think of the word I wanted. I will leave a word out here and there and be unable to catch it (until days later). Worse, I may realize something’s amiss with what I wrote but be unable to pin it down. I must be doing something comparable with speech because there’s a certain look that people give me. Like they’re just waiting for me to stop blathering so they can politely make themselves scarce.
    None of the meds I’ve used over the years make much of a dent in this brain cloud business. I’m learning to accept this as a fact of life, a necessary step on the road to avoiding stressing myself over my inability to control my life.
    Can you tell I’m wandering around that cloud right now?

  • Ronan
    2 years ago

    One of the moderators sent me this link. All I can say is Wow!! I had myself tested a few years back. I was told I had a slight neurocognitive disorder. Between depression and migraines, I have had most of my life this makes so much more sense

  • RTurner
    5 years ago

    Thank You! I am not the only one that has permanent “brain freeze”. I felt that I was the one that had this problem. I lost my CEO/CFO job of 15 years because of this. I am now ashamed to go out of the house if it involves speaking to people that do not know me. I have to look to my husband to finish my sentences or fill in the word I can’t remember. I will re-read this post at least 3 times to make sure I did not type the same sentence or partial sentence twice. I, too, provide myself with exercise walking from room to room because I cannot remember what I went into one room for. I used to be able to multi-task, heck now I have to force myself to stay on task to finish putting the dishes away before I fold the laundry. I make a TO DO list and put the 3 MUST COMPLETE items for the day in the order, then I put extra things to the side. It is very difficult some days to get my 3 items done because I am so tired or my brain just litterly will not function – probably sounds crazy. This makes things between me and my husband difficult.

    Thanks for the great article and also for all of you responded. At least I know I am not alone.

  • The Migraine Girl moderator
    6 years ago

    Tammy, I love this post and am considering printing it out and keeping it as a reference for myself and for loved ones who wonder why I have morphed from a very smart person to an occasional dimwit. 😉 All joking aside, I appreciate this so much!

    -Janet G.

  • Luna
    6 years ago

    Found myself having a “walking stupid” day today. What really gets me is that I didn’t feel foggy or anything. Something I don’t remember enough is the days I feel ok are usually the days I’m most apt to do brainless things. I miss the me that used to be very capable, was the go to person when anything in any way went wrong at work. If something needed done I could figure out a way. I like the suggestions in the article if only I could remember them to use them.

  • The Migraine Girl moderator
    6 years ago


    I was just telling Tammy, author of this article, that I’m considering printing up a copy of this to keep on hand so that when I’m really brain dead I can refer to it. Maybe that’s one way to start remembering some of the suggestions: use a cheat sheet!

    -Janet G.
    “The Migraine Girl”

  • Garangwyn
    6 years ago

    I had brain fog from fibromyalgia for several years prior to the onset of chronic migraines, so this was nothing new to me. But the chronic migraines — and the side effects of the medications given to me in what as so far been only a mediocre attempt to control them — have created the mother of all “migraine brains”! I am also very glad to see this subject addressed, not only with facts to verify what we already know exists, but also with real coping strategies to help us on a daily basis. Looking forward to reading more. Thank you!

  • Kerrie Smyres moderator
    6 years ago

    Thanks, Tammy. What great information. I’ve learned to not get (too) frustrated with brain fog and to plan my activites around it, but never considered the strategies that help people with brain damage could also be effective for migraine’s brain fog. I’m eager to read the series.

  • Jules2dl
    6 years ago

    Wow! Thank you so much for this post! And thanks also to all the people who posted comments as well. I’ve had chronic migraines with chronic daily headaches for 44 years, but in the last 2 1/2 years, my daily headaches became migraines as well.
    It took 2 years, but I finally got disability benefits. I was a cook for most of my life, which is both a physically and mentally active job. My cognitive abilities have really drastically gone down the tubes. My husband is afraid for me to drive to the grocery store. I almost never can finish a sentence by myself. I’ll say something like “you know..the song by the singer with the blonde hair whose name starts with a B”.
    The worst thing is, I can never get my day started. I’ll start out playing a game of words with friends on my phone while I’m eating breakfast (because word games are good for your brain, right?). * hours later when my husband gets home I’m still in pajamas playing games on my phone, and the house hasn’t been cleaned, dinner hasn’t been cooked.
    I have 4 kids, all grown now. I once kicked my 21 year old son out of my house because I couldn’t stand to see a 21 year old man playing computer games all day long, not working, not going to school, not contributing in any way. Now I’m doing the same thing he was doing!
    I’m not motivated, I’m overwhelmed when I see how much has to be done in our tiny, over packed little farm house. My head hurts, and I’m exhausted before I start. It’s causing difficulty between my husband and I. I want to be “a good wife”. So now basically what you’re saying is that this is one more symptom of “migraine brain”, but that “ve have vays” of dealing with it so it does not take total control. This is a wonderful thing. Thank you so much for bringing this out in the open! This was something I was very much ashamed about. God bless you Tammy.

  • Pete
    6 years ago

    Jules, being ashamed about a medical condition is simply self-abuse. Believe me, I know. In my first years of total disability, I can’t tell you how many time I sat with a loaded gun…
    Try to hang onto the good things/times, and let your husband know when you are having a flare day /week/month. Interesting- I also am extremely distractable and often have multiple projects hanging fire. Some days my best efforts are nuking a meal I made a week ago (WHEN I am able to cook, I usually make lots extra, to freeze for my bad days.
    Try to find a group, or at least a fellow-migraneur to talk to. I wish there was such a group for my long-suffering wife; I think it is harder on them, than on us. Crawling along the floor, screaming, crying and beating my head against the wall with the suicide clusters does wonders for one’s ego. I was a fearless trial lawyer, captain of most of my soccer teams, a very successful volunteer soccer coach, on multiple civic boards,etc. Now, sometimes a good day is being able to give my wife a neck rub at night watching TV.
    For the others, you bet I screw up with not only words and phrases,but concepts: today I shot a very short video of a possible pollution area to send to the OEPA (worthless); in reviewing it (less than 2 minutes) I found that I confused North for East, and a major route that runs parallel with one that crosses. I’ve known these roads for over 44 years. I didn’t realize what I was saying, and I truly thought that I had it right. I violated my own rules about “walking stupid”; you’d think I’d learn my own lesson!!
    Fortunately, most people who know me understand that it may be days until they get any kind of a reply from me, and it’s not that I’m being rude. For me, it’s much better to have them wait and get it right the first time rather than screw it up (sometimes without knowing) and spend 3X the time trying to “fix” it.
    FYI- I’ve been battling these for 29 years; I’m 62, and still hangin’ in there. Good luck, and know that we all are pulling for you! Find something that you like to do that can make you feel good about yourself!

  • bluebird
    6 years ago

    The roller coaster ride of fine functioning undercut at any moment by migraine syndrome feels like an arbitrary negative reinforcement schedule. It is a most powerful training tool in behavioral management. Unfortunately, the variability of what you have presented as changes in Executive functions, clarifies how corrosive this process is to a sense of identity as a person used to being responsible and competent, reliable and creative.
    I wonder what specific techniques might be applicable.
    Thank you for this post.

  • MaggieG
    6 years ago

    This uncertainty and struggle with writing and composing with migraine or postdrome drove me to decide to retire from an executive position that required me to communicate all day. My problem was leaving out words when I composed and having my brain automatically filling them in when I reread. I don’t know if there is a term for this brain function but the problem got worse over time and migraines. Now retired, I am relieved not to have to worry about whether I might inadvertently affirm something that I wanted to negate by accidentally leaving the word “not” or “no” out of my sentence and not seeing it missing even when I proof read it. Like you, I found that being aware of what I was doing wrong and not having a strategy or technique to correct it was frustrating. My fear of losing my positive career reputation led me to opt out.

  • Pete
    6 years ago

    I call it “walking stupid”, and I try to avoid any in depth tasks; my wife knows that if she tells me something during these periods, that she will have to repeat it after I come out of it.
    Since the docs retired me from law practice, I do all of the food work (buying, prep, cooking and cleaning); when I’m like thus, I always double-check recipes, even if I’ve cooked it 100 times, as I don’t trust myself to be complete. I also “lose” words, and names are long gone.

  • The Migraine Girl moderator
    6 years ago

    I love your term but hate the phase it describes: “Walking stupid.” You hit the nail on the head there, Pete! Would you mind if I wrote a full-length blog post using that term as a starting point (to dovetail with Tammy’s posts about “Migraine Brain”)?

    Thanks, all for your comments that make me feel a little less loco.

    -Janet G.
    “The Migraine Girl”

  • MaggieG
    6 years ago

    ” walking stupid” is a great term to describe the experience. Do you also find that you leave out words when you write an email and still do not see them missing when you proof read? My brain just inputs the words and races ahead with the thought and I cannot overcome it easily. This is my issue and it has gotten progressively worse. Does any one else have this problem?

  • Garangwyn
    6 years ago

    “Walking stupid”! I like that! LOL I can’t trust myself either…even when I don’t have a migraine! After I was put on disability for the migraines, (I was working at a community college, and going to school to get a degree in accounting prior to that), I thought maybe I could start sewing out of my home. I found out that no matter how hard I tried to focus, I would end up doing things like sewing the pockets on pants to the seam on the backside, then I would rip them out, only to sew them to the bottom of the pant legs.

    Double-checking everything does me NO good. I don’t even know what I’m missing until it’s a done deal. And my neurologist still hasn’t said I’m permanently disabled. I wonder what kind of work he thinks I’d be able to do at 60 years old? If it’s not the migraines, it’s surely the meds…or the lesions, as Tammy mentioned. Because I do have them, and at one time they were even testing me for MS because of them. But no MS…”just migraines” I guess.

  • msruff
    6 years ago

    I just read an article in Science News about chronic pain and (the lack of) motivation that I think will be of interest to migraineurs of all types. It is too long to post here, and you have to be a subscriber to read it online, but if anyone’s interested, e-mail me at, and I’d be happy to send it to you. Research is turning up some pretty interesting things.

  • Luna
    6 years ago

    This looks like a good review of the research paper that Science News put out on pain and motivation.

  • Sara
    6 years ago

    Interesting. As a school psychologist I use these areas of executive functioning as entry points for intervention for my students regularly…just never though about trying to apply the strategies when I am struggling with migraine brain! Thanks Tammy!

  • Tammy Rome author
    6 years ago

    Hi Sara!

    I was introduced to the practical use of executive skills while working with ASD kids when I realized how much they an apply to my own life, too.


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