A Case of Migraine Triggerphobia?
Some people with episodic migraine are able to identify a few, or maybe even one distinct trigger that sets them off. This is good news. If these triggers are avoidable (let’s say red wine, loud lung-rattling concerts, and jaw clenching) then that person has the potential to reduce their attacks significantly, or maybe even bring them to zero.
Fearing every possible migraine trigger
But people with more frequent and severe migraine attacks, whose neurological brain-pain paths are well worn, can have too many triggers to count. In fact, some people’s brains are so prone to migraine attacks that their triggers can basically be summed up under the label of “daily life.” When stress, synthetic fragrances, vigorous exercise, loud noise of any kind, the weather, and list of foods as long as your arm all cause disabling pain, it can become pretty hard to go out in the world without being just a little bit afraid of the consequences.
This fear is understandable. The thought of spending hours or even several days in bed, disabled, with severe pain can be a scary premonition -- especially when the stakes are high -- so things that have the potential to trigger that pain can be scary too. Firetruck coming this way? Say it isn’t so! What? That salad I just ate was packed with aged cheese? Ahhhhh! A cologne soaked stranger riding the elevator with me all the way to the 22nd floor? Noooooo!!
Triggers and anxiety
But what if our fear of triggers and the resulting anxiety is actually worsening the pain? According to a 2009 study published in the journal Pain,¹ it is. One of the study’s authors, Dr. Sean Mackey, chief of the division of pain management at Stanford, says that fear can cause a cycle of "more pain, more anxiety, more fear, more depression. We need to interrupt that cycle."²
Okay, great. So when we are launched into a trigger-riddled space that is out of our control, we may benefit from learning to steer our own reaction to the situation.
But how do we do that?
Facing a trigger
The first time I intercepted this anxiety and fear in the face of a trigger was on a night I dared to go out with a friend. I chose the restaurant because it was close to home, and I thought it would be pretty low key. Unfortunately, when we arrived, the only booth available was right under a booming speaker. I asked the staff to turn it down. They did: by an almost imperceptible degree. As the overzealous 80s guitar solo drilled into my ears, I started to panic. I felt my heartbeat quicken as I desperately tried to gauge whether or not I should flee the scene. I was distracted. I could not participate in conversation. My friend called out what he was seeing.
“Well don’t worry about it. That’s not going to help.”
Although I wasn’t impressed by the bluntness of this observation, he was right. Allowing fear into the situation was not helpful. I took a deep breath, and decided that I wanted to stay and chance the pain. If it came, I could handle it.
Clear decision making and deep breaths have not always been the answer for me, but that night I got lucky and did not have a migraine attack; I had fun.
Since then I have tried to become more aware of my reaction to triggers, particularly when there is nothing to be done about them. Rather than letting my negative thoughts and fears get the better of me in a vicious cycle of catastrophizing, I try to take things as they come. Mindfulness exercises and meditation have been especially helpful in learning how to catch myself before fear and anxiety have a chance to spin out of control. But perhaps the most important tool in letting go of my migraine triggerphobia has been learning not to fear the pain itself by making up, repeating, and starting to believe little mantras such as this:
The pain will come when it comes. It’s a part of my life. I’m managing the best I can. I can’t live in a bubble. The pain will come. It’s okay. I’m okay.
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