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A Case of Migraine Triggerphobia?

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 Painit 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.

Practicing mindfulness

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.

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.

  1. Ochsner, KN, Ludlow, DH, Knierim, K, et al. Neural correlates of individual differences in pain-related fear and anxiety. Pain. 2006;120(1-2):69–77.
  2. Beck, M. Rewiring the Brain to Ease Pain. The Wall Street Journal. 2011.

Comments

  • Macbeck
    2 years ago

    Spot on!! I’m just beginning to recognize how fear and anxiety are affecting me! While Botox keeps the pain mostly at bay, I also have Vestibular and “ocular” migraines – this includes simple imbalance or full-on vertigo, and double/triple vision in my left eye. A friend recently said I was having an anxiety attack about a specific situation. That made me stop and start analyzing my reactions to different things. I think I’m “rolling with the punches” in life a little easier again.

  • migraineprisoner
    4 years ago

    Absolutely on point. My neurologist explained this to me a few years ago, before I recognized how paralyzed with fear I would become at even the thought of facing a trigger head on. In fact, anxiety became the trigger to trigger the trigger. Weird, but true. As you indicated, once I recognized the panic and learned to talk my self down from the ledge, I could much better handle the trigger and/or the looming migraine. When we are anxious or fearful, we tense up. For me, that’s a ride on the express train to migraine city. Talking myself through a trigger has worked for me, even if it means I have to take the local.

  • tammay
    4 years ago

    Nice article. It’s so true that getting obsessed with migraine triggers can become a self-fulfilling prophecy, especially since for chronic migraine suffers, it’s so hard to know where your threshhold of pain really is. So something that normally wouldn’t trigger a migraine (like, say, a few squares of chocolate) can suddenly trigger one because it’s coming at the end of a cycle of triggers so it’s going past your threshhold of pain.

    I also wonder if triggers can change, especially food triggers. For example, I used to have no problem with balsamic vinegar but a few weeks ago, I started making a salad dressing with a few tablespoons of balsamic and noticed that soon after I ate it I got a bad headache. I took it out and no more headache. The same happened recently with a soy-based sausage and now I also think that maybe too much spinach at one time can cause me bad headaches, as that’s what I had the last two days. Today I left out the spinach and no headache.

    Tam

  • Holly H.
    4 years ago

    Tammay, it does seem like lots of my triggers are like moving targets when I think I’ve got that extensive list figured out. There are those that are carved in stone where I am always affected by it, and I stay a bit more functional if I just don’t go there or eat that, etc. But there are those that just seem more inconsistent. Perhaps they cumulative. Perhaps they have an stronger impact if a spike is building or the longer a spike goes on. Perhaps it’s a combination of foods, environmental factors, flashing lights, etc., in a short time period.

  • Anna Eidt author
    4 years ago

    Triggers are so tricky to identify because it is rarely just one thing that sets us off!

  • Maggie H.
    4 years ago

    I, too, needed to read this article now. It so identifies what I’ve been experiencing for the past several years. Like Charlotte, I have been afraid to go to sleep at night, knowing that I would awaken with a pounding headache that would develop into a migraine, if I was fortunate enough to not awaken with a full blown migraine already in progress! Almost 20 years ago I began taking Excedrin Migraine nightly and that would alleviate some of the severe pain. Now, I’m paying the price for that because for the past 3 years I’ve had rebound headaches and a constant headache 24/7 for the past 9 months! I so identify with the statement of “daily life” because that’s what mine is – it seems that daily there is another trigger that I didn’t notice before, or that a food that was OK a week ago is not OK now. I’ve had to really come to terms with the anger and frustration of this debilitation that I so don’t like. Like you, I find mantras, prayer, meditation, and exercises help tremendously and if there is one other person with migraines that I can help, I gladly help them! Thank you for your informative and sometimes humorous articles! We still need to add the humor to our lives, don’t we?!

  • Anna Eidt author
    4 years ago

    We sure do!!

  • BCN
    4 years ago

    This is one of the best posts I have read here yet. I have suffered from migraines for 30 years and it is only now that I am really observe my reactions to the first symptoms or being in a danger zone. Not breathing deeply or correctly is definitely one of the most important ones besides getting tense.
    I now start breathing deeply and become more conscious of my surroundings. It has made me realize that I could even say some of my headaches have been self-inflicted by my own reactions.
    Scary cycle, eh?!
    Mindfulness is key.

  • Anna Eidt author
    4 years ago

    Indeed!

  • Maggie H.
    4 years ago

    You are so right! This has to be one of the best articles I’ve read here! Like you, I’ve had the migraines for 30 years, (since an auto accident in 1984), and I’m still discovering ways that I may have contributed to my own headaches by my reactions! At the same time, sometimes it’s difficult to see the forest for the trees, as the saying goes. I totally agree – breathing deeply and stretching usually alleviates some of the pain, keeping as regular eating schedule as possible helps tremendously, and removing myself from stressful situations has helped me a lot. I’m no longer a “people pleaser” when I will be the one to suffer the consequences of a headache – I’ve learned thru these years that I must attend to my health and these migraines are so NOT understood by so many people that sometimes we feel that we are all alone in our pain. I will remember your statement of mindfulness is key – so important. Thank you.

  • Charlotte Best
    4 years ago

    I needed to read this article right now. For the last seven mornings I’ve woken up with a migraine already raging. It almost makes me afraid to go to sleep each night for fear of waking with another one and then I worry about it much of the day. Your article puts everything in perspective and reminds me to work on controlling my fears. Repeating your mantra will be my lullaby and prayer tonight. Thanks.

  • grammayumyum
    4 years ago

    For me, mindfulness means being very aware of upcoming events in my schedule before I take a risk of exposing myself to known triggers. I have to count the cost, and decide if the risk is worth the potential consequences. How important is this person/event/food/etc to me? Do I have enough flexibility in my schedule to allow for a possible migraine, trip to ER, recovery, etc? After all, if I don’t look out for me, who will?

  • Holly H.
    4 years ago

    I really value reading how other people go about life with their migraine from both the articles and comments. Being in the constant/intractable mode for over 5 years now, I have become super-reactive and hypersensitive to so much. There are those circumstances/places I know not to even try, especially if I’m already feeling crummy. However, as in strong perfume in the elevator or unknown artificial sweeteners in a food, there’s times when the triggers just are instantly there in my space. I, too, have realized that the more I stress, the deeper I may be sending my migraine systemic reaction and pain.

    I also use self-talk a lot, as in, “I’m OK. I just may get away with this today. Just breathe and relax a bit.” Or, “Jesus is in charge of me, not this _____; and He makes me OK no matter what.” Or if it’s in the middle of something that was supposed to be enjoyable, “It is what it is, do what I can and enjoy what I can, now, in this moment.”

  • retiredprofessor
    4 years ago

    Consider another angle to this problem. Many of us get headaches when the weather changes or is about to change. Often we have no way of anticipating the change unless we are watching a barometer or going to a weather app obsessively. Of course, the weather is out of our control. So, we can’t exactly be anxious about it, but when it happens we have been zapped.

  • aurohra
    1 year ago

    I use the MigraineX ear plugs and it has an app that sends you notifications when the barometric pressure is changing… it has been really helpful for me. Even if I don’t have my ear plugs with me then I can watch out for signs that mean it’s time to take something

  • grammayumyum
    4 years ago

    I tend to ignore weather reports unless traveling. I don’t want to know there is an uncontrollable potential for migraine. I would rather live my life happily avoiding my other known/controllable triggers and doing the best I can, not living in dread of an oncoming storm. Don’t get me wrong, my weather-triggered migraines can be my worst. I feel the effects of weather changes more than half the state (about 250 miles) away (Colorado). If I sense an oncoming migraine, I self-evaluate to see if I’ve been exposed to any known non-weather triggers. When I eliminate other triggers, I check the weather reports to see if that is the source. If so, that’s when I go into hibernation mode; everything stops while I do self-care. I compare it to flight-for-life for my son’s ruptured appendix: everything else stops, and I attend to basic survival needs. If I don’t, I’ll be visiting the ER.

  • migraine mistress
    4 years ago

    Thanks so much for writing this article! W/ complex chronic migraine having reached the completely debilitating stage in recent years & subsequently being forced to really, really slow dwn over the last 9 mos. (which I wld have refused to admit to myself that that was a necessity & just not a choice anymore) I feel I’m finally ready to let better choices sink in. Those neurological pain paths are deep, deep trenches by now & sometimes it feels staggering to imagine forging new patterns. So grateful to be “back home” in my mindfulness meditation practice again & watching its influence in many other areas. Your article really supported & validated that. Thanks!

  • GailV
    4 years ago

    Several years ago, my son was seeing a neuropsychologist for brain wave biofeedback. while my son was practicing the biofeedback, I was telling the doctor about a recent experience I had in the elevator with a person heavily perfumed. He suggested that I could be my own worst enemy if I started to panic at the smell. He encouraged me to try biofeedback or deep breathing the next time I was “trapped” with an over-perfumed stinko. I used the biofeedback and found out I did have more control if I didn’t panic. If I’m stuck with a heavily perfumed person all day – I’m probably going to get a migraine. But I usually can survive an elevator ride using my relaxation techniques!

  • thisisendless
    4 years ago

    Thank you for the mantra. After reading The Power of Now and doing morning mindfulness meditation, I too have just started to work with the panic. I don’t even know if I have triggers per se, I just know that either I am getting migraines every day or I”m not.

    I just got married and went on my honeymoon. I wasted so much time worrying about whether or not I was getting sick, I didn’t remember to enjoy where I was. The constant self assessment of whether I am feeling sick or not. The: “Oh no is that a migraine? I can’t tell omg!” thoughts. “My whole honeymooon will be from the inside of a hotel room!” Even though I Was very sick the week before, I was able to mostly manage my symptoms during my trip. (Wedding day was pain free, btw and I felt great. So grateful for that.) So all that worry and break downs and catastrophizing didn’t help me at all, and just took a lot of energy.

    It is so hard for me to break out of this pattern of behavior.
    I am just starting to catch myself and break out of this habit. I just have to remember that acceptance is my greatest ally. And to stop fighting it all. the. time.

  • ChronicM
    4 years ago

    I agree and learned it like you. I wanted to attend a concert, my friend flew in for it, when we were younger we followed the band to multiple states (not on twitter). It was a big deal to me, and this undefined, uninvited 5 month every changing migraine was not stopping me. I was scared that I was running into a bee’s nest, and I very well could have been, but I got lucky. Now I really ask myself, do I want to push my luck… When you can honestly answer yes, you are also saying I will deal with whatever the repercussions are because I am going to make a memory I cannot live without! (I still have these headaches, 8 months and counting. I do not do everything I have my heart set on like dating or camping and sometimes my decision turns out to be all wrong, but it does not make me a less strong or dedicated person).

  • Anna Eidt author
    4 years ago

    Indeed! Sometimes we risk the pain for a very good reason…

  • ChronicM
    4 years ago

    PS I did have a lot of pain later, this was when I was still wearing a heart monitor also, but it was worth the experience and the control I felt I still had.

  • JDJ
    4 years ago

    Thank you for reminding me that I still have some control, even though it may not always be a lot, over how I respond to a situation.

  • Anna Eidt author
    4 years ago

    🙂

  • Debbie
    4 years ago

    I’m unfortunately one of those people who have so many triggers it’s almost impossible to know what’s going to set off a migraine. I have had migraines for 35 years and they are debilitating. I am going to be exploring mindfulness and meditation however, I realize that I am wired this way and it’s going to be another really tough struggle to learn how to truly practice these principles. I seem so laid back but inside I am anything but!

  • Anna Eidt author
    4 years ago

    Acceptance + mindfulness is a winning combo in my books 🙂

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