Guest Post: The Emotional Side of Migraines - Part 2

We are pleased to share Part II of this guest post with you from Nathan Feiles, MSW, LCSW-R.

Part II:

We left off part 1 with a discussion of how deep emotional processes that are out of our conscious awareness can have a hand in bringing someone closer to, or across the migraine threshold.

So, what do I mean when I say "emotions"?

This is an important question because there are layers to everyone's emotional processes. There are the more “top layer” emotions -- for example how you may be experiencing emotion in any given moment. There are many possibilities: happy, sad, stressed, angry, frustrated, tense, scared, enraged, joyful, and more.

You may notice that when you experience emotions in the moment that your mind and body respond to these emotions in their own ways. For example, if you feel stressed you may notice thoughts racing, muscles (including in your head and face) tensing, heart rate and rate of breathing increasing, maybe even sweating, and otherwise. Stress releases cortisol and puts your body into "fight or flight” mode. Every emotion has its own impact on your mind and on your body (resulting in chemical changes as well). These responses in their own right can either be triggering of migraines, or bring people closer to the triggering threshold. (Hello let-down migraines, or migraines triggered when experiencing intense stress).

Yeah, but there's more...

Going a bit deeper, emotional and relational states can actually be carried over extended periods of time without us even being aware of the long-term response systems we carry. Or, more importantly, we dissociate and separate ourselves over time from emotions and states of emotion that became threatening to ourselves in some way. These tend to be generated more by how we grew up and have to do with how we emotionally responded to relational processes in those years.

There are many examples of how this can play out in people:

  • fear of conflict
  • fear of being outwardly angry, or of internally experiencing anger
  • being "too nice"
  • passive-aggression
  • feeling or making yourself small around others
  • people-pleasing
  • caretaking
  • ruminating, obsessive thought processes that tend to cycle
  • habitual problem-solving
  • inhibiting your voice out of fear of being too much for others
  • sacrificing your needs to not be a burden
  • and others not included here

Coping with emotional pain

The common denominator in each of these is pain. These are all ways people unconsciously learn to cope with emotional pain while internally aiming to create a sense safety, whether from rejection, criticism, judgment, abuse, or otherwise. These characteristics and other patterns of dissociation I have very commonly seen in people who struggle with migraines. (Not everyone has every quality above, but many have at least 3 or 4, if not more).

These types of processes become established within people over time, and when this happens, the mind and body respond to them. However, with long-term processes, the response isn't acute such as with in-the-moment emotions, but actually continue to be reinforced again and again over time, creating a stronger and stronger response system. For many people with migraines, when an issue comes up that works against these established internal processes (for example, someone who avoids conflict ends up in a conflict, or is preparing to face a conflict), it can trigger an internal distress that can be triggering or set up someone for a migraine.


This may all be quite complicated, but suffice to say that it's worth every migraineur's while to learn about their emotional and relational processes. Much of what I describe process-wise tends to be out of a person's awareness. People generally live their lives as they've always lived it. It's amazing the amount of things we internally and externally just do out of habit, and have little conscious awareness of them -- and unfortunately how those things can work against us at times without even realizing it.

I have worked with people who struggle in different ways -- debilitating migraines a few times a month, all the way to those who have chronic daily migraine. I also see a lot of people who have tried many medications and have not received any relief from medication.

Emotions are not the cause or cure

As we work on altering these underlying emotional and relational processes, the mind and body begin to alter their responses as well, and it often loosens the strength of these reinforced processes, making them less likely to trigger. What people often start to notice is that they're having a couple of headache free days that week, or this month had only two migraines instead of four, for example. Shifts start to happen as the mind and body changes its responses. When people are experiencing lower levels of stress and anxiety, or able to loosen longer term processes, it can put a greater distance before other potential triggers can hit the threshold.

Now, again, I want to make sure it's clear that what I describe above is one piece of the migraine pie (though from what I have seen, it can be quite a significant piece for many). Emotions and relational processes aren't the cause or the cure for migraines. Having a neurologist and medical care is something I require of everyone I work with for this issue. But in general, these underlying processes are often a heavily overlooked and an underestimated piece of the pie that could make a big difference for people who have found little relief to this point.

In future posts I will be focusing more on specific components of emotional and relational areas, and how they contribute to migraines, as well as more about how I work to help and support people through their struggle.


Nathan Feiles, MSW, LCSW-R is a psychotherapist and specialty coach in full-time private practice in New York City. Nathan specializes in working with people who struggle with Anxiety, Migraines, Relationships, Depression, Commitment Issues, Decision-Making, Life Transitions, Fear of Flying, and Performing and Visual Artists. Nathan has received extensive education and training in comprehensive psychotherapy and relational psychoanalysis. He is a graduate of New York University and is affiliated with National Institute for the Psychotherapies in New York City. Nathan works with people nationally and internationally via online coaching if outside of NYC. For more information about Nathan’s work, or to meet with him, visit

By providing your email address, you are agreeing to our privacy policy. We never sell or share your email address.

Join the conversation

or create an account to comment.