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Being stressed over migraine is a migraine trigger

I never used to think of stress as a migraine trigger for me, but I’ve discovered in the last few years that my migraine frequency does increase in times of extreme stress. Unsurprisingly, right now qualifies as highly stressful and migraine kicked my butt for weeks this spring.

I tried all my usual tactics—I made sure my sleep and diet were in good shape, stopped reading the news, made exercise a priority, and committed to lots of relaxation. Nothing made a dent in my attacks. They got so bad that I had to take a leave of absence from TheraSpecs and stopped my advocacy work. Still no change.

After three weeks of frustration, I had an epiphany—maybe the stress of the increased migraine attacks was itself triggering more migraine attacks. While I had pulled out all the self-care stops, I had continued to obsess over my triggers and be frustrated every time an attack landed me on the couch for the day.

So all I had to do was stop being stressed! Aiming for that goal is usually a recipe for increasing my stress levels, but this time I managed to let go. I decided to drop all the worry and, for some reason, it actually worked. By the next day, I started to feel better. Within two days, I could definitively say that my attacks we less frequent and less severe, plus I felt better between attacks than I had in months.

I asked psychologist Dawn Buse, PhD, for her thoughts on the stress of migraine as a migraine trigger. She pointed out that it’s impossible to tease out which came first, the chicken or the egg, and explained more about the relationship between stress and migraine. She said:

“The relationship between stress and migraine has many different forms which can change from person to person, and over time and life phases for an individual. Stressful events or periods can contribute to triggering an attack. This can occur during a period of high stress or after the stress level has reduced, which is called the “let-down” effect. Long periods of stress (such as a personally difficult time or the global pandemic) can be associated with increased frequency of attacks. And some stressors such as childhood maltreatment are associated with the onset of migraine disease. Conversely, stress is also a consequence of living with migraine. Migraine can have significant negative impact on all important aspects of life and negatively impact relationships, careers, finances, academics, family, friendships and fun, just to name a few areas-—which can be very stressful.”

Dr. Buse also gave some information on managing stress, which I’ll include in an upcoming Migraine.com article on this same topic. Most notably, she shared a quote from Jon Kabat-Zinn that spoke to my recent experience: “You can’t stop the waves, but you can learn to surf.” My attempt to stop the waves was not only ineffective, it made me feel like I was drowning. When I attempted to surf, my migraine attacks improved within a day.

I’ve been trying to surf for a couple weeks now and am doing well enough that I’ve spent this week on advocacy work and will head back to (remote work at) TheraSpecs next week. I’m nervous, but excited to get back to a life beyond my own health.

I’ve been thinking of you all and hope you’re doing as well as possible. Life is so weird right now.

hand reaching up through surf
Photo by Nikko Macaspac via Unsplash

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The Stress Caused by Illness

We all know that stress can be a cause or a trigger of illness, but we rarely hear about the inverse — that illness itself is a major stressor. In a national poll by the Harvard School of Public Health, the Robert Wood Johnson foundation and NPR, illness, whether one’s own illness or that of a loved one, stands out as huge source of stress.

When asked what their biggest source of stress was in the previous year, 43% of respondents to this open-ended question said health-related problems.

Respondents who were ill or disabled were most likely to have experienced a lot of stress in the month prior to being polled. The top three groups experiencing high stress in the previous month were all health-related:

  • Poor health condition: 60%
  • Disabled: 46%
  • Has a chronic illness: 36%

(The next most common stressor was income less than $20,000, which applied to 36% of respondents.)

Illness is stressful in so many ways: not being able to participate in your normal life, grief and identity loss, not being able to work and financial concerns, being cut off socially, fearing for your quality of life (or life itself), and many, many other issues. There’s also the physical stress of illness itself. Episodes of a illness, like a migraine or cluster headache attack, physically stress the body, as does the daily grind of a chronic disorder.

And, as this poll shows, our most important self-care mechanisms — the ones that are likely to make our bodies and spirits more resilient — go out the window when we’re stressed. The top four things that change when people are stressed? Sleep, proper nutrition, exercise and spiritual practice (listed in descending order).

Stress definitely can be a trigger for a lot of illnesses, but the fact that illness itself is a stressor is too often overlooked. People with chronic illness are told they’d feel better if they reduced their stress. Those who offer such advice are rarely aware that illness itself is responsible for a large part of our stress.

Fortunately, there are programs that specifically teach people how to cope with illness-based (and other) stress. Mindfulness-based stress reduction (MBSR) was a major help for me. Unfortunately, these programs can be expensive in terms of money, time and energy. You can get a decent approximation of the course for less than $30 by reading Full Catastrophe Living and listening to Jon Kabat-Zinn’s Guided Mindfulness Meditation Series 1 CD set. (A lot of libraries carry the book and CDs, so you may be able to introduce yourself to the concepts for no charge). There’s also a $199 interactive online MBSR course offered by the UMass medical school, which developed the program.

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Soothing Sneaky Worries With Mindfulness

Friday and Saturday are crammed full of sessions at American Headache Society symposium, Sunday is the American Headache & Migraine Association patient conference. I’ve been fretting for days about how I’m going to feel over the weekend and which sessions I’ll be able to attend.

The worrying was initially disguised as planning:

  • Which talks do I most want to hear?
  • Should I conserve energy for the patient conference or go all out at the symposium?
  • Do I go to the Saturday night cocktail hour and mingle or rest?

Those are all reasonable questions but they devolved quickly into worrying:

  • I haven’t been able to get out of the house before 1 p.m. in weeks, how can I expect to make it to the meetings?
  • Will I even have enough stamina to commit to a few hours Friday and Saturday and all day Sunday?
  • The forecast shows rain for the weekend, will I be able to attend anything?
  • I hope I don’t waste the money I spent to attend the symposium?
  • Will I even be coherent when I meet people at the patient conference?
  • Will I even be able to stand at the patient conference?

Stressing out now is not going to improve my chances of having a successful weekend, so I’m practicing mindfulness to keep myself calm and grounded. When I catch my mind churning, I remind myself that I can’t know what will happen this weekend until it arrives and that right now is the only moment that matters. I bring myself back to the present, close my eyes, and breathe for a few minutes.

This strategy kept me from getting worked up yesterday and I’m determined to keep practicing mindfulness throughout the week. Maybe reducing my stress will give me a better chance at being able to attend all the sessions I want to. Maybe not. At least I’ll know I attempted to live in each day this week rather than giving my moments over to fears about something I cannot control.

(And I hope that committing to a mindfulness practice publicly will help me stick with it.)

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Revamping Traditions to Reduce Holiday Stress

If your headache disorder tends to flare up during the holidays or you get so stressed about getting everything done that you wind up harming your health, it may be time to rethink your holiday traditions. Start planning now to scale back the stress and fatigue of holidays while still honoring your most important traditions so you can join in the revelry instead of curling up alone in a dark room.

Read my suggestions in Holiday Traditions on Migraine.com.

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Our Thoughts Do Not Cause Illness, We Cannot Think Our Way to Health

What’s the likelihood that the content of the community college meditation class I’m taking in order to qualify for student health insurance would infuriate me? Almost inconceivable, I would have thought, just as I would have thought it impossible that a PowerPoint could cause me to literally shake with rage. The first slide says:

“If you don’t want to be ill… Speak your feelings.

Emotions and feelings that are hidden, repressed, end in illnesses as: gastritis, ulcer, lumbar pains, spinal. With time, the repression of the feelings degenerates to the cancer. Then, we go to a confidante, to share our intimacy, ours “secret”, our errors! The dialogue, the speech, the word, is a powerful remedy and an excellent therapy!”

And it goes on slide after slide with similar explanations after each of the headings, “If you don’t want to be ill…”

  • “make decisions”
  • “find solutions”
  • “don’t live by appearances”
  • “accept”
  • “trust”
  • “do not live life sad”

Really? All I have to do is think the “correct” way and I won’t have chronic migraine? Gee, sure wish I’d known how easy it is to erase a neurological disorder. And I bet my doctors haven’t told me about this quick fix because they’re shilling for pharmaceutical companies.

Our thoughts do not cause illness. In case that’s not clear: OUR THOUGHTS DO NOT CAUSE ILLNESS!

As with so many widespread misguided notions, there’s a grain of truth in the connection between thoughts and illness. Stress, which is often intensified by thoughts, can exacerbate many already existing illness, including migraine and other headache disorders. Chronic stress can lead to ulcers, heart disease or adrenal failure. Still, stress is not solely perpetuated by thought, but also by circumstance. Furthermore, a genetic predisposition to a particular illness is usually present in those who develop so-called stress-related illnesses, and environmental factors can also contribute to illness. In other words, the connection is not as simple and clear-cut as this PowerPoint states.

Illness is fickle and cruel. It cannot be controlled, despite our greatest wishes. It can’t even always be treated. Our thoughts can make illness easier to bear (read How to Be Sickfor fabulous guidance on this), they can inspire us to keep trying, but they cannot, cannot cure us. Perpetuating this belief comes at the great cost of further alienating the sick from the healthy. People with illness do not need judgment and righteousness, but understanding and support.

Plenty of people are brimming with negativity and hatred, but are perfectly healthy. Many others are fonts of optimism and hope, yet are mired in chronic or life-threatening illness. We are not to blame for being sick, our thoughts are not to blame. No matter how many people, how many teachers, how many PowerPoints by doctors with unspecified credentials may tell us otherwise.