The Mindful Migraine

Dr Aimie Apigian was interviewed about trauma for the series of interviews held at the 2024 Migraine World Summit.  I made a promise to myself when I started this blog at the beginning of the year that I would not post content that I felt might be triggering to myself or others. I don’t think this post crosses that line, but it does make reference to issues relating to mental health, so feel free to give it a miss if you’re not feeling up to it and know that I’m sending lots of positive vibes your way.

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Dr Apigian started her interview with a personal story about how she became a foster parent to a 4 year old boy.  It was through her attempts to help him settle in that she totally shifted her thinking about how to heal trauma.  She went into the situation believing that love and stability and time would be enough, but soon found that this sort of support made many situations worse.  She felt that her love was scaring him, and she needed a different approach.

She stated very clearly that she believes adverse childhood experiences lead to adverse health issues later in life.

She also clarified that trauma is NOT about a traumatic event [such as being in a car crash or witnessing a tragedy] rather, it is a bodily experience, which evokes a stress physiology.  She belies trauma effects the BODY more than the MIND – and she summarizes it as an experience of overwhelm.

Any time you are overwhelmed, your body experiences trauma-physiology.

Moreover, she believes that most people don’t leave overwhelm behind, the associated trauma is NOT IN THE PAST but is ONGOING.  Also – it is individual, so there is no comparison between people – your worst experience is still your worst experience, regardless of what is happening in other people’s lives.

[So don’t let people minimize or dismiss your chronic pain, stress or sorrow as being inconsequential… to THEM it may well be irrelevant, but to you it is ‘overwhelming’… hence, traumatic.]

Stress is a “high energy state of response”, Dr Apigian says; our body sends too many panic-signals too fast.  It’s designed that way to energize you and get you out of trouble.  However, if the stressful situation lasts too long, is not resolved, or we struggle to respond appropriately, it leads to overwhelm.  This creates “havoc” in our body. She refers to this cycle, or loop, as “dysregulation” – and it increases the feeling of being unsafe or unhappy.

She believes that unresolved trauma can be carried in the body, within our nervous system.

In the past, Dr Apigian notes, the emphasis was to treat trauma by focusing on the BRAIN [traditional counselling, for example relies on talking about memories and what you ‘think’ about something].  But she believes more and more people are coming to understand we need to focus on the BODY, or as a minimum, the mind-body relationship which resides in the autonomic nervous system.  To really resolve trauma, she believes we have to work with our bodies.

She reiterated that stress is not bad – we’re designed to ‘move into action’ in an emergency. The problem is when we perceive a reality that is filled with emergencies, one where almost any situation can seem life threatening and inescapable. When we think we’re in serious trouble, then we cross the line from stress to overwhelm to trauma; we become focused on survival… all… the… time.

Stress generates energy, we perk up and get ready to fight or flee. 

Trauma, on the other hand, aims to conserve energy, and often shuts us down or freezes us.

She noted that she thinks of herself as a smart, logical person, but even she knows her brain jumps to the wrong conclusion about risk.  It’s not her logical brain that perceives trouble, it’s her autonomic neurosystem that perceives that survival is the best instinct right now.  She said you can feel the shift when your blood pressure increases, your heart rate too, and your breathing changes.  Chemicals are being released into your bloodstream. She refers to this as her ‘guardian angel’ – her body is getting ready to protect her.  The problem is when that angel is primed to see danger everywhere, and your body is always in defense-mode.  If everything, always, is a threat to your existence – it’s EXHAUSTING.

She believes that this state of being [having this over-vigilant-guardian-angel] is the result of a combination of inherited genetics AND lived experience. Some people’s biology is primed for a hyperactive response [and the life they experience exaggerates that predisposition].

So, what to do? We need to calm down [don’t cringe] – we need to learn to stay calm in the face of risk [and realize that not everything is a ‘risk’].

THEN, you need to try to get to the root cause of what in your lived experience might be affecting your nervous system.  Anything else that you do will be a “band-aid” approach to healing, she says.

Stress, she noted does not apparently affect your autoimmune system – it’s the overwhelm or trauma that does. Eventually your body [or exhausted, overworked, over-vigilant, guardian-angel] ‘turns on itself’ and moves you closer to long-term syndromes, dysregulation of your nervous system, metabolic problems, and insulin resistance [and I would imagine – chronic migraines].

She highlighted the need to give your parasympathetic nervous system the chance to rest and digest [see my notes on the vagus nerve or my post about our ‘reptile-brain‘ for more info].

Dr Apigian says that whilst the science all points to the fact that trauma is bad for our health, the problem is doctors don’t know how best to respond. They tend to manage symptoms and miss regulating the nervous system.  Therapy, she notes, helps, but only if it acknowledges the problem is ‘not all in your head’.

[In defense of my neurologist – he was very vocal about the need for counselling/therapy AND adjusting my lifestyle towards calmness and mindfulness AND healing my body through movement and breathwork.]

Dr Apigian encourages people to explore somatic healing, as well as movement that aids the nervous system.  BUT – she was also adamant that some forms of movement are too restrictive [for example, exactly following the lead of a teacher] and suggests a more intuitive body-led approach to motion.  She gives the example of deep breathing in a way that feels natural, NOT doing counted breaths and holds. 

[As I mentioned in my post about ‘Mindfulness-Lite’, I recently moved away from routine-breathwork and strictly following Tai Chi videos towards what I call “homemade Tai Chi and Yoga” which involves me remembering the movements in my own way, spending longer on what I like and feels right, and avoiding motions that made me frustrated or resentful. It sounds weird that a Yoga move might make me feel resentful, but there are some that do – I just feel myself shifting from ‘Zen’ to ‘grumpy frog’. To make things trickier; what moves trigger my grumpiness, changes from day to day! But awareness of the shift in my mood is helping me identify a different set of triggers.]

She also cautioned people from retelling their trauma-stories too often. Each time you ‘re-tell’ the story you ‘re-live’ it and potentially become ‘re-traumatized’ all over again.  You risk your body (not your mind) slipping into overwhelm, and reinforcing those feelings you were trying to remove.

Instead – she talks about creating a feeling of safety and calm – focus on reframing events that amplify the good. Focus on modalities that are concentrated on the here and now, not the past.

The nervous system drives the immune system which leads to fatigue. She believes that there are several illnesses, such as MS, IBS, chronic fatigue and migraine which are increasing in prevalence, possibly because overwhelm is becoming more prevalent.

One solution she also suggested is magnesium. Apparently, the nervous system needs lots of magnesium to function efficiently.  Zinc and (I think) B6 were also mentioned.

We need to train our body not to react to small stressors – otherwise it will see ‘inescapable problems’ everywhere, and our body will start to believe it can’t protect us, so it goes into that trauma-shut-down mode.  Overwhelming fatigue is a way that your body is saying; ‘I can’t save you anymore – I’m done – if you sleep, you’ll be safer than me pretending I can help you in a fight/flight situation outside in the real world.’

At the end of the day, she notes it doesn’t matter what created the overwhelm that leads to trauma – it could be biological, environmental, abuse, tragedy, toxins, anything – what matters is how you try to handle it.

Dr Apigian recommended that we all try to understand our nervous system so we can make the best life for ourselves.

Take care and remember (more often than not) you ARE safe, Linda x

PS – here’s Dr Apigian’s website if you’re interested in more information: About Trauma Healing Accelerated

[PPS – disclaimer: remember that I’m just a blogger with migraines, not a therapist or doctor, so if this post has raised issues that you would like to explore, be sure to reach out to your local health care providers for help.]

PPPS – I updated the image based on a revised “migraine summit” prompt – this is the one you’ll see for the next few Migraine World Summit posts as they come out.