The Mindful Migraine

In Australia we don’t usually say ‘therapy’, we say ‘counselling’ – but they mean the same thing: talking to a professional in the hope of feeling better. When it comes to living a life with chronic pain, I think it can help.

I know I keep going back to the story about meeting with my neurologist nearly 2 years ago, but it really was a fork in the road when he said, “more medicine doesn’t equal less pain – you have to change your lifestyle and mindset in order to heal.”

One of the problems, on the day of the meeting, was that he mentioned that my anxiety might be making things worse, and that maybe seeing a counsellor would help. I didn’t see myself as an anxious person at the time, so his suggestion didn’t really resonate. In fact, it made me a bit angry that he was judging me. I’d had counselling once or twice in the past following specific events (such as when the whole department I worked for, all lost our jobs on the same day). I understood the point of it – but I could not see a connection to counselling and migraine pain.

After a couple of months had passed, and the neurologist’s advice to take up mindfulness techniques to reduce stress seemed to be working, I decided maybe he had a point. I decided to give therapy a go.

The version of therapy that my neurologist recommended was called CBT = Cognitive Behavior Therapy (more about that in a minute).

Because I was still very sick at this stage, and in bed for at least some part of every single day, the idea of travelling to an appointment was too hard, so I found a therapist who could do counselling sessions over the phone. The lady was not a CBT practitioner, but I didn’t realize this at first, and because it was relatively convenient, I ended up going to maybe half a dozen sessions (eventually being well enough to go to a couple face to face in her office).

[Disclaimer – I’m not a health care professional, or a counsellor / therapist – everything that I’m telling you is based on personal experience, not medical advice – please seek your own specialist information that is best suited to your individual needs before making any changes to your treatment profile.]

The style of counselling that my therapist used is probably closest to ‘talk therapy’ – she encouraged me to talk, with prompts along the way: “why were you reluctant to talk to a counsellor? … how does it feel now that you’re talking? … you use the word ‘abc’ a lot; why do you think that is? … when you talk about ‘xyz’ I’ve noticed that you sit up straighter / relax / your voice trembles / you smile … how does talking about this make you feel?”

Oftentimes it felt like we were just having a coffee-chat without the coffee. It felt very casual, and the conversation seemed to wonder aimlessly. Other times, she kept looping back to something she must have thought was important – and perhaps it was – in a way that felt like she was picking at a scab.

Throughout the face-to-face meeting, I realized the lady was taking notes. It was a strange feeling to know that your sense of self was being recorded, assessed, judged… I had to trust them to keep my secrets safe.

After several sessions I stopped.

She didn’t really seem to “get” what life lived with migraines was like, and seemed confused and frustrated, for example, when I said I couldn’t know in advance whether I would attend the next meeting in person or not (because I didn’t know in advance if I could get out of bed and drive a car, or walk into an office building with bright lights, perfume, noise…). I also felt like we kept circling around the same subjects – which may well have been deliberate – but she rarely offered commentary on what that circling meant, and she almost never gave me advice. Perhaps that’s not her role, but I thought she might ‘joins the dots’ for me, as it were. I thought she might say, “have you considered whether you always feel this way when that happens … or … have you asked XYZ about ABC … or … maybe the pain isn’t budging because you keep doing / thinking / feeling this, that, or the other?” I felt like it was on me to figure a lot of things out…

Overall, the experience did not reconcile me to my pain.

It did however make me a little more aware of some of the emotions that I was feeling. I used to focus on the pain and the sad hopelessness of my life with a chronic illness. After talking to her, I realized that there were other emotions simmering behind that sadness: fear of failure, concern that I was a burden, even low-level rage at the injustice of it all… But being aware of those feelings without knowing what to do with them, was a bit like opening Pandora’s Box without any forewarning or instructions on what to do next. What do I do with this new awareness that I was afraid and angry?

Talking DID help me see myself in a new light though, and placed my pain in a different context. It did NOT however, seem to shift my relationship to the pain or reduce my suffering.

Mindfulness; meditation, Tai Chi, Yin Yoga, setting boundaries, listening to my body, making deliberate decisions to rest when I felt I needed to rather than keep pushing through, realizing that self-care is not selfish, repeating positive mantras and singing upbeat songs to myself… these are the things that seemed to help me the most.

Equally important are all the mini-adjustments that I make throughout the day; adjusting my posture to include power-poses rather than being hunchy-scrunchy, relaxing my pug-puppy face, noticing when butterflies were being born in my stomach and asking myself why, recognizing that my mind is starting to wind itself up into a knot and reminding my brain: “you’re ok, you’re safe… no migraine required today, thank you.”

That said – I do think that CBT would help with your chronic pain, because it recognizes that there is a mind-body-feelings-thoughts-behavior relationship.

It acknowledges that if you feel pain > you might have fearful thoughts > which lead you to avoid going out > which in turn makes you feel isolated > which in turn creates more sadness > which creates more pain.

CBT aims to break those links in the chain and stop you spiraling into a darker and more painful life.

I found a great video from Standford Pain Medicine (here) that explains the relationship between CBT and chronic pain (it is long though at 49 mins). Straight up it recognizes that pain is a physical AND emotional sensation, so it makes sense that there will be a medical and psychological aspect to healing. The main role of CBT is to help you identify, challenge and reframe the negative thoughts, feelings or behaviors that you might experience in relation to your pain. The hope is that you can create more space for positive experiences, memories, and useful coping mechanisms.

Here’s a couple of screen shots from the video that help explain chronic pain and each point at which CBT might be able to offer assistance:

We are all SO different – our pain, our situation, our ability to attend therapy (in terms of distance, time or finances) – so it would be silly of me to say you should or shouldn’t go – YOU have to figure out if you think it is right for you.

The only advice that I will give you, is consider looking for someone who has a bit of experience in (chronic) pain counselling. There’s a greater chance that you’ll get advice that is fit for purpose, no confusion, no judgement.

Curious to know if any of you have had any luck with therapy that you’re willing to share.

Take care, taking care, always, and know that you’re not alone,

Linda xox

PS: I mentioned above that I sometimes sing a happy-made-up-song to myself to put me in a good mind-frame. Well here it is… I posted it back in July (how the year is flying!) – it’s a short soundtrack of me singing my “today’s going to be a good day” affirmation song I made up – the voice reveal might be a bit of a jump scare if you’re new to the blog, but if it brings a smile to your face (cringey or otherwise) it’s worth it:

PPS – if you’re curious to explore peripheral ideas to this post, I have also written about Compassion Focused Therapy, Radical Acceptance and the fear-pain-cycle