The Mindful Migraine

I’m always on the lookout for information that will change the way I relate to and understand my chronic pain.  In my search, I came across a book online called “Unlearn your pain” by Dr. Howard Schubiner.  (The book is on his website here).  The title alone made me optimistic… and tired.  It implies both hope and effort… and as I read the book, that’s what I discovered – lots of good ideas, all of which require you to do the heavy lifting… which is fitting… but exhausting.

The aim of the book is to acknowledge that your pain is real, AND that you no longer have to put up with it – you can unlearn your pain.

Dr Schubiner starts by explaining that “Pain begins when neural pathways from the brain to the body are stimulated or ‘fired’. Overtime, these pathways can become ‘wired’ into the brain’s circuitry” (p.16).  After a painful event, the body heals, but the pain forgets to drop the message.  At the most extreme end of this notion are ‘phantom pains’ where people have an ache in a limb that is no longer there…

The messages are firing from the body to the brain, within the brain, and then from the brain back to the body… back and forth… check and recheck… the trick is, he writes, that those pain messages in your brain are “amplified” by other things that are going on in your brain.  Feeling tired, sad, angry, fearful, anxious?  Then those pain signals are going to land differently… pain is going to hit harder.

Later in the book, he acknowledges that the brain is also constantly reprioritizing pain: you’re running across a field and twist your ankle; you’re going to slow to a hobble (“ouch-stop!”)… unless there’s a lion at the other end of the field looking in your direction, and then the pain in your ankle is going to disappear (“keep-going!!”) (42). 

Then there’s another layer on top of all of this – “predictive coding” – we start to feel what we expect to feel.  For example (mine not his), the last time I went to a movie theatre I got a migraine, so I begin to believe that movies give me migraines, and wouldn’t you know it – the next movie I go to gives me a migraine…  In a way, we become “primed” to pain based on past triggers, especially if they are repeated often enough.

[I wrote about predictive coding a while ago when I wondered if my grey hair was making me look old / feel old (here).] 

One of Dr Schubiner’s concerns is that doctors are trained to treat the body, not the mind-body connection, which is where he believes chronic pain resides.  Doctors, he believes, have created a form of “medical imprisonment” in the form of medicalization (34).  For some illnesses, however, such as chronic migraines, there is more than just the body in action, so any solution has to involve more than just the body.  He refers to this arrangement as MBS or Mind Body Syndromes (and elsewhere PPD or Psychophysiologic Disorders). 

He is very blunt – if there is no structural problem with your brain or eye or neck – then the pain that you are feeling is MBS.

You pull a calf-muscle; it hurts… and then it heals… and so it stops hurting, and you forget about it.

You experience whiplash in the car and it hurts… and then it heals over time… or else it doesn’t… and you can’t stop thinking about it… you can’t forget the accident… the pain, the fear, the phobia…

“…the body is the barometer of the mind…” he writes elsewhere (53).

Dr Schubiner gave the example of people who were put in a SIMULATED car accident – they were NOT injured in any physical way – BUT – 10% of participants still had whiplash pain 4 weeks later – they had pain even without the injury – the IDEA of the accident was enough to make the brain experience pain and hold onto it… and all of them were recorded as highly stressed individuals BEFORE they went into the simulation.

He points out that demolition derby drivers crash and tumble for a living, day in day out, they put their body through whip-lash-like scenarios and constant collisions… and yet they statistically they don’t seem to report as many pain problems… it’s as if they expect accidents, accept them, heal, and then move on…

The first step to recover, Dr Schubiner states, is to have MRIs and eye-scans and neck examinations – make sure there is no physical anomaly that could be causing the pain.  Then you begin the job of looking into MBS.  In the same way that you uncontrollably blush when you get embarrassed, some people will unwittingly get a headache after a stressful day – there’s no fault or blame – it just is what it is.

He noted that the idea of “fight-or-flight” response is often lumped together, and whilst they share the same blood-rush or adrenalin, they have different emotional contexts (123).  We run when we’re scared and fight when we’re angry, he says.  (I’d suggest it’s a bit more complicated than that but OK, I can see there could be some sense in it (read more on the FOUR possible “F-responses” in my post here.))

The book then moves into the task of investigating the fears and anger issues that might be affecting your physical health.  To do this, he wants you to explore potentially repressed emotions, even “reliving” them as you journal them or talk about them.  His theory is that if you fully express the rage that you feel, you can release it. 

[Disclaimer – please remember I am not a doctor or psychologist – I would suggest you seek professional advice before reliving your traumas without assistance.]

Dr Schubiner encourages you to REALLY feel the anger you have stored away, get red in the face, hot, flustered, let it well up inside you as you clench your fists (125).  Swear, curse, yell, say all the things that you wish you had said when things made you angry in the first place. 

Then, when the anger has subsided, see what emotions replace it; sadness, guilt, compassion? (126).

Then straight afterwards (!?) you speak kindly to yourself, and your inner child, and love yourself.

[Click here for previous posts which recommend similar ideas: “taking out the trash-talk“, “your inner child” and “write a love letter to yourself“.]

If things that might be making you angry (or especially emotional) don’t come to mind, journal 3 present stresses, 3 past stresses, and 3 of your personality traits that might be contributing factors, and then address the one that jumps out as the BIG issue.

I felt a little adrift about how this process evolves… I can see that I might be angry at the universe for sending us into lockdown when I started my PhD, and thus was deprived of an on-campus experience… and I guess I can understand how screaming “UGH!” into my pillow might release all my pent-up frustration at that ‘lost opportunity’ and make me feel better… and I suppose I can imagine then saying, “that made me sad”… but I’m a little lost as to how I then pivot to self-love… I guess through compassion and reframing? “You did miss out, it’s true, and it’s right to be sad and angry and frustrated – but the past is the past, and you’ve made the most of the new situation… let go… look how far you came regardless…”

He suggests you work through your issues an hour a day, taking deep breaths, reminding yourself you are ok, challenging your negative narratives, journal, write a letter to the people in your past who have hurt you (but don’t send it), desensitize yourself of your triggers, remember that progress is better than perfection, work on gratitude and forgiveness, then slowly move towards being more future-focused…

I liked the premise of this book – I think there was a lot that I am interested to explore further – but I would still caution people to consider getting support if difficult emotions might be a big reason that pain is manifesting itself in your body.

You don’t have to do all this on your own.

Take care taking care, Linda x