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There are approximately 45 million Americans who have migraines. While many have only occasional migraine attacks and can control them with medications, there remain up to five million migraineurs who have frequent and severe symptoms that are unresponsive to medications, Botox and other treatments. These unfortunate individuals may lose hope and can end up isolated and unable to work or participate in meaningful activities. This blog describes a unique approach that can hold the keys to recovery for some.
The vast majority of migraine sufferers have normal MRIs of the brain, which indicates that they are not structural disorders of the brain or head. Therefore, it is important to understand the brain and how the brain handles pain.
Most people understand that the brain controls the body. We know that our brains constantly send messages to our bodies to regulate our breathing, our heart rates, and our GI and urinary tracts. We remember how to ride a bike, walk, gesture and laugh, and these physical responses are also controlled by the brain. However, when we have pain, especially severe and chronic pain, it is very difficult for most people to conceive of the possibility that the brain could generate this pain.
The truth is that all pain is generated by the brain. There are two types of stimuli that can cause the brain to generate pain: a physical injury or an emotional “injury.” Both of these types of injuries activate the “danger” areas of the brain (the amygdala and related areas) to create the pain that we feel. If the danger signal is not activated, we will not experience pain. See my last blog on this website for details on this.
It is true that there are genetic predispositions in many people for migraine headaches, and that migraines tend to run in families. However, the degree to which these genes influence outcomes is much less than those of cystic fibrosis or sickle cell anemia, diseases that are completely determined by which set of genes you inherit. The genetic tendency in migraine requires activation of those genes in a process that scientists call epigenetics, the study of the way in which environment influences how genes are “turned on” or “turned off.” In other words, our environment and the stresses of daily life determine if the brain activates migraines or not.
There have been reports of serious disorders associated with migraine. However, early reports of premature onset of cognitive decline have not been substantiated. Migraine has been known to be associated with stroke, although it is not clear that migraine actually causes stroke. Fortunately, this association is very rare, as experts believe that a stroke may be related to migraine in about less than one in 2,500 people with chronic migraine.
Many patients and doctors view migraines as being caused by hormonal changes or by weather, smells, light or foods. Obviously those factors don't cause migraine in every one. They are best considered to be “triggers” of migraine, i.e., they trigger the brain to activate the painful responses. Yet, recent studies by Martin and Hougaard have shown that many of these triggers are not reproducible, and that avoiding triggers is often counter-productive in the long run. My clinical experience suggests that these triggers can be turned off, or unlearned.
Over the past decade, I have learned that migraine, along with other related conditions, such as chronic tension headaches, pelvic and abdominal pain syndromes, chronic neck and back pain, and fibromyalgia are often caused by a combination of stressful life events and emotions that are neither expressed nor processed. All of these conditions are associated with early onset of adverse childhood events, which sensitizes the danger signal in the brain.
Emotions are not only mental processes, but physical ones as well. Think about how your body feels when you are suddenly afraid, angry or grief-stricken. Our bodies are intimately connected to our minds and it is quite common for many of our feelings to be relegated to the subconscious portion of the mind. Therefore, we may experience emotions in our bodies (in the form of pain) without being aware of the emotion itself.
Consider the story below. This woman was stricken with migraine headaches that were so severe that she ended up in the emergency room on two separate occasions. She had over 40 consecutive days with severe pain. The usual migraine medications and strong pain medications were not working. She had nowhere to turn. However, she found some resources by myself and Dr. John Sarno that led her to look inside her mind and in her life for the answers.
“Lucky. That’s how, at 18 years old, I described being raped at knifepoint by an intruder in my very first apartment. Lucky. A lot of women get raped and murdered, I told myself. I’m still alive, so I have no right to feel sorry for myself, to be angry. Thirty years later, debilitating migraine headaches that found no relief with modern and alternative medicine, led me to read Unlearn Your Pain. I got angry at my rapist for the very first time. I screamed, “You have no right to touch me!” over and over until decades of pain erupted like an exploding volcano. I imagined my neighbor and I kicking his crumbling ass to the ground in the narrow courtyard of the apartment building. I finished the story with the police arresting him. I began to heal a wound I never even knew I had.”
“I don’t remember ever thinking I deserved to feel compassion for myself, no matter how bad the situation. There was always someone who had it worse than I did. This caused me to take care of everyone else and put everyone’s needs before mine. This personality trait, a toxic concoction brewed from an upbringing I now think must be the most common of my generation: 60s & 70s girls reared by 50s moms. My mother loved me, something I never doubted. But I also could not reveal myself emotionally to her without having her judge me. So instead of letting things out, from very early on, I began to catalogue an extensive library of fear and shame and trauma deep in my subconscious, completely without my knowledge. Just deal and keep smiling. Throughout my life, this trait earned me all kinds of praise, “She’s so strong…She’s so nice…She can handle ANYTHING.” No one ever saw me upset, or angry, or grumpy or rude.”
“I did everything I could to ignore my body and brain's attempts to get my attention. It wasn’t just chronic migraines. My back went into spasms during a bad marriage. I doubled over in abdominal pain for 9 months under the subordination of a terrible boss. The day I was set to start my field work for my master’s of geology, traversing a 14-thousand-foot volcano alone, both my knees collapsed beneath me. I just kept going but never connected the dots; never understood what these symptoms signified.”
“That is, until three months of crippling pain forced me to dissect my very soul. What I found was that the person in my life who was doing me the most harm, the person who held the key to my chronic pain and the only one who could unlock the mystery of my anguish, was me. The realization of how much pain I had caused myself now layered upon me a heavy blanket of sadness and grief. To heal, I needed to allow myself to feel; to feel the grief as it welled up and flowed out of me, and to feel the anger. Not only did I have anger towards the rapist, but towards my mother; and to myself. I found that to heal, I would literally have to divide myself in half. On one side, I would have to express anger toward A PART OF ME—for 40 years of utter neglect of my emotional needs. This anger came quickly, boiled up unexpectedly, and gave me an instant feeling of healing from physical symptoms in my chest and head. My migraines have all but subsided. Healing the other part of me is more difficult and ultimately more important. It is the painstaking process of rebuilding a broken relationship. It is the reconnecting with someone I abandoned long ago. And it is the learning—maybe for the first time—to be a loving and compassionate caretaker of myself.”
This is a remarkable story. Severe pain forced this woman in her 40s to reassess her life and herself in a new way. She began to connect the dots and explore the relationship between the mind and the body. What she found astounded her, and ultimately also freed her. Yet, it was a difficult and painful process. It took brutal honesty and courage to admit that aspects of her childhood, her life, and personality wove together in ways that were so stressful that it affected her body. In other words, that emotional pain led to physical pain.
The work she did that gave her relief from migraines had several components. She had to be open enough to search for a non-medication, non-injection form of treatment. When she looked closely at her life, she recognized the patterns and the essential truth about what was actually causing her symptoms. Once this occurred, she could begin to work on healing herself as a path to pain relief. She felt emotions that had not been identified or experienced. She found that there was a lot of anger she was taught to ignore or suppress.
This anger flowed out of her once she was able to admit that it was there. She wrote about it and expressed it in words and images. This process also led to the recognition and experience of other emotions, notably deep grief and sadness for her losses. She shed tears for the young woman who was raped and couldn’t tell her parents for fear of causing them pain; and for the woman who had felt controlled and unappreciated by a husband and a boss; and also for a child who didn’t feel she could speak up on her own behalf.
This grief held the seeds of compassion: compassion for herself on all of these levels. And with this compassion, came the realization that in her work and her relationships, she did not truly identify or attend to her own needs. As she started acting on those needs, she not only felt that she was being true to herself, her body relaxed and her migraines went away.
Many people will never look at their migraines or other painful symptoms in this way. Most people don’t want to face painful emotional experiences. But I think that she would argue that she was forced to. She was desperate to end the unrelenting pain, and nothing else had worked. Every person with migraines and other chronic painful syndromes has a unique story. The only way to know if this mind body approach applies to you or those you know is to take the time to look. And, if you look closely with an open mind, you may find a path to healing chronic pain, rather than trying to manage it with medications.
To your health,
Howard Schubiner, MD
