Migraine (Issues/Conditions Series)

Heads up right from the beginning:
If you suspect that you experience migraines, organise to have them/you checked out by your physician. In Ireland, if you wish to have an in-depth assessment, set up an appointment with one of the headache clinics in the country. The Migraine Association of Ireland has contact information: http://www.migraine.ie
 
The first thing to realise is that a Migraine headache is not a just a headache, it’s a neurological disorder with headache as a symptom. Sometimes (it’s rare) but people don’t even get headaches, they get might experience nausea or even get an aura without any pain.
 
There’s a term: “Biopsychosocial”. It comes up when managing all sorts of chronic issues (remember chronic doesn’t mean bad, it means long-term or repeating).  The term implies that chronic issues have biological, psychological and social components.  You can use this concept to help identify triggers as well.
 
A trigger is anything that contributes to the onset of a migraine. As I said before, a trigger can be biological, psychological or social. Indeed, triggers are always a combination of all 3  (whether you can see it at the time or not).
 
The important thing to realise is that triggers are also cumulative and sometimes what will trigger a migraine on one day may not trigger it on another.
 
In another post I’ll talk about how potential triggers change on a daily basis. In regard to their cumulative nature let me give you an example: Imagine that you will get a migraine when you reach 10 points (a purely fictional number).
 
You won’t get to the 10 the same way every time but when you do you’ll get a migraine.

• So you don’t sleep well the night before (4)
  
• You’re anxious about that work meeting/presentation later that day (2)
  
• You haven’t done any exercise in 3  days (3)
  
• You ate something that you had previously identified as a possible trigger (2)
  
• You’re depressed and anxious because of that argument you had with “?” (2)
  
• The medication you are taking is not suitable to head off or deal with the headache (3)
  

Total 16 points
 
You've totaled 16 points so the migraine is inevitable and on the way (if not already here)
 
Instead you learn to manage everything a bit more efficiently (It takes weeks but you do it):
You learn how sleep a bit better so instead of it being 4 it's now a 1.
You’re a little less anxious about that meeting/presentation so instead of it being a 2 it's now a 1.
You have started to exercise regularly so instead of it being a 3 it's now at 0.
You’ve become convinced that the food you ate was not as big a trigger as you thought  so instead of it being a 2 it's 1.5.
You’ve re-assessed the argument and your mood is slightly better. Instead of it being a 2 your still upset but not as much so it's down to 1.5.
The medication you’re taking is suitable and helps you head off the headache and because you've got better advice and acted on it the meds aren't contributing so they go from a 3 to 0.
Total      5

You’re only at 5 points so the migraine is not going to happen
 
This is how management using the biopsychosocial model works. Biofeedback in general and Biofeedback Ireland specialises in helping you identify and knit all the different aspects of the biopsychosocial model. If we look at the six components we already listed you can see how this works.

• So you don’t sleep well the night before.  

Over period of weeks you learn how to quieten down. You can learn to deliberately produce more Delta EEG activity before you sleep. You learn about sleep hygiene (good habits). Over the period  you begin to find that it takes you less time to fall asleep or you can get back to sleep when you wake up/you’re not falling asleep when you shouldn’t/you’re not waking too early etc.

• You’re anxious about that work meeting/presentation later that day

Using the biofeedback instruments you can see your Heart Rate (HR), Respiration Rate (RR), your skin temperature, muscle tension, EEG activity in your brain, Blood Pressure (B/P) etc. You learn how to reduce the effect of anxiety. You also learn that anxiety isn’t all bad and how to use it so it doesn’t overwhelm you.

• You haven’t done any exercise in 3 days

You see about how motivation works and that it is inevitable that you falter (in order to learn). You learn how not to judge yourself and give yourself a break. You see the almost immediate effect on your physiology of giving yourself a hard time.

• You ate something that you had previously identified as a possible trigger

You start a process where you begin to look again at triggers and view them with a scientific eye.

• You’re depressed and anxious because of that argument you had with “?”

Everybody talks about “letting go”. We use the instruments so you can learn what it means and how to do it. We use some of the same techniques used in Cognitive Behavioural Therapy to help you reassess your relationships.

• The medication you are taking is not suitable to head off or deal with the headache

Getting your medication right is essential. Remember, the functional use of medication is employing it so you can do the things you need to  minimise the need for it. For example, if a person with lower back pain takes a tricyclic antidepressant like amitriptyline so they can exercise properly…that’s functional.

Sometimes the misuse of the medication can be a cause of the headache being worse such as with a medication overuse headache. Getting the balance right is essential.
Most biofeedback therapists/psychophysiologists are psychologists and do not prescribe. Work with your general physician or specialist to get your meds working for you.