Suffering from any kind of chronic pain takes its toll. I’m sure you have felt the frustration and despair with each new headache. We often talk about the pain and the things we do to mitigate it, but the psychological aspects of regular and sometime frequent episode takes its toll.
I’ve suffered from migraines since I was a child, and they have only gotten worse as I’ve grown. Fortunately medical science has progressed as well. But pain is only half the problem. Migraines impinge on my life in many ways.
Alcohol is a trigger for me. That means I’m often the odd one out at both personal and professional events.
Reduction in stress is a strong trigger for me. This means that the first few days of vacation are usually down days while I work through the inevitable symptoms.
Migraines are insidious like that. They permeate your whole life even when you aren’t in pain. Whether its a food trigger requiring constant vigilance, or a sleep trigger that strains your relationship with your new baby and partner the effects can be profound.
Comorbidity
The follow-on effect (or comorbidity) of migraines with depression is well documented. In one study migraineurs were up to 4 times more likely to suffer from depression compared to the general population. In fact migraines are associated with increased odds of generalized anxiety disorder, panic disorder, and bipolar disorder.
The reason for this comorbidity is fairly obvious, but still difficult to manage. Depression naturally comes out of a sense of helplessness in dealing with symptoms and other impacts on one’s life.
Stress is related as well. Migraines can disrupt our work and personal lives with no regard for the impact. This can strain relationships and hamper work. This is not helped by the fact that stress is a common trigger, creating a destructive feedback loop.
As I dig in to these symptoms the feedback loops layer on top of each other. Sleep is another area that has a similar impact. Stress, depression, and pain can disrupt sleep. Correcting poor sleep has been shown to improve migraines, but if the headaches are conspiring with other symptoms to prevent this your life is made much harder.
Impact on Treatment
The psychological impacts of migraines have a self-reinforcing element to begin with, but when you start to account for what is involved in regular treatment of migraines this interrelationship gets deeper.
Many migraine sufferers have multiple elements to their treatment program. Just looking at the medication side there is usually a prophylactic treatment and an abortive treatment. Both of these require careful monitoring and vigilance. This can be made more difficult if the treatment is complicated or has side effects of its own. A sense of helplessness can make all the work seem pointless. This can set you up for a self-destructive backslide in managing your symptoms.
Beyond medication, trigger management can be difficult and confusing to track. Many triggers are not under your control, or force you to break patterns of behavior. Moreover, some activities that you enjoy may become activities you must avoid. If changing habits is hard in the best of circumstances, throwing depression, stress, etc. on top of it only makes the process more difficult.
Find Help
While adding more elements of a complex treatment program isn’t always needed, a psychologist can benefit your overall happiness and perhaps improve the effectiveness of your treatment.
Breaking or dampening these feedback loops can have far reaching impacts.
You should consult your doctor about the best way integrate a mental health aspect in to your migraine treatment program. Try to find someone with specialization in chronic pain and depression. If you have trouble convincing your neurologist of the benefits of this additional treatment point them to Dr. Nicholson’s excellent article outlining how mental health issues can impact the effectiveness of even simple treatments and how bringing a psychologist in to the mix can help treat the whole person.