Mindfulness for Migraines (eBook)

Introduction

I was nine years old when I experienced my first migraine. The combination of pain and fear has made that memory a dark fixture in the back of my mind. It was evening, and all of my siblings were home, making a ruckus. Though the chaos was probably typical of that time in my life, it seemed to be a bit louder and more aggressive than usual. I remember starting to feel a dull ache behind my eyes. My mother gave me something chewable, probably Tylenol, and told me to lay down. The pain kept getting worse, throbbing rhythmically, and the light was hurting my eyes. I started to cry. My mother patiently took a rag, soaked in cold water, and pressed it to my forehead. She lay down with me on our shabby, brown couch in the living room and rubbed my neck and back until I fell asleep. My mother wasn’t a doctor or a nurse, nor did she have any medical training. She was a parent and a teacher. A sufferer of migraines herself, she understood that medicine alone is not always enough.

Many years and countless headaches later, I am still working on internalizing that lesson. I am an emergency medicine physician with experience in several different hospital systems, multiple emergency departments, as well as urgent care and telehealth. Prior to returning for my post-baccalaureate education, I worked in the mental health field for over 10 years with children and adults diagnosed with developmental disabilities and mental illness. My work in the social services arena combined with formal medical training have led me down the path of utilizing multiple techniques to manage my own headaches.

As an ER doctor, it is my job to identify and address all types of potentially dangerous conditions. We are trained to manage an incredibly broad spectrum of pathology, as pretty much anything can come through our doors at any time. Headaches are one of the top five most common complaints in the emergency department with about four million patients a year in the United States coming into the ER for a headache – and many millions more in outpatient settings.

Of course we must first eliminate dangerous conditions such as stroke or meningitis but in the vast majority of cases, the patient is indeed simply suffering from a bad headache and attempts to treat it at home have failed. If you have ever felt pain on this level, I can definitely relate. You may have even gone to doctors and specialists and tried countless therapies and yet still suffer terribly. I have personally gone down this bumpy road myself and despite my experience and medical education, I found that I was still succumbing to increasingly debilitating headaches. This is why I am always looking for better ways to manage pain.

There are multiple nonmedicinal treatment options available for migraines including mindfulness, biofeedback and cognitive behavioral therapy (CBT). Biofeedback is performed by specialists using techniques such as electroencephalography (EEG) or heart rate monitoring. The goal is to provide immediate feedback to patients about their symptoms using their physiologic responses, thus allowing some control over otherwise unconscious behaviors through education and awareness. Research shows that there are small, but significant improvements in headache symptoms, duration, and frequency with this treatment and it can also help to ease underlying anxiety and depression (Nestoriuc et al, 2008).

Cognitive behavioral therapy is a psychological intervention that utilizes problem-based strategies to address issues involving emotions, thoughts, and beliefs. It combines multiple elements of therapy, and uses a systemic approach to address patient concerns. With headaches, therapists will typically seek out any underlying thoughts or issues related to migraine triggers, such as anxiety or sleep deprivation. A number of studies have been conducted evaluating the effects of CBT for migraines with a moderate level of evidence supporting its use (Pérez-Muñoz et al 2019). Non-pharmacologic management techniques including CBT and mindfulness have been shown to reduce headache intensity as well as lead to improvements in some underlying triggers (Probyn et al, 2017). There are definitely some great potential benefits to a comprehensive approach including a decrease in medication reliance, and a more fundamental understanding of the disease. Many of these interventions can be performed in conjunction with medication management, patient education, and mindfulness.

For many years now, I have been practicing mindfulness-based meditation for a variety of reasons. It has been shown to increase relaxation, productivity, and happiness, as well as countless other health benefits (Van Dam et al, 2018); it has even been proven to be useful in managing pain. While this modality has not been extensively studied specifically for this purpose, there has been a growing body of evidence showing the positive effects of meditation on migraines (Gu et al, 2018, Seminowicz et al, 2020, Wells et al, 2020). Many people suffer from intermittent or chronic pain, and while none of these modalities will make your pain suddenly dissipate the first time you meditate, my goal with this book is to provide you with some tools that may address the underlying contributors to these symptoms. Stress, anxiety, and sleep deprivation are some of the most common culprits known to trigger and exacerbate pain.

This book is divided into three general sections. In the first segment, I will aim to explore the underlying problem. What is a headache? Why do we experience pain in the way that we do? Perhaps most importantly, I will make some recommendations on when it might be a good idea to seek emergency treatment. The second part of the book focuses on the underlying triggers that are often associated with headaches. Some of these include anxiety, stress, sleep deprivation, and dietary issues. Finally, I will discuss some of the ways we can manage our headaches, in particular by focusing on trigger identification, education, and prevention.

Throughout the book are a series of mindfulness modules aimed at addressing pain, triggers, or areas of self-help. If you have never practiced mindfulness in the past, please do not worry or feel intimidated in the least. These are designed to be short, very basic, and easy to follow guided meditation sessions that will hopefully assist you with a number of the goals we will identify throughout this book. I recommend reading them in the order they are laid out first, as they relate to a particular chapter or subject, but feel free to review them more than once, or in any order that works for you. You may get the impression that there is some repetitiveness to these modules. That is no mistake. It is the very act of repetitive practice that allows these techniques to be successful, and for you to properly utilize them in your daily life. By actively participating, practicing, and applying the included modules and the recommended lifestyle changes, you will become better equipped to address and reduce the number and severity of your headaches. True progress takes time and effort. Please keep in mind that making small, sustainable changes is the best way to achieve lasting success.

Mindfulness Module 1:
Introduction to Mindfulness

Mindfulness is all about being in the present. It is very natural that we spend much of our time ruminating about the past, thinking about all of the things that we wish we could have done differently, or worrying about what the future might bring, and what steps we need to take to prevent potential issues from arising. The inevitable result is that our present is often filled with stress, pain, or anxiety; we are overwhelmed by both the concerns for the past and the future. How many times have you found yourself lying in bed awake at night with this exact problem? The goal of this process is to find a way to focus your attention on the here and now without getting bogged down in all of our day-to-day concerns. By being present, you will find that there are valuable tools which can be applied to all sorts of areas of your life, including headaches. Try to follow along with the directions of these modules, but please do not judge yourself harshly if you feel like you’re not doing it correctly. There is no such thing. The very act of being here and trying to create a better mindset for yourself is an amazing start.

If this is your first time meditating, you will notice that it is very easy for your mind to wander off during these modules. That is perfectly natural. When you notice this has happened, please just acknowledge the thought in a nonjudgmental way. It is absolutely normal for your brain to move from thought to thought. So when you observe this happening, simply redirect yourself by gently bringing your mind back to the present task. For the time you are doing these modules, try to keep the mindset that this is your only responsibility in this moment. For just a few minutes, give yourself permission to place everything else on hold. You will be better suited for all of your other obligations like your work or family, if you can first bring yourself to a healthy and centered place. The first few times you attempt this will likely be very challenging. In fact, even the thousandth time you do this, you may occasionally find yourself feeling almost the same way. However, the more you try, the easier it will become to redirect yourself to where you want to be.

Meditation can be done under any circumstances and in any location. However, for optimal success, I would recommend finding a quiet place where you can sit down in a comfortable and upright...