Migraines & Head Pain
Neuroplastic & Mind-Body Resources TO UNLEARN SYMPTOMS
By Kent Bassett
It’s pretty widely known that there are not enough effective treatments for migraines, head pain, cluster headaches, and tension headaches. A recent PBS News hour segment was titled, “15 percent of Americans have migraine disease. Why aren’t there better treatment options?”
Is a Migraine Caused by Damage in the Brain?
Dr. Howard Schubiner’s blog post about migraine, “Severe Migraine: Finding Answers in the Mind, Not in Pills,” is a great place to learn more about the mind-body understanding of migraines and other headaches.
“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. ”
Only 2-3% of people with migraines or severe headaches have something clearly structural—like a tumor, infection, bleeding, or poisoning—that explains their pain. Most have clean scans. And most drugs do not work all that well. The hypothesis explored in our film This Might Hurt is that the vast majority of migraine headaches are caused by a learned neuroplastic process that can be reversed.
Are Migraines Genetic?
Migraines often run in families and are commonly thought to be heritable in nature. But what do we mean when we say migraines can be genetic?
“[For migraines] 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’s good evidence that people can overcome genetic sensitivity to their environments, and unlearn head pain and migraines.
“But my headaches have clear triggers — so they’re physical”
All pain is real; migraines and headaches are physical pain. But determining the cause of pain can require some tricky investigation. For example, triggers are different than causes. And triggers can be learned and unlearned through a process called neuroplasticity. Again, here’s Dr. Schubiner on triggers:
“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 [links to studies below] 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.”
Dr. Kristy Lamb describes how migraines result from a type of unconscious anxiety that creates temporary, physical changes to the brain.
Migraine recovery story:
Post-Concussion Syndrome
Concussions are structural injuries that can take weeks to heal. But sometimes symptoms last long after healing has occurred. That is due to the brain learning the symptoms and triggering them even in the absence of damage. This happens usually because of a combination of the same factors that drive other pain syndromes: psychosocial stress, fear of underlying damage, trauma, and underlying emotional conflicts. For others, it is simply random noise generated by the brain and there’s no obvious reason for it—for all of these causes, the symptoms can be unlearned.
After traumatic brain injuries, through extensive rehabilitation, people are typically able to teach their brains and bodies how to speak again, how to walk again. With the help of professionals, they can slowly teach their brains to rewire around damaged parts of their neural networks. It is the same principle of neuroplasticity that is recruited to teach people how to unlearn chronic pain. If re-wiring can be done for TBIs, then the same can also be done to unlearn migraines and head pain.
Here’s an inspiring success story of someone who overcame their post-concussion syndrome:
“Run Towards The Danger: Confrontations with a Body of Memory”
Sarah Polley’s book “Run Towards the Danger” has a compelling story about dealing with post-concussion syndrome. Here’s how she describes her journey:
“When I first met concussion specialist Dr. Michael Collins, after three and a half years of suffering from post-concussive syndrome, he said, ‘If you remember only one thing from this meeting, remember this: run towards the danger.’ In order for my brain to recover from a traumatic injury, I had to retrain it to strength by charging towards the very activities that triggered my symptoms. This was a paradigm shift for me - to greet and welcome the things I had previously avoided.
As I recovered from my concussion, ‘run towards the danger’ became a kind of incantation for me in relation to the rest of my life. I began to hear it as a challenge to take on the project of addressing and questioning my own narratives.” […]
“These days I try, in the chaos of everyday life, to be mindful of the contradictory lessons I learned from needing to slow down and then to speed up again. I learned to breathe, fully, and to be in the moment. I learned to sit on the floor and play with my kids and let the tasks and obligations of everyday life fade far behind us as we played with small objects or read books or talked. And I learned to have faith that I could do more than I thought I could, to not be afraid, or to proceed despite my fear. I wonder, sometimes, if I can find a way to live in the middle of all the conflicting things I have learned. Can one run towards the danger at the same time as being present in the moment? I don’t know. But at least I have my brain back, to help me sort it out. […]
Now in my forties, I have changed in ways that reach far beyond the limits of my concussion recovery. I know now that I will become weaker at what I avoid, that what I run towards will strengthen in me. I know to listen to my body, but not so much that I convince myself I can’t do things or that I can’t push myself; not so much that I can use the concept of listening to my body as a weapon against my vitality. I do the highway drive I’m nervous about doing. I prepare to make a film. I write the book I’ve always wanted to write. ‘Run towards the danger’ is a way of being that I have taken into my life with me; a treasure, a spell, a sword.”
(Thanks to Lilia Graue, MD for drawing attention to this resource.)
Migraines and Head Pain Recovery Stories
Tools for Overcoming Migraines and Headaches
1. Read Dr. Schubiner’s blog about migraines and/or his book, which is more detailed, Unlearn Your Pain. The general guidelines around unlearning pain you can find on our site here are also useful. A majority of people with migraines have other symptoms associated with learned neuroplastic pathways like fatigue, brain fog, insomnia, and chronic pains elsewhere in the body. These five steps to unlearning symptoms can be useful for all of those symptoms.
2. Listen to this podcast: Alan Gordon, LCSW, helps Paola—who has had years of migraines—assess her pain as a neuroplastic, reversible symptom.
3. Listen to this powerful success story of someone reversing their chronic migraines by using a brain retraining, or mind-body approach:
4. Our film This Might Hurt shows several people with migraines and headaches going through Dr. Schubiner’s brain retraining treatment. You can see intimately how the treatment works.
5. Learn how to journal about the connection between symptoms, fear, and emotions like shame, rage, anger, guilt, and grief. Habitually identifying and feeling these emotions directly in the body has been shown to dramatically reduce head pain and migraines. Nicole Sachs, LCSW has written a comprehensive guide to journaling to overcome chronic pain—her suggestions are a great place to start.
6. Read Lee Canter’s book: My Migraine Breakthrough: How I Journeyed out of the Darkness of my Migraines, to the Light of a Reclaimed Life
Lee Canter is a PPDA board member and a nationally-renowned educator, author and researcher. He suffered debilitating migraines for years until finding relief from a psychophysiological approach. His new book is a useful, clear and heartfelt guide to the journey of self-discovery that that leads to relief of suffering.
7. Another great migraines podcast about a neurology professor at Yale University, Dario Zagar, MD, who was skeptical these ideas could help him unlearn migraines.
8. If you end up feeling that these methods make sense for your situation, it’s recommended to find a qualified practitioner to help you recover. You can find people have trained in these treatment paradigms, PRT (Pain Reprocessing Therapy), or EAET (Emotional Awareness and Expression Therapy), through the PPDA directory.
Success Stories of Unlearning and REVERSING Migraine Disorders
Overcoming Fear of Pain
This is an animated sequence from the special features of This Might Hurt
Scientific Citations about migraines and triggers:
“Managing headache triggers: Think ‘coping’ not ‘avoidance’” This article challenges the typical goal that migraine headache patients are given by providers to avoid triggers, which paradoxically can make one more sensitive to triggers over time: “One aetiological pathway to developing a primary headache disorder may be via attempts to avoid triggers resulting in increased sensitivity to triggers.”
“Provocation of migraine with aura using natural trigger factors” Neurology, January 23, 2013. Authors: Anders Hougaard, Faisal Mohammad Amin, et al