Sunday, October 30, 2016

Migraine Linked to Abuse

Something we never talk about

Abuse is common and occurs worldwide.  It can be physical, emotional or sexual, and it also includes neglect.  There is a strong association between a history of childhood maltreatment on the one hand and migraine and other chronic pain disorders on the other.  This article by researcher Gretchen Tietjen is a good summary of the issue.  http://www.medicaldaily.com/emotional-abuse-childhood-migraines-391660

It is documented and accepted within the community of headache sufferers and specialists that migraine runs in the family.  There is a strong genetic association.  In addition there is now a theory that migraine may be epigenetic.  This means that environmental factors such as early stress and abuse may alter your DNA and that the effects are hereditary.

Scared
Presumably, If you have a genetic history of migraine in your family as well as possible epigenetic factors in your background, you are doubly threatened, but the research on how all these issues fit together is in its infancy.  The belief is that genetics may play a part, but the expression of that hereditary pattern gets turned on or intensified by the addition of environmental stressors.

Psychological therapies, including Cognitive Behavioral Therapy (CBT) and EMDR or Eye Movement Desensitization and Reprocessing are among the approaches that produce some success in defusing traumatic experiences.  Anti-seizure medications valproate and topiramate are FDA approved for treatment (prevention) of migraine.  These drugs are also known to reduce the effects of stress-induced, epigenetic influences and thus may be good choices for pharmacological treatment although they were not effective for me.

While there are researchers like Dr. Gretchen Tietjen documenting the relationship between migraine and abuse, I have found little research-based information on the efficacy of these different treatments, whether medication-based or psychological.

We tend not to address this issue in migraine blogs, and we don't discuss it much on other migraine-related, social media sites.  There is no mention of the link between childhood maltreatment and migraine on the websites of the National Headache Foundation, the National Migraine Association (MAGNUM) nor the American Headache and Migraine Association.  Your physician, even if he or she is a headache specialist, will probably not bring it up.  In my opinion, this is a big hole in our collective conversation about the disorder.
The only photo I can find of all of us together

My family and me

In an attempt to get the conversation going, I'll share a little of my own story. I come from a nuclear family of four: mother, father and older sister.  There was no history of alcoholism, sexual or physical abuse nor of physical neglect.  On the other hand, there was a great deal of scary anger floating around our household.  There was serious stress related in part to my father's illness.  He was diagnosed with multiple sclerosis the year I was born.  While there are a lot of holes in my memory, I remember that my parents fought or argued incessantly.  My dad was the strong, silent type who was more inclined to shut down or leave when things got tense, while my mother's louder anger spilled over and sucked the air out of the house.  My father was in and out of hospitals throughout my childhood even as he continued to work as a civil engineer in the oil fields of California.  My mother had phlebitis and deep-vein thrombosis with a history of multiple surgeries and a near-death event when a clot broke loose and passed through her heart and lungs.

My relationship with my mother was forever difficult.  She was controlling and critical and angry.  I think that became worse over the years as my father's disease progressed and she felt trapped by the circumstances.  While I don't really trust my memory to sort all this out, there is no doubt I was afraid of her.  Perceiving no other way to fight back, I shut down and retaliated with silence, which fueled her anger but gave me some sense of control.  This habitual restraint no doubt cost me as I grew older and had difficulty expressing my own anger, vulnerability and even joy.

As my sister grew into adolescence, she began to express her anger verbally and with lots of door slamming.  As she grew older, she was charming, extroverted and very articulate.  As I began to grow up, I became more introverted and careful to avoid doing or saying anything that might upset the family apple cart.  Sometimes I was the object of my sister's anger and passion.  Six years her junior, I felt powerless and scared.

I have no idea whether or how much my family history has contributed to my headaches.  And among the many questions that remain for me is, "So what?"  Many of us come from an endless variety of difficult childhood circumstances.  Once you recognize that perhaps your early upbringing was less than salubrious, you can begin to learn and choose better ways of living with yourself and others.  Nonetheless, your early history remains and sometimes reinforces genetic predispositions.  While we are constantly learning new ways to help those who have experienced recent, trauma-induced pain and disability, there has been less success with the physical fallout of decades-old, poorly-remembered events and patterns of family disruption.

Over the years I have learned to be more expressive of my feelings and more open to myself and others.  I can identify and clarify thoughts and emotions as they arise.  While these are valuable skills, my headaches persist.  I have a mental health therapist I see regularly, and I continue to explore all avenues that my one day help reduce or eliminate my headaches.

Friday, October 21, 2016

Chronic Migraine is Boring

Retreat

It's 6:00 am when my head prods me awake with a burning pain at the top of my skull.  I roll out of bed and make it to the bathroom, the only stop on my way to a prolonged sequestration in my bolt hole.  Sometimes I can tolerate a cup of black tea but not now.  This morning all I can do is retreat to my futon, lie on my side with an ice pack on the opposite temple, breathe into the pain and hope my abortive meds don't come retching back up before they've had a chance to take effect. This being one of my bad days, I vaporize cannabis, which settles my stomach, helps me relax and maintain some distance from the pain. Thanks to the cannabis, I drift off to sleep for a couple of hours. The day wears slowly on until, almost imperceptibly, the pain begins to ebb around 3 or 4 pm.

Boredom

My plan was not, never is, to spend the day buried under pain.  While the pain is acute, I'm either breathing into it, trying to relax and put a little distance between myself and the hurt or, thankfully, asleep.  I may be downhearted that I'm back at it, but I'm not bored.  As the pain eases, boredom sets in.  I can't get up yet, can't eat, can't read, can't tolerate music nor any auditory input.  So I wait as this tedious day slowly wears on.

The Merriam Webster dictionary defines boredom as the state of being weary and restless through lack of interest.  That's not quite it.  I have no lack of interest in a multitude of things, but pain, along with the host of neurological symptoms associated with migraine, very often leaves me adrift, unable to muster focus or energy.  I am caught in a sticky web of tedium, trapped like a fly in a spider web.

There is another difficult aspect to this struggle, an ominous sense that time is running out, that my tiresome days languishing on the futon are stolen from the finite number I have left.  And that I am, perversely, wasting them.

spider web

Antidote

How do we cope, or better yet, what can we learn from this common reaction to illness.

Patience is a homely, old-fashioned virtue, out of style in our frenetic, techno world.  But it is a soulful attitude.  Related to fortitude, grit and tolerance, it can smooth over the rough passages.  The question remains, how do you or I move from impatience to patience in the face of such difficult circumstances?

Witnessing and naming are good tools to acquire.  I try first to step outside of my discomfort for a moment to recognize that I'm struggling, not just physically but emotionally.  Then I put a name to my pain:  impatience, fear, anger, self blame.

Compassion is the next step.  I allow as how anyone would feel this way under the circumstances, and it's ok, a normal reaction.  Sometimes I pair this attitude of permission with a comforting physical gesture like running my hands across my temples, over my forehead and through my hair in a little scalp massage.  I also have a private term of endearment.  Speaking silently to myself as if it were my mother, husband or best friend, I say, "Look, Sweat pea, you're good.  This is all going to pass.  Nothing stays the same."

Breathing deeply into my belly and letting the tension in my shoulders go helps extract me from the grind of thoughts ferreting around my brain and calms me, at least for the moment.

Curiosity is the act of wondering.  What about this or that?  What if............there were something I could do to help myself feel better?  It requires an openness to possibilities large and small.  In a small experiment yesterday, I hung a mirror at the foot of my futon.  Now I can lie there and see the sky and trees reflected from the window above my head.  I can watch the leaves move in the breeze and notice the birds and insects flit across my visual field, see the sun glint off a long spider web.  I feel a little less hemmed in.

Focus on one thing.  In her book, "How to Be Sick," Toni Bernhard reminds those of us with chronic illness to stick to one thing at a time, no multitasking.  Eventually, a day or two after a migraine, I surface and begin to reapply myself to life left behind.  Once I'm feeling better, the temptation is to try making up for lost time, cram into the day all the things that didn't get done when I was down and out.  This kind of frantic, over-doing-it tends to make us sicker.  So the trick is...........take it easy, choose your focus, one step at a time.  If this sounds a lot like AA (Alcoholics Anonymous), there's a reason.  The more pressure you put on yourself, the more likely you are to slide down the slippery slope into pain and then, perhaps self recrimination.  So let that steam off the pressure cooker, relax when you can and enjoy whatever one thing you have chosen to do at this moment on this day.

 

Saturday, October 8, 2016

Alternative Treatments

Have you tried.........?

Somewhere on the long, winding road we travel seeking a remedy for our migraine pain, most of us resort to so-called alternative treatments.  We tend to pigeonhole curatives such as acupuncture, rolfing, homeopathy and cannabis as "out there," unproven, therefore worth less than the pills and surgeries prescribed by our doctors.  Yet we all have much to learn from the health and spiritual practices that come to us from the East and elsewhere around the globe:  acupuncture, Tai chi and Qigong from China, Buddhist spiritual practices from Japan and Tibet, ayurveda and yoga from India, Native American healing from throughout the Americas, and more.

Every individual's migraines are different, and the cause of migraine continues to be poorly understood.  I believe it is not only sensible to explore all avenues to improve your health but imperative to stay open to trying new treatments, new doctors, spiritual practices and life style choices.  That said, whether you're choosing among physicians or therapeutic traditions, my advice is, "Go slow, do your homework, don't overlap new trials of treatment, give it time and, finally, keep careful track of your body's response."

I have tried all of the following over the long years of living with migraine:

•  Acupuncture
•  Psychotherapy
•  Chiropractic
•  Naturopathy
•  Homeopathy
•  Aroma therapy
•  Cranial sacral therapy
•  Massage
•  Rolfing
•  Herbs and supplements
•  Cannabis
•  Diet, nutritionist
•  Oxygen
•  Neurofeedback
•  Music
•  Meditation
•  Yoga
•  Tai chi, Qigong
•  Shamanism
•  Clairvoyant

None of these approaches cured my headaches, but some have given me worthwhile relief from other ailments and helped my body and mind feel a little better, more centered and at peace.

Acupuncture has given me relief from carpal tunnel syndrome and digestive problems.  However acupuncture needles in my head or face will trigger a migraine, so I no longer allow placement of needles in those areas.
My naturopath has helped me with everything from yeast and urinary infections to gut problems and written a prescription for cannabis to treat pain.  He is my first stop for ordinary health problems and anything related to diet.  His treatments are often effective and less likely to cause side effects than many medications prescribed by my family practitioner.
Psychotherapy has helped me cope emotionally with chronic pain, giving me an outlet and resources to express my fear, grief, despair, anger and hope.  It reminds me to stay open to possibilities and remember that anything can happen.
Massage        When I'm at a low point of constant headaches, massage has lead me to appreciate my body as a source of comfort, not just pain.  However, I have learned not to let my masseuse dig too deeply into that sensitive area underneath my occiput, which can trigger a migraine.
Hemi-sync is a system of music enhanced with binaural beats to promote brainwave synchronization.  It aids relaxation and rest when I'm tired, over stimulated and frazzled.
Meditation calms me, lowers anxiety and takes the pain down a notch.
Yoga, likewise, helps me keep a sense of strength, flexibility and balance in my life, both physically and spiritually.  I neither meditate nor do yoga as regularly as I should, but both are there for me when I remember and determine to devote myself once again to regular practice.
Cannabis has been a huge deal for me.  When my headaches were at their worst and most frequent, it gave me great comfort to know there was something I could turn to for pain relief that didn't cause intolerable side effects.  I live in a state that has legalized marijuana for both medical and now recreational purposes.  I vaporize it in loose flower or bud form when I have a severe migraine.  It reduces or eliminates the pain and anxiety and allows me to sleep.  I have never used it for mild pain because I don't like feeling sedated or less than alert during my waking hours, no matter what the drug.  I also vaporize it in the form of a vape pen as a sleep aid.

Neurofeedback is a form of biofeedback that uses EEG or electroencephalography to promote subconscious self-regulation of brain function.  Sensors are placed on the scalp and ears to measure output (brain activity) and provide input to the client in the form of video displays or sound (music).  The video or sound supplies positive feedback for desirable brain activity or negative feedback for undesirable patterns.  Evidence-based studies are beginning to support use of neurofeedback in treatment of ADHD.  There are indications that it helps in treatment of alcoholism and opioid dependence, seizures, autism, depression, insomnia, stroke, PTSD, migraine and more.  I am now into my fourth week of neurofeedback, so the jury is still out.  An average of 10 to 20 treatment sessions are usually required to alter symptoms.  There is, of course, no guarantee neurofeedback will decrease the frequency or severity of my migraines.  But there is no sure outcome no matter what the therapy.  I have dutifully tried every preventative medication prescribed by my excellent physician, who is a headache specialist.  Only two resulted in measurable improvement in my headaches, and all came with increasingly difficult or intolerable side effects.  The efficacy of those 2 medications decreased over time and eventually diminished to zero.

Biofeedback is a mainstream approach to headache prevention.  While it did not help my headaches, it was and is a powerful tool for me in other respects.  I learned to use progressive muscular relaxation techniques, which later helped in meditation.  It also gave me significant control over a difficult gut problem, the urgency to have a bowel movement, sometimes when no bathroom was available.

Integrative medicine

We are at the beginning of an era when alternative health care approaches and western medicine are slowly coming together in the new field of integrative medicine.  https://nccih.nih.gov/health/integrative-health
As this process develops, we will begin to understand new and different ways to deal with old problems, and patients will no longer be stuck in the middle, forced to choose.