Love & Sex Magazine

Migraines: Your Internal Migraine Environment

By Nathan Feiles, Lmsw @therapynathan

Chronic migraines are life-changing. It is a lonely struggle that family and friends don’t tend to understand without experiencing it for themselves (and migraines are a very individual experience, so even those who have had a migraine don’t necessarily know the struggle of another). With chronic migraines, the fear of the next attack always looms. In fact, the fear itself can even become debilitating.

People have often relied on medical and alternative practices to try to relieve themselves from chronic migraine attacks. These methods can all be helpful, and it’s especially important that people have a neurologist following the progression of their migraines. However, what isn’t focused on enough is the role mental health plays in chronic migraines, and how much certain types of therapy can help with relieving migraines.

In my psychotherapy and coaching practice, I specialize in working with people who struggle with chronic migraines and headaches. This includes people who have attacks with and/or without aura, people who get them once or twice a month, people who have chronic daily migraine for months or years, and anywhere in between.

First, I should clarify that there are many possible triggers for migraines. Each person comes in with their own migraine history, including different triggers (and triggers can often work in combination, as opposed to just one clear trigger).

One piece of the work I do with people is to help them identify what these triggers are for them. But this isn’t as simple as it seems. While some triggers can be easier to identify (certain foods, weather changes, sleep patterns, etc.), what I focus on more centrally with people is what I call their Internal Migraine Environment.

The Internal Migraine Environment is, in the most basic terms, what is happening behind the scenes in a person’s present life and history that sets the stage for attacks. The Internal Migraine Environment is different for everyone, depending on their life histories. Some people seem to be generally primed at all times for an attack when the smallest of possible triggers presents, whereas others seem to have a bit more leeway for stressors and triggers before reaching the threshold of an attack.

When migraines are non-organic (meaning there isn’t a notable medical basis for the attacks), people tend to believe that they just “get migraines.” But there are always reasons for each attack…whether the triggers are tangible — such as chocolate — or whether it’s something more difficult to see — such as psychological and emotional life patterns and tendencies that have long been present and reinforced over time.

There are many things to talk about with what comprises the Internal Migraine Environment for people (I’ll address more of these in future posts). For here, one of the themes that seems to be common among many migraine sufferers are patterns of over-containing theirs and others’ emotions (without many, if any, outlets for release of this energy), while their own internal needs have been stifled; and also the tendency to unconsciously disconnect from certain emotions and parts of themselves, likely because of how this was learned when growing up.

This is a simplified summary, and really is quite complicated from one person to the next since this shows up in so many different ways for each person. One example of this is someone who is used to pushing off their own needs because of a pattern of being forced to meet others’ needs first (maybe from demanding parents who were more focused on their own needs than on yours). Now in the present, there is a strong discomfort of their own needs, and others’ needs are still primary. At the same time, there may be an internal frustration and anger that their own needs are never met. They begin to notice that whenever their boss at work demands of them, they feel internally enraged and end up with a migraine rather than being able to deal with the situation in a healthy manner.

Another example is a person who was raised to fear their own anger — whether because they learned that they will hurt or lose others, or because they were hurt or abused in return from showing anger. This person may unconsciously avoid feeling anger (dissociation), or hold it in (repression). When a situation presents where feeling anger would be appropriate, the learned response is to disconnect from it and possibly even try to cater to others instead in order to keep them closer. This piece of emotional disconnect causes the energy from the stored anger to go elsewhere, and can result in physical symptoms over time.

Imagine a time you’ve had an intense feeling/emotion that you’ve had to hold inside, and consider what it was like to feel this. Now imagine doing this daily, since childhood, for years and years. The energy needs to go somewhere. Imagine a glass filled with water to the top. One little extra piece (a trigger) in that glass, and it overflows. When this happens it causes symptoms. For some people it can be gastrointestinal issues, general anxiety, depression chronic fatigue, etc. For others it can be headaches and migraines (as well as depression, anxiety, etc.). For people who experience daily symptoms, it’s possible their glasses are constantly overflowing. If we can empty out some of the water and change how we emotionally respond in the present so it doesn’t keep refilling the glass, we can reduce the frequency of filling and overflow.

When the Internal Migraine Environment becomes more clear, and when adjustments are made to the ingredients that fill the glass, I’ve seen people suddenly start to go weeks or months without attacks, or reduce from daily to once every couple of weeks, etc.

Reducing the Internal Migraine Environment has also been notably effective for people who have not experienced relief through medication. It’s also worth mentioning that recent developments in neuroscience show that certain kinds of psychotherapy can rewire neural pathways — meaning one isn’t doomed to their long-time struggles.

I will focus more in future posts about the types of issues that can comprise the Internal Migraine Environment for people. It’s important to note that these posts will give people things to consider about their migraine picture, but it won’t substitute for the therapy (knowledge is the start, not the end goal). It’s not just knowing your glass is mostly full and why, but being able to empty the glass more and more without refilling it so easily.

Also, not every therapy approach will address migraines in an effective manner. There are many schools of therapy, older and newer, that help with different types of issues. I would caution against choosing a random therapist under the assumption that simply any therapy will effectively address your migraines. What seems to be effective in working with migraines is a combination of therapy approaches, including more contemporary forms of treatment rooted in relational therapy, neuroscience, and trauma techniques, as well as elements of migraine coaching.

Other aspects of what I do for migraines include general migraine support, teaching techniques to help reduce mental and physical stress, and techniques to help cope during migraine attacks.

People who are interested in migraine-focused therapy or coaching are welcome to contact me for more information.

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