Anxiety Symptoms May Adversely Affect Migraine

Everyone feels anxious on occasion. It’s a normal, healthy emotion that alerts us to possible threats. It’s only problematic when our natural alarm sounds during otherwise safe situations. Anxiety is one of several associated symptoms of a Migraine attack. After all, the pain and emotion pathways in the brain are closely linked. The same neurotransmitters are involved in both, too.

For the 50 to 60 percent of Migraine patients with a comorbid anxiety disorder, these chronic symptoms can have a negative impact on Migraine management. Untreated, these symptoms can lead to:

• Increased frequency and severity of Migraine attacks
• Increased risk of progression to chronic Migraine
• Treatment resistance in which potentially helpful treatments fail

Physical sensations of anxiety

Anxiety, like all emotion, is initiated in the brain. The entire body responds to these neurological changes. The physical sensations associated with anxiety may include:

• Shortness of breath
• Increased heart rate
• Chest tightness
• Sensation of throat closing
• Vertigo
• Dizziness
• Nausea
• Double vision
• Sweating
• Difficulty thinking
• Cold hands and feet

Elements of anxiety affecting Migraine

1. Hypervigilance happens when we are constantly on the lookout for potential threats. This constant state of “high alert” can make us feel exhausted, but unable to relax. It’s easy to get caught up in hypervigilance. After all, Migraine management involves paying attention to a lot of different things. There are triggers to avoid and medication schedules to follow. All that great advice about staying hydrated, not skipping meals, getting enough sleep and managing our stress can feel overwhelming. With a head swimming in Migraine, we must also make decisions about when, how, and what we use to treat attacks. All that focus on avoiding Migraine can easily have us seeing danger everywhere.
2. Self-fulfilling prophecies take on a life of their own. Whatever we look for, we’re likely to find. When we try to avoid every possible trigger, the world feels like a dangerous minefield. There’s a new threat lurking around every corner. We may focus so much on avoiding that list of potential triggers that we miss the most obvious triggers like poor sleep quality, dehydration, or disruptions in our daily routine. Self-fulfilling prophecies can work to our benefit or detriment. Sometimes we get a little relief from the placebo effect when our hope overrides reality. At other times, our discouragement can derail a potentially helpful treatment with the nocebo effect.
3. Catastrophic thinking can become a habit. Our fears grow larger and more ominous. Worries about job loss, abandonment by family and friends, or even fears of life-threatening problems may consume us. We’re unable to distract ourselves from these fearful thoughts. Each new Migraine attack only worsens our fears. We believe that we’re beyond help and begin to lose hope.
4. Avoiding what we fear is natural. Unfortunately, this instinct actually makes anxiety worse. The more we avoid, the more we believe that our behavior is protecting us from bad outcomes, the more we try to avoid. In managing Migraine, our fears can cause us to unnecessarily avoid healthy, enjoyable activities. Our fears of the next attack may tempt us to overtreat to avoid a potential Migraine attack. We can get caught in a cycle of medication overuse, making a bad situation even worse.
5. Reinforcement gives anxiety the fuel it needs to keep going. We find what we look for. We prevent what we avoid. Fear is a powerful tool for survival. Trying to interrupt these impulses is no easy task.

Factors of Migraine management affecting anxiety

1. Keeping a Migraine diary can become anxiety-provoking. Trying to document every detail may backfire, leaving us with a mountain of unpleasant feelings. We can lose ourselves in the details, forgetting the purpose of tracking. The purpose of tracking our attacks is twofold: identify triggers and assess the effectiveness of our treatment plan. Not everyone needs to track every single symptom or every possible trigger. If your Migraine diary is stressing you out, then it’s not fulfilling its purpose.  Simplify tracking by using a tracking app, asking a loved one to document your attacks, or using a scaled-down tracking tool. We’ve created a Migraine Diary Workbook that includes several versions. Download the workbook and choose the version that works for you.
2. Trigger avoidance doesn’t have to be complicated or stressful. New research on triggers is yielding some surprising results. Much of what we have assumed about food and environmental triggers is proving either incorrect or over-emphasized. Migraine doctors are moving away from telling patients to avoid a long list of potential triggers. Instead, they are encouraging patients to focus on a few basics because these factors have been shown to have a greater impact on Migraine attack frequency and severity.

Keep it simple

Migraine specialist Larry Newman, M.D., developed an acronym to help doctors and patients remember these basics.

Amaal Starling, MD shares this about SEEDS, “Nonpharmacological treatment options and lifestyle changes are important and proven to be effective in clinical studies in migraine. A good mnemonic is SEEDS: Sleep hygiene, Exercise, Eating healthy, keeping a headache Diary, and Stress management. These are the SEEDS for success in headache management.”

SEEDS for Migraine treatment success

• Sleep – consistent, healthy sleep hygiene
• Exercise – daily Migraine-friendly exercise
• Eating – regular healthy meals
• Diary – simple tracking of attack frequency and severity
• Stress – healthy stress management

No shame in asking for help

If anxiety is complicating your Migraine treatment, don’t try to resolve it alone. Ask your doctor for a referral to a behavioral health provider. Acute pharmaceutical treatment can help, in the short term, but using it alone increases the risks of dependency. It also treats symptoms rather than addressing the underlying causes of anxiety. Psychotherapy is essential to treat the emotional, cognitive, and behavioral habits that maintain anxiety. Asking for help could make all the difference in Migraine treatment success.

Not sure where to find help?

1. Ask your family doctor or Migraine specialist to recommend a good counselor.
2. Ask family and friends for their recommendations.
3. Check with your insurance or Employee Assistance Program (EAP).
4. Search the American Counseling Association, Theravive, or GoodTherapy.org.

Sources:

1. Asmundson G, Norton P, & Norton G. (1999). Beyond pain. Clinical Psychology Review, 19(1), 97-119. doi: 10.1016/S0272-7358(98)00034-8.
2. Email interview with Amaal Starling, MD on August 17, 2017.
3. Hamm A, & Weike A. (2005). The neuropsychology of fear learning and fear regulation. International Journal of Psychophysiology, 57(1), 5-14. doi: 10.1016/j.ijpsycho.2005.01.006.
4. Lucchetti G, Oliveira A, Mercante J, et al (2012). Anxiety and Fear-Avoidance in Musculoskeletal Pain. Current Pain and Headache Reports, 16(5), 399-406. doi: 10. 10.1007/s11916-012-0286-7.
5. Matatko N, Ruppert M, Zierz S, et al (2009). Fear-avoidance and Endurance-related Responses to Pain in Migraine. European Journal of Pain, 13(S1), S273c-S274. Doi: 10.1016/S1090-3801(09)60974-5.
6. Nicholas, M, Asghari A, Sharpe L, et al. (2014). Cognitive exposure versus avoidance in patients with chronic pain: Adherence matters. European Journal of Pain, 18(3), 424-437. doi: 10.1002/j.1532-2149.2013.00383.x