S-T-R-E-S-S. It's amazing how those six little letters can have such an impact on both our physical health and emotional well-being. In every life, there are typical stresses: arguments with loved ones, budget concerns, bad days at work, parenting issues. In the case of a chronically ill person such as myself, I have some of those same stresses and also others that are unique to my situation. For instance, my chronic migraines are too frequent and too severe for me to have a job outside of the home right now. This leads to concerns about money but also to a feeling of stigmatization. I was a preschool teacher when I was able to work and I loved it. It was so much more than just a job to me; it was a lifestyle. Being forced to step back from my career was stressful enough but the comments that other people made were what broke the camel's back. People often say to me "Oh it must be nice to just lay around all day and not have to work!" Another common one often comes after mentioning that I'm tired: "You think YOU'RE tired? Some of us worked all day!" What people don't realize is that having chronic migraines is like its own full-time job and let me tell you right now: Chronic migraines are the worst boss you've ever had.
Other causes of stress due to chronic illness include arguing with insurance companies who don't want to cover the medication I need, consistent guilt over missing deadlines or cancelling plans due to a migraine attack, and never knowing when I'm going to wake up with a migraine or which symptoms I'm going to have. Will the medication work? Will I get so dehydrated from vomiting that I have to go to the emergency room? Will I be treated like a drug seeker? There is a constant tape playing in my head of questions that must be considered minute by minute as circumstances change. A migraine can come on within a matter of seconds and then I have to rearrange my whole day, possibly even my whole week. So how do I do it? How can someone with chronic migraines manage stress?
Most migraineurs I know have at some point had the "chicken and egg" discussion about their migraines: Which came first…the migraines or the stress? For me, the answer was cut and dry. I was diagnosed with Obsessive-Compulsive Disorder (OCD), anxiety, and panic attacks when I was 13 years old. My migraines didn't rear their ugly head until they were 19, so it's clear that, for me, stress came first. Because of this, I have never had the same kind of reaction to therapy as migraineurs who weren’t in therapy prior to their illness. I think that a lot of people believe that when a doctor suggests therapy as part of a treatment plan for migraines, the doctor is suggesting that the person's migraines are all in their head. I don't doubt that this is true for some doctors. However, therapy has been an unbelievably helpful tool for me on my migraine journey.
I was initially sent to a chronic pain psychologist who referred me to a Dialectical Behavior Therapy (DBT) program. DBT is usually reserved for people with a diagnosis of Borderline Personality Disorder, which I do not have. At the time I was referred to the program, they were expanding the program for a short amount of time and accepted me despite the fact that I was an atypical patient for the program. DBT focuses a great deal on utilizing and honing skills that you already have. You meet with a therapist individually once a week and you go to a skills group once a week where you work on topics such as distress tolerance, emotion regulation, interpersonal effectiveness, and mindfulness. DBT taught me valuable skills such as how to "cope ahead" (prepare for success in an upcoming situation that had the potential to be challenging) and how to "check the facts" (separate my feelings and judgments from the actual facts of a situation) both of which have had huge impacts on my life as a chronic migraineur.
DBT also focused a great deal on mindfulness, which is basically being aware of the present moment as it is happening, without judgment. Because of the constant judgment that accompanies a chronic invisible illness, learning to be less judgmental was challenging but also freeing. Another aspect of mindfulness was distress tolerance. Learning about distress tolerance taught me many ways to stay in the moment, using things like the five senses to keep myself grounded in the present. For instance, putting on lotion that I enjoyed might soothe my sense of touch and my sense of smell. Eating a peppermint candy might appeal to my sense of taste, touch, smell, and even hearing! It was shocking how comforting these little rituals could become during a migraine attack.
Music has always been a stress-reliever for me. Even though I have extreme sensitivity to sound during a migraine, I always try to have soft music that is "migraine-friendly" that I can play in the background. Often watching a low-key movie or television show can be a helpful distraction. I have even found coloring to be a great stress-reliever, though that is more effective before the migraine hits.
Lastly, focusing on my body and my breath are two of my greatest stress relievers. Even during a migraine, I can scan my body and tighten and release my muscles into a feeling of relaxation. I can usually pinpoint one area of my body that doesn't hurt, even if it's as seemingly insignificant as my left big toe. Somehow, it feels better to know that, even though most of my body is in pain, there is at least one part that isn't. Breathing exercises also help to work through the pain and allow me to focus on something else. My therapist told me that most of us take in more air when we inhale than we let out when we exhale. Therefore, I usually count to 7 on my inhale, hold for 10, and exhale for 15. I can feel my body pushing out the extra air and my heart rate slows. While none of these are a magic cure-all for stress or chronic migraines, they do drive home one of my favorite quotations from Jon Kabat-Zinn: "As long as you are breathing, there is more right with you than there is wrong with you." As a person with chronic migraines, sometimes it's nice to remember that there are, in fact, things that are right with me!