Stress Management

Life Out of Control? Learn Stress Management & Anxiety Reduction

Managing stress is important in controlling headache frequency. But managing headaches is also essential. Headaches can exert a significant toll on everyday life.

Relationships can suffer—one study found that in 30% of cases, migraine sufferers reported tension with a spouse due to their migraine headaches, and 24% reported that sexual relations were impaired.

In a 1999 UK survey, 58% of migraine sufferers reported that migraines prevented them from maintaining a sexual relationship—this survey was of both sexes, not just women, it is important to stress. In a 1998 study, it was found that 10% of migraine sufferers who are parents reported losing patience with a child during a migraine attack, 22% felt that their children sought more attention because of their headaches, and 94% reported that their migraines interfered with parent/child activities.

So don’t let your headaches run your life—and don’t let your stress ramp your headaches up and out of control.

Do You Have Good Ways To Manage Stress?

We all have stress in our lives. It is not possible to do away with it. We can’t even really control it all. We can learn to manage stress, though. Here are some ways to cope:

  • Learn better time-management skills.
  • Become more organized.
  • Learn to delegate.
  • Practice yoga.
  • Regular massages.
  • Relaxation therapy.
  • Biofeedback.
  • Meditation.
  • Have more fun.

Stress Management Techniques

The following are strategies that have been found in studies to work effectively for migraine management. 

Biofeedback is a way of using your body’s own information – heart rate,blood pressure, skin temperature, or muscle tension to retrain your system and reduce headache frequency. It is noninvasive.

Relaxation training focuses on methods of instruction in relaxing specific muscle groups systematically. This helps you relax in general, as well as targeting muscles which may be tightening up and acting as headache triggers. The goal is to achieve a general feeling of calmness. It is considered both a physical and a psychological form of treatment.

Cognitive behavioral therapy is a form of psychotherapy that addresses unhelpful thoughts and beliefs, misperceptions, and faulty learning that can result in anxiety, depression, low self-esteem, and being “stuck” in one’s pain. It focuses on behavioral strategies to enhance coping skills, alleviate emotional distress, and promote positive change.

There is also a difference between regular everyday stress and the kind that is unusual and unhealthy. Sometimes this comes from problems you are having in your life, sometimes it comes from things in your past that are affecting your health now, and sometimes it just comes from coping with chronic headache pain.

There are specialized techniques for dealing with this kind of psychological stress in addition to the above:

  • Cognitive therapy
  • When appropriate, marital or family counseling
  • Hypnotherapy
  • Psychotherapy

 

Headaches: Better Coping Through Biofeedback

Biofeedback for Relaxation Techniques in Headache Management

In the previous article, we reviewed the relationship between headaches and anxiety. Given this well-established connection, promotion of the relaxation response is a key goal for many seeking to reduce the frequency and intensity of headaches.

It would be nice if stress reduction were as simple as popping your favorite CD into the stereo or kicking your heels up on the couch for a few minutes. Unfortunately, it’s often not that easy, especially in the face of recurrent pain. Without the proper skills—that’s right, skills—in place, you may not get far in your quest for the elusive relaxation response. Even after weeks of doing various exercises in deep breathing, mental imagery, and muscular relaxation, the migraineur may be left to wonder: is this stuff really going to work, or is relaxation just another gimmick to be filed away with snake oil?

Real Step-by-step Progress in Relaxation Training Skills

With biofeedback, you can verify whether your new relaxation skills really are working. The proof is in the electronic sensor that monitors different physical functions that occur during the relaxation response. Depending on the type of biofeedback, you might see the rise and fall of your finger surface temperature on a computer monitor. Or, you might hear a tone that fluctuates with the levels of muscle tension in your forehead, neck, or shoulders. This feedback provides a window into your body’s functions, and it does so in a way that is comfortable and non-invasive.

With time and practice, better body awareness translates to better body control. Once the ability to evoke a relaxation response is established through the biofeedback equipment, it becomes easier for clients to apply the relaxation skills during their daily activities. Typically, after a few weeks of practice in biofeedback, many individuals naturally begin to apply their new skills to real-life situations. Of course, a good biofeedback practitioner will go a step beyond this natural learning process, by helping the client to develop individually tailored strategies for generalizing the skills.

Advantages of Biofeedback

The enhanced learning curve that comes through biofeedback is just one of the positive aspects of this type of treatment. Many clients like the fact that biofeedback involves neither needles nor drugs. A related advantage is the fact that, unlike with various headache and pain medications, there are few if any negative side effects associated with biofeedback. Also, the fact that biofeedback is a teaching tool for relaxation means that once the skills are learned, you can continue to benefit as long as you choose to maintain practice; there is no continuing cost after treatment is completed.

Finding a Biofeedback Practitioner

As in all areas of medicine and allied health, there are highly effective biofeedback practitioners as well as less skilled ones. If you are interested in finding a good clinician, you should plan to do a little research. Your primary care physician, neurologist, or migraine headache specialist may have information about where to find biofeedback providers in your area. Additionally, two good internet resources are the websites of the Association for Applied Psychophysiology and Biofeedback (aapb.org) and the Biofeedback Certification Institute of America (bcia.org). When you contact a potential provider, it’s a good idea to ask how long they’ve worked in biofeedback, what health conditions they have treated, and whether they are certified in biofeedback. Although there are effective clinicians who are not formally certified, finding a practitioner who has met certification requirements helps you to be more assured of your choice in a practitioner.

Biofeedback clinicians who work with migraine headache are often masters or doctoral level psychologists, but you may also find practitioners in counseling, physical therapy, and other allied health professions. What’s most important from a consumer standpoint is that you find a professional who has specific experience in treating headache conditions.

What About Insurance?

The willingness of health insurance companies to reimburse for biofeedback therapy varies among insurance carriers as well as among different health conditions. Fortunately, because the effectiveness of biofeedback for migraine is particularly well-documented, the chance of receiving insurance reimbursement is often greater than for other health conditions. Contact your insurance provider for further information, and solicit assistance from health care professionals familiar with your history and diagnosis. As an alternative to direct insurance, some individuals may be able to use flexible healthcare spending accounts or make affordable out-of-pocket payments. Such options are well-justified by the pain relief and improved functioning that the therapy can provide.

From Headache Understanding to Ability to Cope

The challenge of using relaxation skills to control migraines is not so much in understanding the connection between mind and body (you’ve already figured that out); the challenge is in building new skills to override the automatic and often subtle effects of anxiety on migraine pattern and intensity. If you’re willing to explore, biofeedback can help to light the way.

written by Luke Patrick, PhD

Luke Patrick, Ph.D. is a licensed psychologist practicing in Portland, Oregon. He specializes in the psychological management of chronic illness, as well as biofeedback and sport psychology.

Migraine and Anxiety: From Awareness to Effective Coping

The Migraine and Anxiety Connection

Do stress and migraines have any connection? “Of course,” you say, “I’ve heard it a thousand times!” Perhaps you have read that as many as 80 percent of individuals with chronic migraine also meet criteria for an anxiety disorder. Or maybe your awareness of the connection comes from your own personal experience. Even among migraineurs who don’t have an anxiety disorder per se, many find that increased stress is at least one of the factors that seem to bring on a headache. Researchers are still working to understand the mechanisms behind the anxiety-migraine connection. The brain’s limbic system, which is largely involved in emotional functioning, likely plays a role. Neurochemicals such as serotonin, which are involved in depression and anxiety, are also believed to influence the onset and pattern of migraines.

The muscle tension that usually accompanies anxiety may also play a role. Headache pain and other stressors often lead to tightening of the muscles throughout the forehead, scalp, jaw, neck, and even shoulders. Resulting muscle soreness, as well as inflammation of the trigeminal nerve, may then perpetuate the cycle by creating more pain, leading to more anxiety, leading to more pain. While the headache patient is busy attending to whatever stressful issues and for the development of headaches or migraines. In addition to tracking headache triggers, tracking your patterns of responsibilities she or he faces, muscle tension builds in a gradual and insidious way. Most likely, it is a combination of these and other factors that moderates the high correlation between anxiety and migraine. While we still don’t fully understand the mechanisms behind the connection, we certainly have established that it exists. If you live with migraine headaches, knowing the causes of the connection may not be as important as knowing what can be done to counter the stress response.

Lifestyle and Habits

It’s easy to discount the important role that lifestyle modification can have in minimizing the effects of stress. We live in a society that values productivity over pacing. For many, hard work is rewarded by a satisfying sense of achievement. It’s important to keep in mind, however, that there is a point at which the drive to achieve can become counterproductive. In an effort to “soldier on,” the migraineur may ignore small opportunities to reduce stress throughout the day. Taking periodic short breaks, avoiding the temptation to over-schedule personal and work events, and maintaining pleasurable leisure activities are all examples of lifestyle factors that can help to control stress in a significant and appreciable way.

Relaxation Training Techniques

Sometimes, even consistent changes in lifestyle habits are not enough to control stress and anxiety adequately. Fortunately, several methods for relaxation are also available to help counter the body’s stress response. Among them are diaphragmatic breathing, progressive muscle relaxation, mental imagery, self-hypnosis, mindfulness practices, and other forms of meditation. Advantages of these skills for headache management include the facts that they are drug- free, fairly simple to implement with regular practice, and require no costly equipment or doctor visits once the techniques are established. You may be able to learn these skills through self-help books or CDs. For many, one-on-one therapy with a counselor or other behavioral health professional may help to more fully develop the necessary skills for relaxation, and to increase awareness of the physiological effects of stress before they trigger yet another migraine.

Some migraineurs may benefit from a more intensive type of relaxation training, known as biofeedback therapy. As the name implies, biofeedback counters stress by providing individuals with information about their physiological functions —such as muscle tension and blood flow—through computer monitoring. With appropriate training and practice in biofeedback, individuals can gain mastery over physical reactions that are normally thought of as involuntary and outside of one’s personal control. With control comes reduced anxiety, and with reduced anxiety comes better migraine management.

written by Luke Patrick, PhD; clinical psychologist with expertise in biofeedback and sports psychology