Talking to a professional about the psychological effects of migraines.

Hello all,

I'm a 30 year old female who has had migraines and cervicogenic headaches since my late teens. They seem to be getting more frequent, painful, and longer in duration. I am very self aware, and can see myself (increasingly) distancing from social situations, activities and relationships. Over and over again it's reinforced for me that I have less pain (physically) when I am on my own - doing things that I know won't cause pain/migraines.

Upon realization of my avoidance behaviour, I have been wanting to ask my Dr. to refer me to someone to "talk to", but for some reason am having difficulty asking. Perhaps due to my stubbornness, appearing weak, or I'm trying to ignore the fact that the constant pain is taking over my life. I have amazing parents and very caring friends, but feel like I do not have the support or anyone to talk to when it comes to discussing chronic pain and what I am going though.

So my question is, does anyone on here see a 'professional' to discuss the psychological effects/issues of your migraines? If so what type of professional do you see? Do you feel it has helped?

I appreciate any feedback,

-Christina

For a long time I've avoided seeking any sort of psych help, although I know it can be very helpful for chronic pain patients. My rheumy (who I see for fibro & undiagnosed auto immune) nicely suggested I try therapy, quoting a study that childhood trauma makes fibro patients have higher perceived pain levels than those without the childhood trauma. Although I believe this can easy be untrue, due to it being one study, who knows what the sample size was, and the fact that more people would answer yes to the question of childhood trauma (since I'm sure almost all of use has either had divorce, death, emotional or physical abuse, etc, of varying forms), I do agree that it can't hurt to check this out. I won't get into my childhood history here, but it was pretty intense. I've talked to family and my now hubby about it though, and I don't feel I am affected by it on a daily type basis, but a lot of this can be subconscious (I've had anxiety ever since that time of my life...not really specific to any sort of feeling though...its more all the time).

At the very least, maybe I can be helped with some coping skills...my life has changed so much in the last five years with my pain (it started my second year of college--eek). My rheumy gave me a therapist referral. Usually you go see a therapist/psychologist first. If they feel some meds may be of order, they refer you to concurrently see a psychiatrist. I've put it off for a bit because I'm moving across town and starting a new job (in the opposite direction of where I moved), but I hope to start soon. Most of the time insurance covers it for a copay, no max visits a year, although once a week is typical at first, then maybe tapering off. If you don't want to ask for a referral, if you don't need one for insurance purposes, you can look at reviews online and choose one. Also consider their office hours. Thankfully, a lot of them now work evenings and weekends. Going once a week during work hours (if applicable) can be tough. We all need someone to talk to, and in our case, a therapist may be the best type of person, especially one who specializes in seeing people with chronic health problems. Our family and friends, although they mean the best, most often don't know what we are truly dealing with. Best wishes.

Hi,

I have New Daily Persistent Headache/ Chronic intractable migraine for 13 years now. I have almost always talked to some professional about it. I have found it helpful, as it relieved some of the burden from my wonderful friends and family. No one ever said it was psychological or anything. I just needed to talk to someone about the effect that migraine has had on my life. I think it has been helpful for me. I would certainly look into it- if you need it or just want to talk to someone else.

Pain free days,
sailingm

Hi Christina

I have been seeing a psychologist for the last 6 months. I'm quite reserved and to be honest, its taken me a long time to really open up to him and explain how I feel. I tend to keep things quite close and have always struggled with the "needy" factor in a friendship. I don't want to be that "needy" person who is always complaining so keep everything to myself which eventually becomes all too much. I couldn't cope anymore. I have to say the last month or so I am really starting to see a difference. My confidence has increased and I'm even going out a little more (not much but every little bit counts). The isolation from suffering with chronic pain is so real and this has an enormous effect on our mental state. I'm really starting to see the benefits of having someone outside of friends/family to talk to - someone who is not biased. Sometimes I don't feel like talking at my sessions, sometimes we'll just do some meditation but its a way of letting things out. You have nothing to loose from trying Christina and yes, it can be confronting when other thoughts/feelings start coming out but the sooner you deal with them the sooner you can accept the situation. One of the things I have really found since seeing my psychologist is how much writing is helping me. I have so much going on in my head sometimes its no wonder I get a migraine. I'm finding just sitting and writing all the stuff that's going on down on paper helps get it out - I feel a sense of calmness and clearness in my head. All the best and ask any questions you might have!

Regards,
Lissy

It is apparent, Chucky, that you have a very high level of self-awarness in terms of the reasons why you might be seeking psychological help and this also means that you are more likely to benefit from good couselling.

Where it does not work, is when people's expectation are unrealistic, hoping that it will actually make their head better, or what is worse, their doctors believe that the "pain" is caused by psychologoical factors, which is their way out of offering an appropriate treatment. Sadly this happens all too often.

The way you describe your way of coping with pain, by restricting actvities which might trigger more pain, is very familiar to most of us. We do it because it helps. But it has consequences, we became isolated and imunderstood.

Personally I have completely re-structured my life, diet, and social life (what social life?) in order to prevent some of the triggers and this indeed has seriously reduced the number of my h/aches.
Togetheter with a preventative and Imitrex, as a rescue medicine, as well asan occasional occipital block injection to the base of my scull (lidocaine and steroid) now, after decades of suffering I feel much more in control of this condition.

I have also been through some a courses of session with a good counsellor, when I had to adpat to dealing with all this, and also some addtitional health issues and this definitely helped me to cope much better.

And just as other said: this also meant that I was able to unburden many negative feelings in a safe place to her, without having to distress my patient friends and family, any more then it was absolutely necessary (to explain my behaviour etc).

Frankly you've just reminded me, that it might be a good idea to get in touch again as the negative feelings can build up, even when we are not aware of it.
Few sessions might do me good.

It has been good talking to you - so do not disappear and let us know how you got on.
Just make sure that you "click" with your psychologist: if for any reason you are not comfortable with the person no matter hwo well qualifieed, it means that they might not be right for you. Trust your instinct in that - change! A good personal fit in this resepct is vital.

Good luck and keep posting.

Thank you Mini, Lissy, tortoisegirl, and sailingmuffin for your kind responses!

I hope that hearing that your experiences will help me feel a little more comfortable speaking to my doctor. I have my next appointment on June 18th and will try to get the courage to ask about seeing a psychologist.

-Christina

I do hope that you will get your referal from your doctor - shame you still have to wait, but it is not very long.
In meantime keep chatting here, Christina - we all found that it is good to share many different aspects of living with this condition, I personally found it invaluable, specially when we have difficult days and have a feeling that no one understands how it is for us.
I am in, UK BTW, so it is also good to know sometimes how treatments and approaches differ in various countries.
So stay in touch.

Hi Chucky

Your welcome and good luck with your Doctor's appointment. I hope you have the courage to talk to your Doctor about how your really feeling.

So I saw my specialist today and finally got the nerve to ask for "help" - a neutral person to speak to.

After describing my patterns and how my life has changed, he concluded that I most likely have low serotonin from my many years of chronic pain - resulting in what could be depression.

He has started me on the anti-depressant Cipralex at 10mg/day - increasing to 20mg in two weeks. I follow up with him in 3 weeks to see if the medication has helped and if so if I still need to be referred to a therapist.

I'm not sure how I'm feeling about this at the moment. I hope the pills help for the fact that I can feel myself again, but I'm nervous of side effects and having to be on this type of medication the rest of my life. I never thought of using the word depression to label my symptoms and how I was feeling, but the more I think about it - it makes sense. :-(

I want to say 'thank you' again for the support and responses earlier. It may sound silly be I think it was just what I needed to go forward with speaking to my Dr. today.

-Christina

Hi Christina

I"m so glad you found the courage to talk to your Doctor. I was very nervous about commencing an ant-depressent as well - depression can sometimes feel like a "label" but there is no point hiding our feelings. This illness affects us in so many aspects of our life and its important to treat this. My Doctor has no intention of me staying on an ant-depressent for the rest of my life, in fact he see's this as a short term arrangement! Working with my psychologist and the meds, I will have increased coping mechanisms to deal with the migraines. Once I stabilise for around 6 months, he wants to start reducing my med's. Obviously everyone is different but don't look at this as a permenant solution.

I am taking 1 x Cipramil 20mg a day and definately noticing the difference. I had some initial side effects when I first started it - sleep issues, nausea, dizzy but that has since settled (well the sleep issues haven't but that's another issue) and I don't seem to have any other side effects - apart from feeling a little more mentally stable! If the Cipralex gives too many side effects, it may be worth trying another type and don't be afraid to ask your Doctor. Everyone reacts differently and its important to find one that works for you. Who wnats a whole host of additional side effects when we have enough to deal with!

Good luck and please ask any questions :-)

Lissy

Chucky said:

After describing my patterns and how my life has changed, he concluded that I most likely have low serotonin from my many years of chronic pain - resulting in what could be depression.

Question, I wonder why the doctor did not prescribe some like 5-HTP, which would add serotonin to your brain chemistry?

I am not in the medical profession, just asking. I am presently reading a book called "The Chemistry of Joy," and he memtions the plus and minus of anti-depressants and 5 -HTP. He is not against anti-depressants.

Martin

Hello Martin,

As of today, I'm brand new to the world of anti-depressants and alternatives - looks like I need to start educating myself on what's out there.

My specialist is a neck and back chronic pain specialist who I have been seeing for 5 years. Generally speaking he mentioned that he has had postive results with other patients with similar symptoms to me on Cipralex - Then handed me some samples to try for the next three weeks. If this medication does nothing or makes me worse, I can ask about 5-HTP - is this type of treatment common? (did a quick google search/read).

Lissy,

When you first started the medication, when did you start feeling the side effects? When did you start feeling the side effects decrease? Lastly, when did you start feeling an improvement in your mental stability?

I would like to do the same as you and still go to a therapist to help with pain management. Here in Canada it looks like that would be a psychiatrist (as it's covered) vs. pshychologist (expensive and out of pocket). I'm happy to hear you have had sucess with Cipramil. Gives me hope :-)

Chucky, here are the reviews for the book that I mentioned, the reviews will give you an idea on the book and depression treatment options:

http://www.amazon.com/Chemistry-Joy-Three-Step-Overcoming-Depression/product-reviews/0743265076/ref=dp_top_cm_cr_acr_txt?ie=UTF8&showViewpoints=1

I just downloaded it to my Kindle yesterday morning, and had been reading it most of the day when I read your posting. I thought I might mention it to you.

I bought the book, because, at times, the constant headaches get me down. And, the book speaks about depression and chemical imbalances in the brain, diet recommendations, and Buddhist philosophy (not religion) on how to turn your mind around. Not, that we are going to feel good all the time, but on how to deal with depression. The book has some good meditation techniques by John Kabot-Zinn, who taught meditation to chronic pain patients at a university hospital.

I did take an anti-depressant, Imipramine HCL, for my chronic daily headache. It did nothing for the headache or my state of mind. The side effects were drowsiness and difficulty in urinating. At that time, the headaches were at a higher pain level.

Martin

Hi Christina

I started feeling the side effects about 1 week in - when I started having 1/2 a tablet every day. My Doctor started me off pretty slow - 1/2 tab 3 times a week, then 1/2 every day for 2 weeks then 1 every day. The side effects eased about the 4 week period. I still get a bit dizzy sometimes but that could just be my migraines as I get dizziness with them. In terms of feeling increased mental stability that didn't happen till about the 5- 6 week mark. Initially when I started them I had relief that something was going to hopefully change but I quickly slipped back and it took quite a few weeks to notice any difference. The changes were very gradual and I was very up and down. I've been on them about 2 months now and although I still have my ups and downs, when I'm down, I don't stay down for as long as I used to. I'll have a few days down and then pick up again.

I have regularly started having a few more days in between my migraines the last few weeks but that's hard to tell if its the ant-depressents, talking to my psychologist, gluten free diet, reducing my hours at work or the combination of them all!!! Either way, I'm not going to make any drastic changes in the hope that things will slowly improve. I've had no migraine for a week now and definately enjoying the relief from pain. I still have very strong muscle pain in my neck / shoulders but sometimes just a relief from the head pain is enough to give me some energy.

Good luck and I really hope you manage to speak to someone. Psychologists are covered under our health system here for up to 18 sessions. I've passed that but luckily my private health insurance now covers about half the session so that helps.

Lissy

Lissy, I have read with interest what you say about anti-depressants and therapy combined.

I definitley think that this is the best short/midle term plan, with the objective of giving up the anti-depressant, in not too distant future.

I have only ever used ant-depressants as preventative long time ago but I did not get any relief from pain, and I had bad s/e: sleepiness and weight gain, so I gave them up.
However I found therapy extremely helpful when dealing with all aspects of living with this debilitating chronic condition.

I still get short bouts of feeling down, which come directly in connection with days of migraine, but not otherwise, so by now I have learned to live with this, since I know that when the bout of migraine passes away, so will depression, so I know how difficult it can be.

One more thing I want to mention.
If you have bad pain in your shoulder/neck region I found that a 10% ibuprofen gel, rubbed in that region few times a day works really well.
It has no smell, but it is a paikiller, so you must not mix it with other painkillers at the same time. I am sure you will be able to get it in Australia, and it is cheap, over the counter as well.

Chucky, I am so very glad, that you found courage to speak to your Dr and take some action.
It is important to have depression treated, as it can rally affect quality of life and relationships.

I do not see depression as an embarassing illness; it is just part of a human condition - very common, indeed. Most people suffer some form of it, at one time or another.

Also migraine is associated with depression, as the same chemical process can set off both. It is definitely not your "fault", any more then your migraine is.

I do hope that you will get relief from the tablets, but I agree with Lissy; if you can, I think seeing a therapist might be very useful. Talking helps.

Thanks Mini - I've tried a few gels and they help but I don't like using pain killers every day if I can help it. I'm worried I'll become addicted to this kind of stuff. I've been alternating with a herbal spray which helps so that breaks up the dependency a bit.

So the last two days I felt like a space cadet. Tired, shaky, dizzy, thirsty, and out of it, waking up constantly throughout the night with weird dreams - dreams similar to the ones I get when I have a fever (unfortunately work related ). Waking up in panic. A bit of paranoia (thinking I've left the stove/bbq on or water running) which I've had for sometime, but seems more magnified now.

The third day today, only a bit of fatique and paranoia remains.

Arg... the issues with drugs interactions:

So what migraine medicaton do you combine with anti-depressants? I made a special trip to speak with my pharmacist today to talk about drug interactions, and she said I can't take my Replax with the Cipralex. I also shouldn't take my advil T1 combination due to increased risk of stommach bleeding (which I've gotten before), and Lyrica (anti-seizure mediction) combined with Cipralex can cause heavily sedated effects. I'm scared for when I have an attack and can't reach for relief. I need to see my dr. soon to get alternatives. I'm surprised he didn't bring up the interactions when he passed the medication over to me.

Martin, I went to a couple book stores to find that book (yes, I still buy hardcopies! ) but it was not available. I did pick up two other books though which I look forward to exploring.

Hi Christina
I posted a reply in the other thread but I am taking Maxalt with the Cipramil and doing ok on that.