Ctrl M Health: Before we dive into self-care for migraine, let’s talk for a moment about the time and energy it takes to live with migraine. It can feel like a part-time job. Sometimes a full-time job.
Dr. Caryn Seebach: Yes, and more than that, even! Migraine is a way of life. Attacks are largely unpredictable, so you have to be ready to pivot at every single moment. Then the pain experience of migraine is obviously long and draining — between the pre-migraine phase, the during, and the post-migraine phase, you could be down for the count for a week. And then you consider the tremendous time and energy it requires to manage migraine. You have to stay vigilant all the time! People who don’t have a chronic condition have the luxury of time that chronic sufferers don’t have. You don’t get a day off. You have to be so judicious with your energy. You have to be, like, superhuman.
So people with migraine barely have time for the things they want or need to do — and then they’re told to carve out time for self-care. Why would someone even want to spend any of their precious “free” time on migraine self-care?
First of all, let’s define the term “self-care.” I’m not talking about an extracurricular activity, or a box to check off your to-do list. I’m really talking about showing yourself compassion, and integrating self-compassion into your life as much as you can. It starts with an attitude of: Life isn’t always going to look the way you want it to look, and you have to forgive yourself for that.
Now of course you’re right: Who’d want to focus on anything migraine-related when they aren’t being forced to? Especially because over time, the psychological stress of pain can become a reinforcer or perpetuator of migraine, and that turns into a vicious cycle. So why would you voluntarily turn your attention to that? Because self-care can give you tools to deal with the part of migraine that’s in your control. These tools can often turn down the volume on migraine — whether that means the frequency or the intensity, or both. But they can also give you some powerful ways to cope with the suffering.
Wow. Well, now that you put it that way, it sounds pretty appealing.
[laughs] Most people with migraine would say, “Yeah, it’s worth trying.”
But how do you make time for self-care when you have no time? What does that look like?
We start with the most foundational forms of self-care, which are: sleeping, nutrition, and hydration. These are the high-impact items. If you put your attention into those three core health categories it’s a huge payoff. And the key with all three is consistency.
So, with sleep, ask yourself: Are you sleeping the same amount of time each night, and is your opportunity for sleep at a time that’s optimal for your body? Think back on trends over your life. In childhood, or at a time when you were sleeping well, what number of hours did you sleep, and at what time? Our sleep tendencies are pretty much built into our biological clock, so knowing your tendencies is important for your unique sleep schedule. But to boil it down further, it just comes back to consistency. The migraine brain doesn’t like inconsistency. So if you can get to sleep at the same time consistently, that’s a good start.
Same goes for hydration. Hydration needs vary based on many factors, but there’s some consensus that men need 15.5 cups and women need 11.5 cups. If you can consistently get that every single day you’re doing great. When in doubt, let thirst be your guide. Same goes for the meals you eat, that’s fuel for your brain, so don’t go too long without eating. Consistency, consistency, consistency, if you’re doing that, then you’re doing an amazing job on the foundation.
Once you manage to cover those three fundamentals, then what?
When you have that solid foundation to build on, and you can take on a little more, then you can start on the “higher order” techniques. First is exercise. On a biochemical level, exercise is hugely helpful for a migraine. But again, migraine doesn’t like a lot of variation. It wants a little bit of exercise every single day, at a moderate intensity or even a mild intensity.
Start conservatively. If you feel like you could run, start with walking. If you’re already running and feel like you can do more, add five minutes instead of 20. And if you haven’t moved at all in a while, and you’re in the throes of chronic migraine, try one minute of gentle stretching — which may cause tension, but should not cause pain. And try to build on it a minute a day. And when you feel that urge to say “I feel great, I’m going to add another 15 minutes” — you’re going to avoid that urge! [Laughs] The boom and bust, where you pinball between all or nothing, is hard physically but is also a vicious psychological roller coaster, and it’s where a lot of guilt and shame comes in. So whatever level of exercise you’re doing, you’re going to build slowly, go three minutes and then four minutes, celebrating rather than minimizing your incremental progress. Because everything counts!
After exercise, what migraine self-care priorities are next?
Next is what I call “brain training,” which is mindfulness, meditation, and relaxation. Mindfulness means intentionally being in this moment using all your senses, without judgement; the formal practice of mindfulness is called meditation. Especially in the beginning, it is common for both to feel uncomfortable and not necessarily relaxing — and that’s okay. On the other hand, Relaxation is a practice where you’re actually effecting a change to reduce physical tension, and often the mind follows, so thoughts are slower or become more pleasant.
Both relaxation and mindfulness recalibrate the brain so it can counterbalance the “fight or flight” stress response — we’re hard-wired that way, so we need to build and reinforce its opposite, the relaxation response. Every time you draw your attention from being stuck in the future and the past, you are starting the groundwork for a new neural network. It’s like a tiny bicep curl. And if you do a tiny curl, over the weeks and months you’ll build a muscle. Reinforcing the relaxation response will help mitigate the fallout of the pain or stress when it comes.
On the priority self-care list, I’d also include staying connected to people and things that are meaningful. Isolation and loneliness are actually morbidity and mortality factors — so an actual or perceived lack of meaningful connections correlates with being sicker and dying earlier. But pain, at its heart, is so isolating. It’s innately impossible to understand if you don’t have it, even for well-intentioned people. With migraine, there’s also stigma. And then on top of that, when you’re in the throes of a migraine you physically can’t be around people. So it’s important to stay connected however you can.
You know what? This migraine self-care list feels very doable, taking it one bit at a time.
Good! If you ever get knocked off course, just remember your home base: Are you sleeping, are you eating well, are you drinking enough water. Consistency, consistency, consistency! But also bear in mind, this is foremost about meeting yourself with compassion, saying to yourself, “I didn’t ask for this, I don’t deserve it. But this is my lot, so let me look at it from a place of empowerment, and let me not do it alone.”