Sometimes the fear of a headache is almost as debilitating as the headache itself. The psychological and emotional trauma that comes with never knowing when your next headache is going to strike can be paralyzing. Left unchecked, this anxiety can take over, causing headache sufferers to decline invitations, avoid travel, and bypass new and exciting opportunities.
As upsetting as headaches are, however, you can’t let the fear win out, says Michele Nicosia, a pain management physical therapist at St. Louis Behavioral Medicine Institute in Missouri. “Anxiety is a normal response to uncertainty, but it can also make things worse,” she says. When people are anxious, they tense their muscles, which decreases blood flow and can lead to more headaches. “It becomes a vicious circle.”
Chronic anxiety diminishes quality of life and increases the frequency of headaches, especially for tension-type headache sufferers, says Arthur Elkind, MD, president of the board of directors of the National Headache Foundation and director of the Elkind Headache Center in Mount Vernon, N.Y. “Many migraine sufferers get anxious they may get an attack when they’re going to do something pleasant,” he says. “That alone can make them upset and impact their quality of life, even though they may never get the migraine.”
To break that cycle, you need to start by giving yourself a break, says Kathleen Farmer, PsyD, a psychologist with the Headache Care Center in Springfield, Mo., and author of the website Managing Migraine: A Patient’s Guide to Successful Migraine Care (www.managingmigraine.org). “Migraine sufferers have hyper-excitable brains,” she says.
Of course, that's not always a bad thing. It can lead to many positive attributes, such as having an excellent memory for numbers, a strong drive for achievement and a detail-oriented sensibility. But it also means migraine sufferers are more likely to be anxious about the feeling that they have no control over their condition, Dr. Farmer says.
The best way to tamp down that anxiety is to recognize it for what it is, and implement tools and strategies to calm your nervous system and put your fears into perspective.
Our experts offer this advice to reduce headache-related anxiety and get back to living a normal, more stress-free life.
1. Acknowledge that Your Headache Stress is Real and Appropriate.
Anxiety is a common condition among migraine sufferers, who also are more likely to experience depression and sleeplessness, Dr. Elkind says. Because of the biochemical pathways in their brains, migraineurs are more vulnerable to stress, and the uncertainty of not knowing when a headache will strike is a legitimate trigger for feelings of anxiety.
Recognizing this fact can help ease your worries that you are overreacting to fears about when the next migraine will strike.
Rather than feeling bad about the anxiety, recognize it as a related symptom and take steps to mitigate it. “Things that will help reduce anxiety are biofeedback—which helps control anxiety by controlling bodily reactions—or diverting their attention by having them engage in exercise,” Elkind says.
2. Know Your Headache and Migraine Triggers.
People with hyper-excitable brains are more susceptible to the environmental stressors that can trigger headaches and anxiety. But if you take the time to identify what these stressors are and manage your exposure to them, you can minimize both the headaches and anxiety about not knowing when headaches will occur. This launches a positive cycle of confidence and control. “Understanding what triggers anxiety can help dissipate it,” Dr. Farmer says.
3. Be an Active Participant in Your Headache and Migraine Care.
The patient’s role on the medical team is just as important as the physician’s, psychologist’s and physical therapist’s, Nicosia says. Doctors and therapists can help identify the causes of headaches and offer medication and therapy to reduce headache occurrence, but they still need your support for their efforts to pay off. Unless you actively communicate your needs and concerns, take the time to identify your triggers, and actively participate in your treatment plan, the medical team can’t be effective, she says. “You have to be on board to help yourself, or the treatment won’t work.”
4. Use Relaxation Tools to Manage Your Headache Stress.
Yoga, exercise, meditation, prayer, positive affirmations, and biofeedback (a technique used to consciously control involuntary body processes, such as heart rate) all can help ease your anxiety and give you a sense of power over your fears, which in itself is calming, Dr. Farmer says. “Whatever gets your mind off the negative thoughts is of value.”
She encourages her patients to use biofeedback techniques twice a day while also monitoring their finger temperature so they have measurable proof of the impact they are having on their nervous system. She also urges people to schedule time every day for exercise and/or meditation to help them feel more grounded and in control of their lives and their condition. “If they feel anxiety coming on, I tell them to go for a walk or work out until they get rid of those negative feelings,” she says.
5. Get Plenty of Sleep Every Night.
Not prioritizing sleep is one of the worst mistakes headache sufferers can make, Dr. Elkind says. It not only leads to more frequent headaches, but also ramps up anxiety and stress, and reduces you ability to function effectively throughout the day. “Attention to sleep is a very important factor,” he says. “You have to pay attention to it to reduce the frequency of attacks.”
6. Don’t Mask Your Headache and Migraine Triggers with Meds.
Medicine is a valuable part of the headache treatment process—and anti-anxiety and antidepressant medications can certainly be an important part of your treatment plan—but having a drug at your disposal is not a free pass to behave badly. If red wine triggers a headache, it makes more sense to avoid wine altogether than to respond to the ensuing pain with medication, Dr. Farmer says. “It’s better to rid your life of triggers if you can.”
7. Stop Blaming Yourself.
Migraine sufferers often feel like they always have to do everything right, Dr. Farmer says. Because they can be perfectionists, they sometimes see migraines as a flaw in their character. This causes them to feel more anxiety and leads to more headaches. If you want to get control of your anxiety, you have to let go of this drive for perfection and give yourself a break, she says. “The best affirmation we use is, ‘I forgive myself for being imperfect.’”
