Migraines are a common cause of suffering

Stressed and frustrated asian business womanBBC News reported on the problem of migraine this week, interviewing a sufferer about the impact upon her life. Similar to other chronic pain problems, the social dimension must be a focus of treatment. Surely this is a medical problem you say!

The BBC spoke with a neurologist who was asked about the causes and treatment options. Standard and expected questions were posed, to which the doctor answered: genetics, certain triggers before outlining the different types of drug. Nothing wrong in those biomedical responses of course and this is what the listeners would anticipate. However, there is so much more to the pain experience and hence possibilities. These were not mentioned so I shall fill in the gaps.

Whilst there is a medical aspect in as much as the person needs a diagnosis and the option of medication, this does not give them the opportunity to learn about the condition, how it manifests in them and what they can do to transform it. Some may say that they don’t want to transform their experience and would rather take medication; a short cut. However, the medications do not always work, your life can continue to be dominated by the ‘what if I have a migraine?’, the effects can change over time and of course there can be side effects.

This is not to say that drugs do not have a role, as they clearly do in migraine and other painful conditions. But if we widen the picture and see the reality, there is a person with a life within society that is living the experience. This is the context that has implications for treatment, training and coaching.

How does this affect the person and their life?

What must we think about? Here are a few examples:

  1. How does the experience of migraine affect the person’s work, family, relationships and social engagements?
  2. How do these effects then impact upon the person and their life?

The modern way to address pain is using the biopsychosocial model. This way of thinking is a doff of the hat to the biology of pain (physiology, pathology etc), the psychology (how the person thinks and feels about their pain) and the social impact (what does this mean for their life and what can the person do?). Having spoken to and worked with people suffering chronic pain for many years, it is the social dimensions that predominate in effect together with the way they think and feel (based on their beliefs about pain, themselves and the world). People are not so interested in the chemicals, receptors and the brain as examples, and why would they be? When you are in pain you want to, you are compelled to take action to bring about a change in state: from protect to healthy. One of the main problems is that the person with chronic pain will be ‘in’ or ‘near to’ a protect state for much of the time. They must learn how to change state using a range of practices.

We are whole unique people ~ read about WUPs here

Living life with a smile

We change state often through each day. That is normal. However, if the protect state predominates, then we can suffer the consequences in many ways. Pain is one way, but there can also be feelings of anxiety, tension and a range of common ‘ills’ such as irritable bowel syndrome, headaches, fibromyalgia, chronic musculoskeletal pain, jaw pain, pelvic pain and others that result from being on alert. A state of readiness like this uses much energy, it is exhausting, and affects concentration, memory and mood as we adapt and change biologically and behaviourally over time. We learn. Sleep is typically affected because as we lay down, our system check out the environment for danger (lions!) and so we remain awake despite chronic tiredness. Being on alert means that we are ready to fight, run or freeze, all of which require musculoskeletal action. This manifests as tension but we are continually ready to act, especially in a new environment, which is why going somewhere different can be threatening and worrying.

Migraine is also one of these common functional pain syndromes. The physiology of migraine certainly involves the brain but there is a body in which we live, where our thoughts are embodied and we act in the world. The biological changes that occur in migraine and in other pain states are sampled by the brain and given a meaning. If the interpretation is one of threat which results in a state of alert and protection. It is the latter that can result in pain, because pain is part of the way we protect ourselves in the face of an uncertain threat.

How dangerous are bright lights? They can be unpleasant and cause us to look away or close our eyes, yet in the migraineur they can trigger an incredibly potent response that is mighty in bringing that person to a halt. The systems interpret that as being potentially very dangerous. In a predictive processing context, the brain ‘predicts’ that the possible causes of the sensory information are such that my experience is one of migraine. Of course this has a different ‘feel’ in different people including pain, sensitivity to light and sound, nausea and vomiting.

Employers have a role to play ~ pain is a social issue

A focus of the BBC interview was upon employers and how they perceive migraine. We can extrapolate this to any chronic pain condition in as much as without true understanding, there is typically little support. Work and chronic pain have not traditionally been good bedfellows, yet with such numbers of people suffering and the escalating costs to society, this is no longer a debatable point, it must change. At a basic level, surely we want to look after each other and our employees? There are positive changes afoot thankfully, but this must accelerate. Let’s run an example to illustrate the problem.

The person who suffers migraines worries that the symptoms will affect her performance. This raises the pressure. They suspect or know that they receive little sympathy or support from their employer. This raises the pressure further. Stress responses, like pain, emerge in the face of a perceived threat and hence the very thought that your job may be under threat has an impact. This is a simple account without even considering other demands in life. Even from this example you can see how the problem can be amplified. The employer may claim that they cannot afford to have an employee who is off regularly. The counter to this is that they could support an approach that gets the best out of that person because they feel supported — e.g./ positive strengths based coaching. They are not having time off because they want to! The essence of the positive team is to get the best performance from individuals and the team, supporting each other with a purpose and driving towards a shared vision. With open communication and a compassionate approach in the workplace, this can be achieved.

Migraine and the body ~ where am I?

There are many adaptations associated with a persistent pain state. This includes changes in the brain, especially in the emotional areas, which is why we feel different beyond just the sensory qualities or intensity. The world looks different, we think differently and we move differently. Our body can have a different feel as the sense of where we are becomes blurred and less accurate. You may notice being a little more clumsy or awkward. Body sense is inherently part of whom I am and therefore when that aspect of ‘me’ changes, I do not feel myself. Most people I ask will tell me that they don’t feel like themselves. There is a mismatch between what they expect and what is actually happening. In fact, this creates a threat and hence drives us towards a protect state.

You don’t know where your head is at….

People I see with migraine, some coming direct for that problem and others telling me about it when I ask (I always ask!), commonly demonstrate a loss of sense of where their head is in space. ‘You don’t know where you head is….in the nicest possible way’ I say to them.

Keeping our eyes level is a basic survival mechanism that allows us to see the world and look out for possible danger. Naturally this involves keeping our head position upright, which in turn relies upon accurate and efficient sensorimotor control. Anything that affects this is inherently threatening, and we adapt very well. But there is a cost that includes muscles tension from overwork and guarding, which hurts, and altered movement patterns. With the existence of possible threat, the autonomic nervous system is doing its job (working with other systems, in particular the immune system) and preparing us for a fight or to run away. This includes blood flow changes together with the shift in our attentional bias, emotional state and perception that are co-ordinated in a multi-system fashion. In terms of migraine, these mechanisms are all at play.

This is a very brief look at the complexity of how we work, yet one can see from this description how problems emerge in us, but also what we can do. For example, simple practices of creating inner calm to mobilise the parasympathetic nervous system and body sense training are practices we can learn deeply so that we become skilled at shifting state.

As with all chronic pain states, we can choose the positive approach. This means that we decide upon the way we think about the challenge, focus on a vision of what we want and then follow principles and practices to achieve successes. The programme of practices will vary from person to person as we all have our own picture of what we want to achieve in life. The Pain Coach Programme by its very nature is flexible to the needs of the individual but follows the framework of success, using the principles of practice, understanding and compassion.

Everyone wants to lead a happy and healthy life in a sustained way. To enable this to happen we must choose a way onward that keeps this picture in line with our thinking and our actions that are entwined, or embodied, and lived uniquely by the person. Each moment is fresh and new. We change, we grow and we learn, all setting the scene for achieving that healthy, happy life according to the choices we now make.

Please visit the Specialist Pain Physio website for more details of the coaching and treatment programme, Pain Coach

Functional Pain Syndromes — e.g./ IBS, headache, migraine, fibromyalgia

Functional Pain SyndromesFunctional pain syndromes (FPS) are not uncommon and there are likely to be people living their lives putting up with a range of aches, pains and symptoms without knowing.

More common in women than men, though this maybe in part due to more women seeking help, functional pain syndromes account for a great deal of suffering.

Functional pain syndromes include:

  • Irritable bowel syndrome
  • Headaches/migraines
  • Chronic back pain
  • Chronic neck pain
  • Pelvic pain
  • Fibromyalgia
  • Chronic widespread pain
  • TMJ dysfunction
  • Bladder dysfunction (interstitial cystitis)

These are often accompanied by anxiety, depression (or low in mood but not actually depressed), hypermobility, perfectionist traits, early life stressors and complex lifestyles with demands or stress and difficulties that reverberate through the body as painful conditions.

In this recently published article, Richmond looks at functional pain syndromes, which can be overcome with the right understanding and action.

Article here


VulvodyniaVulvodynia is a painful condition, often exquisitely so, located in the vulva, which is the skin surrounding the vagina. Usually unexplained, this troubling condition can arise seemingly from nowhere, interfere with intimate relations and hence attempts to conceive. Vulvodynia is also known as a functional pain syndrome–these are painful problems that lack a pathology of note that explains the extent of the pain and include irritable bowel syndrome, fibromyalgia, TMJ dysfunction, migraine and pelvic pain. Functional pain syndromes are often concurrent with hypermobility, anxiety and depression, a further common character trait being perfectionism and a tendency for the person to be hard on themselves thereby creating a cycle of chronic stress.

The pain of vulvodynia is often very localised and triggered by direct contact. Naturally this occurs during sex and touch, but sometimes sitting position can bring on the pain. As with any sensitisation, there is a primary location of pain but there can also be a secondary area surrounding that is due to central nervous system (and other systems) involvement. Suspected vulvodynia or other pains in the pelvis should be assessed and examined by a gynaecologist as a first step before beginning treatment, and by a consultant who knows and understands both the condition and the impact — Miss Deborah Boyle at 132 Harley Street.

With vulvodynia often being part of an overall picture of sensitivity, it means that there is a common biological adaptation that is upstream of the range of seemingly different conditions (the functional pain syndromes). As soon as the individual understands that pain is not an accurate indicator if tissue damage, but rather a reflection of the perceived threat and prioritisation by the body-person, there is a realisation that the pain can change. Pain can change because perceptions can change as we take on board new information and consequently think and act differently, creating new habits. The new habits set the conditions for on-going and sustained change that includes overcoming pain.

We have limited attention and hence can only be aware of certain amount of stimuli in any given moment. If pain is consuming much or all of your attention and consciousness, then this is all that is happening in that moment, with all other possible experiences being disregarded–it is a matter of prioritisation. When the perception of threat is reduced by a constructive thought or action, the pain moves out of our attention span and we become aware of other thoughts, feelings and experiences. How we respond to pain is unique and learned through our lifetime right up until that point; all those bumps and bruises as a child, how our parents reacted, more serious injuries or illnesses and the messages we received from doctors, teachers and other ‘big people’, then through adult life, moulding our beliefs about ourselves, the world, health and pain each time we feel it. The sum of all this activity, most of which we are unaware of, sets up how you respond to the next ache, pain or injury, blended of course with genetics. It seems that some people are genetically set up to be more inflammatory, meaning that responses to injury are potentially more vigorous and go on for longer. Understanding this means that the right messages and treatment can be given, thereby appropriately addressing the injury or pain. One of the big problems is that this does not happen, and the explanations are structural and based upon the body tissues. This ignores the fact that we have body systems that protect and these systems have sampling mechanisms in the tissues and organs but largely exist elsewhere–e.g./ nervous system, autonomic nervous system, endocrine system, sensorimotor system, immune system. We have to go upstream as well as improve the health and mobility of the local tissues.

Going upstream is vital in overcoming vulvodynia, and this is where the Pain Coach Programme works–this is my part of the treatment programme. You may also choose to work with a women’s health physiotherapist who will work more locally. So what is the Pain Coach Programme?

The Pain Coach Programme is a a blend of the latest neuroscience of pain with a strengths based coaching approach to success. Understanding your pain and that you have the biology and strengths to overcome your pain is a vital start point. You have been successful in the past using these strengths, and you can do so again by drawing on these characteristics and using them to develop your health in terms of how you think and act. Overcoming pain is all about resuming a meaningful life, engaging with activities and people as you want to, in a way that allows you to flourish. The Pain Coach Programme provides you with the knowledge and skills that you need to in effect become your own coach, moment to moment making clear decisions that take you towards your vision of how you want to live. This alongside treatment and specific training to develop normal movement and a healthy body-mind. The skills you learn also help you to fully engage in life, whether this be at home, at work or at play.