S1 E4: Migraine and Mental Health

Migraine and Mental Health

Series 1, episode 4

Heads Up is the award-winning podcast series on all things headache, brought to you by the National Migraine Centre.  Produced by leading headache doctors, it’s the trusted source of information and support for all those affected by migraine and headache.

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Transcript:

[00:00:00] It’s Migraine Awareness Week, and we’re dedicating this podcast to migraine and mental health. Did you know anxiety and depression are significantly more common in people with migraine than in healthy individuals? Mind matters in migraine. Welcome to the Heads Up podcast brought to you by the National Migraine Centre, the only UK charity treating migraine and headache.

 

Dr Katy Munro [00:00:30] Hi, everyone. Today, we’re doing a special extended podcast as its Migraine Awareness Week. It’s Dr. Katy Munro with Dr Jessica Briscoe.

 

Dr Jessica Briscoe [00:00:38] Hello.

 

Dr Katy Munro [00:00:39] So this year, we are raising awareness of how migraine affects mental health. The National Migraine Centre conducted a survey recently and we had such a big response, didn’t we, Jess?

 

Dr Jessica Briscoe [00:00:50] It went down really well. Thank you all so much for contributing to the survey as your stats have really helped us to understand the link between mental health and migraine.

 

Dr Katy Munro [00:00:59] I mean, we’re really aware of how migraine impacts on people’s mental health from the people that we see week after week. And they talk about anxiety and depression. But there were some really shocking things that came out of that survey and we want to share them with you this week. So we’re going to go over to Dr David Bloomfield, who’s our chief exec of the National Migraine Centre. David, you were involved in the survey. Any initial thoughts about that?

 

Dr David Bloomfield [00:01:24] Yes, hello there. First of all, we were really pleased that so many people joined in and supported the survey, nearly 2000 respondents. I think the stand out for me is that nearly 50 percent of people have experienced loneliness. That’s really a surprising result I found.

 

Dr Jessica Briscoe [00:01:44] I think it’s quite significant. I mean, you said it’s surprising. Did you feel that it would be a lot lower than that?

 

Dr David Bloomfield [00:01:50] I didn’t really have a preconception because I didn’t realise quite how isolating it was.

 

Dr Jessica Briscoe [00:01:56]  It really can be. I mean, I speak to people all the time who say that as well as the physical pain and the sort of feeling unwell for the of the period of time of their migraine. It really impacts their sociability, their ability to work and people can be stuck in a room for four or five days at a time. And if that’s recurring fairly regularly, that’s people being on their own for a while.

 

Dr Katy Munro [00:02:19] Because of the people that did the survey, about one in eight said that they were experiencing loneliness or isolation because of their migraine, it was specifically about their headache condition. And I think we hear this, don’t we, Jess, when patients are talking and they say phrases like, I’ve shut down my life, I can’t arrange anything with my friends. And people stop inviting them to things because they’re unreliable, because they never know when they’re going to have a migraine.

 

Dr Jessica Briscoe [00:02:45] Yeah, lots of people will arrange going to the cinema or going to the theatre, and you actually can’t forward plan that sort of thing, so they can’t put it into their schedules because of that fear of developing an attack.

 

Dr Katy Munro [00:02:55] David, what about the stats about depression?

 

Dr David Bloomfield [00:02:58] Well, I think a lot of us hear that there’s a correlation, a relationship. I don’t think unless you’ve either experienced it firsthand or you’ve actually seen these stats that so many people are so concerned, so depressed about what’s happening to their lives.

 

Dr Jessica Briscoe [00:03:16] Yeah, I mean, 65 percent of people who we asked said that they’d experienced depression specifically linked to migraine and headaches. And actually the worrying statistic was the number of people who felt suicidal or who’ve hurt themselves. It was 22 percent who self-harmed more than once a week due to this.

 

Dr Katy Munro [00:03:34] I think that’s absolutely shockingly high. I was aware that people with chronic migraine do get a lot of depression and also a lot of anxiety, sort of anticipatory anxiety of worrying that they might get at an attack. But people expressing suicidal feelings is really just so awful, isn’t it? I gave a talk the other day and at the end a lady said to me, I have felt suicidal because of my migraines sometimes. And, you know, it really brings it home to you when you hear people’s stories like that.

 

Dr Jessica Briscoe [00:04:05] And a lot of them actually don’t admit it in the first consultation. I’ve had a lot where I’ve stopped, we’ve sort of managed to switch the migraine from being chronic, so more than 15 headache days a month, to more episodic and they’ll admit to me at that point, I genuinely felt like I was about to end it all. And that really brings it home.

 

Dr David Bloomfield [00:04:28] I think it’s really shocking when you actually see the scars on somebody’s arm as a result of depression induced from migraine. It really rams it home that this is serious.

 

Dr Katy Munro [00:04:41] I think the other thing that this highlights is not just the impact on the sufferer, but the way that that can roll out and affect families. I remember seeing a lady who was suffering from really chronic migraine day after day and she said, I can’t look after my kids, we can’t do anything. And then on the reverse, the joy that people get when their headaches are relieved. You know, somebody said to me the other day, since my migraines have been helped I can do things with my daughter at the weekend, I’ve managed to enjoy Christmas. So, yeah, it’s the impact on the family, I think.

 

Dr Jessica Briscoe [00:05:16] Yeah and a lot of family members who come along with their loved ones will say, actually the way that they feel really, really gets me down. So I also wonder how many family members also experience mental health issues related to caring or being there for someone who suffers with migraine.

 

Dr Katy Munro [00:05:34] Yeah, I just I think, you know, it’s awful watching someone suffer through a really bad attack, isn’t it?

 

Dr Jessica Briscoe [00:05:41] It’s awful and you do feel very helpless, I think.

 

Dr Katy Munro [00:05:44] Just going back to our survey, we also found there are some other specific things that people had noticed. So 85 percent experience fatigue. Now, some of the time I think that is due to the migraine process itself, isn’t it? So people get tired in the prodromal phase, during a migraine and sometimes in the post ictal or postdromal phase.

 

Dr Jessica Briscoe [00:06:04] Yeah, absolutely but fatigue is also- it can also be a symptom of depression, too. So it’s quite difficult to unpick which bits are depression related to your migraine and which bit is your ongoing attack.

 

Dr Katy Munro [00:06:17] The same thing goes for sleep disturbances, doesn’t it, really? So people who are depressed often have very poor sleep. That can be a trigger. So it’s a bit of a bidirectional relationship. If you’re having horrible migraine attacks, you possibly won’t be sleeping very well and that can aggravate depression as well.

 

Dr Jessica Briscoe [00:06:36] And I think that’s also linked with the changes in appetite. So lack of appetite. If you’re skipping meals, not eating because you feel depressed, that can trigger an attack. And if you’re overeating, so eating the wrong things, having too many sugary foods, then that can also- those changes in blood sugar level can trigger it.

 

Dr Katy Munro [00:06:53] David, I know when you are greeting people, which you do every week at the centre, you have a chat to patients. Are they easily talking to you about how they feel about their migraine or are they more reluctant to bring it out in the open? Do you think it’s a hidden thing?

 

Dr David Bloomfield [00:07:10] Well, I think coming back to the point about isolation, this is a hidden condition. I think it takes a lot of courage to open up and be transparent and share the difficulties that you’re experiencing. And I think the changes in society with mental health and talking about mental health generally, I think people are becoming more willing to share, and that’s only got to be a good thing.

 

Dr Jessica Briscoe [00:07:40] I agree. I also think some people are a bit nervous because, I think a lot of the- when it comes out to us, it’s because we’ve built relationships with our patients, which we hope would happen with a GP as well. And a lot of patients with migraine get worried that their migraine is being blamed on their mood. You have migraine because you’re depressed. You have migraine because you’re stressed. Actually, often it is the other way round. And I sometimes wonder if that stops people from highlighting their mood changes in case people take their attacks less seriously and say, well, that’s what’s causing it.

 

Dr Katy Munro [00:08:13] I think there’s also a certain amount of guilt and shame. And people sometimes say that they feel as if doctors or other health care professionals are saying, well, if only you did things differently, you wouldn’t get migraines or you may be contributing to your own condition. I think that’s really hard for people and so they may keep quiet about how low they feel.

 

Dr David Bloomfield [00:08:34] I think that’s particularly the case in the working environment. There’s an awful lot of fear about job security, promotion and a huge number of people that I speak to simply don’t tell their employers.

 

Dr Katy Munro [00:08:49] Yeah.

 

Dr Jessica Briscoe [00:08:50] Yeah, absolutely. I mean, I think we found that in previous surveys where we found that the reporting rates, more than 75 percent of people with migraine even bother to report. It’s quite low, low level reporting of it.

 

Dr Katy Munro [00:09:04] And I think the other thing that leads to is a a thing called presenteeism, which is where people are getting migraine attacks but still going into work. And of course, that has quite an impact on their employers if they’re not feeling completely fully functioning and up to their normal standards. And they may well try and hide that because of worries about job security. Okay, that’s really good. I think what we’re going to hear from now are some experts about mental health conditions and migraine. And we’re also in the next section going to talk a little bit about what you can do to help yourself. So thank you very much, David, for your contribution.

 

Dr David Bloomfield [00:09:39] Thank you. Pleasure.

 

Dr Jessica Briscoe [00:09:43] OK, so we’ve talked a lot about our statistics and what people are experiencing, but what can you do to help yourself or your family member or friends who are dealing with anxiety and depression related to their migraine? There are actually quite a lot of things that we can do for ourselves, aren’t there?

 

Dr Katy Munro [00:10:01] Yeah.

 

Dr Jessica Briscoe [00:10:02] So I think something that I actually advise quite a lot is practising mindfulness. If you don’t know what mindfulness is, it’s a meditation-like method where you concentrate on your breathing for a certain period of time so that you’re clearing your head from any kind of negative thoughts or any thoughts, really. And that can be very, very useful for managing anxiety and depression.

 

Dr Katy Munro [00:10:24] Some people find it quite hard because one thing I think that all of our brains do is they chatter away to us and if you’re sitting quietly and trying to clear your mind, it can be very easy to get very distracted about all the things that are worrying you. So I would just say to people, that’s quite normal. So it needs practise like anything, if you’re going to try doing mindfulness, there are different ways of learning how to do it. So there are books about it, there are DVDs, there are apps that you can download onto your phone or you can go along to classes and they’re usually running over about eight weeks and they will kind of guide you and remind you that it’s not something you can fail at. Just the fact that you’re sitting and trying to think about your breathing and being present in the moment is a very mindful practise. And it can be, we know from scans of people doing mindfulness, that actually it can help calm the brain.

 

Dr Jessica Briscoe [00:11:17] Yeah. And I mean, I really want to highlight what you’re saying about it sometimes being quite difficult. It’s certainly not something that works immediately. So don’t expect to start practising and feel better after your first session. It’s worth persevering with, sort of fitting into your regular routine.

 

Dr Katy Munro [00:11:33] I think the other thing about fitting anything like that in is actually trying to make a regular time, because even if you’re doing it for just 10 minutes a day, in our busy lives I think it’s really quite hard to set aside a peaceful 10 minutes. So, you know, it’s something you do need to work on and think about trying to do regularly. But it can be very, very helpful helping with anxiety and even improving sleep quality.

 

Dr Jessica Briscoe [00:11:56] Oh, absolutely. I mean, I was actually thinking about other ways that you can practise it, if you don’t get on with mindfulness on its own. I mean, yoga essentially was developed so that people could practise mindfulness in a more Western way, I think. And I think yoga is quite a good way of practising mindfulness, which sort of brings us onto another one of our tips for how to manage anxiety and depression: exercise. So there’s really good evidence that exercise can be more beneficial in mild to moderate depression than antidepressants. And a lot of people prefer it because they don’t necessarily want to take medications. And actually this is something positive that you’re doing for yourself.

 

Dr Katy Munro [00:12:34] So that can be any kind of exercise that you like doing. But from a migraine point of view, it’s better to do little and often rather than to go and blitz it in the gym once a week and then have a crashing headache as a result. There was a study a while ago that showed that people who did 30 minutes of exercise about three times a week tended to have fewer migraine episodes. So that’s something to sort of base your target round. But if you haven’t been used to doing exercise, then start gently.

 

Dr Jessica Briscoe [00:13:00] What kind of exercises would you advise people to do?

 

Dr Katy Munro [00:13:03] I think anything that lift your spirits while you’re doing it. So we know that going outside in the daylight is good for depression, just being out in nature. So just go for a walk in the local park. Or some people are getting really into parkrun, aren’t they?

 

Dr Jessica Briscoe [00:13:18] Yeah, it’s a big drive at the moment, particularly in GP practises, getting us doctors to put our money where our mouth is.

 

Dr Katy Munro [00:13:26] Yes. And so cycling can be good or if you’re more somebody who wants to go and do something like swimming or an exercise class, that can be fine, too. And also, of course, dancing. I mean, I love to dance. Do you like dancing?

 

Dr Jessica Briscoe [00:13:42] I mean, I like to dance it. I don’t know how much people like to see me dance. I enjoy doing it. So yeah, that pushes up your serotonin levels, pushes the endorphins.

 

Dr Katy Munro [00:13:51] And the other thing is a thing that you often do with other people. We know that being sociable also helps lift the mood. So anything you can do that gets you out there exercising in groups is a good idea.

 

Dr Jessica Briscoe [00:14:01] Yeah. You also mentioned sleep and how mindfulness can help with that. Actually, making sure that you have good quality sleep is really important for management of anxiety and depression. And actually we’ve mentioned already how it can really affect sleep so it can stop people from sleeping well, it can stop people from actually managing to get sleep, makes people wake up, people wake up early in the morning. So it really is important to try and regulate your sleep so that you a) improve your migraines, but also it really, really affects the mood.

 

Dr Katy Munro [00:14:32] Yeah. And if you look at any sort of list of sleep hygiene things, there’s some very common things that people can easily change, which may improve the quality of the sleep. So obviously having caffeine only in the morning before midday, having a bit of time winding down for an hour or so before you’re going to bed, not being too busy and not being on the computer late at night.

 

Dr Jessica Briscoe [00:14:56] Yeah, I mean, trying to stop all stimulating screens is how I tend to put it. So not using any television, computers, mobile phones for at least an hour before bedtime.

 

Dr Katy Munro [00:15:09] It’s so tempting to check just that last once before you go to sleep.

 

Dr Jessica Briscoe [00:15:13] Yeah, but that can also spiral. So you can, you know, you quickly look at a social media app and then you find yourself two hours later tweeting.

 

Dr Katy Munro [00:15:22] Yeah, reading a book, probably a good way. And it’s sort of something that’s going to distract your brain, but you’re not going to have that blue light in your eyes, which we know suppresses the melatonin, which is a signal to your brain to get you off to sleep.

 

Dr Jessica Briscoe [00:15:36] And there are actually some things that you can do to help with sleep quality so, I know you are, but I’m a big fan of magnesium supplements.

 

Dr Katy Munro [00:15:44] Definitely.

 

Dr Jessica Briscoe [00:15:44] Which do, sort of, they have a calming effect. They do help sleep quality and can also improve migraine, too.

 

Dr Katy Munro [00:15:52] That’s true. You can take magnesium in all sorts of different ways. So you can take it by mouth or you can use magnesium sprays or you can use it by putting Epsom salts in the bath. You probably won’t get a huge high dose of it if you’re using it topically. But there’s quite good study evidence that taking a high-ish dose of magnesium for at least three months can help calm down the migraine attacks, as well as improving the sleep quality and even anxiety, so it’s worth a try.

 

Dr Jessica Briscoe [00:16:21] Yeah, and then I think something else that that kind of leads onto is caffeine and anxiety.

 

Dr Katy Munro [00:16:28] Yeah.

 

Dr Jessica Briscoe [00:16:28] So we’ve already talked about how you should avoid caffeine for at least 12 hours before bedtime because it does have a very long half life. It really stays in your system for a long time. And if you have it after midday, that can be something that affects your sleep. But caffeine also hits your adrenal system, so it’s quite stressful. It produces a lot of adrenaline, which can make people feel very anxious in themselves.

 

Dr Katy Munro [00:16:52] If you’re not used to caffeine, then you have it. I certainly have found this, that if I have a strong coffee and I haven’t been drinking much caffeine, I feel really jittery and worried and anxious. So watch out for that one.

 

Dr Jessica Briscoe [00:17:03] And there’s another thing that has been shown to be very good for chronic pain and also depression that Katy introduced me to, which is expressive writing. Yeah, so expressive writing. I think it actually has to be done with pen and paper. It’s at least three consecutive days a week and I tell people to do it on a regular basis. You write for thirty minutes at a time, whatever comes into your head, and then you don’t then read it back and process it, you throw it away. And that act of actually getting it down on paper does actually have very good evidence for improving chronic pain.

 

Dr Katy Munro [00:17:36] It kind of feels like it’s a mental detox onto paper and sometimes people think that they’ve got to write things down very neatly or reread it. And the idea is to get rid of it. So pour whatever you’re thinking out onto paper, doesn’t matter about the handwriting or the punctuation or the spelling or the language. Just write whatever you feel like writing. And we know that by doing that, somehow things come to the surface that you may be able to make a bit more sense of. You can work on problems this way. You can even have conversations with people if you’ve had issues with them, but only on paper. And so that’s a technique called expressive writing. And there’s a sort of modified version that I say to people, if you’re struggling to get off to sleep or you wake in the night with your brain chattering, just have a pad of paper and a pen by the bed and sit up and write down the things that are buzzing in your head and actually just then put the paper down and tell your brain to shut up and go back to sleep. And that sometimes works quite nicely. So we haven’t talked about CBT. I expect lots of people will know about CBT or the full term cognitive behavioural therapy. So do you recommend that, Jess?

 

Dr Jessica Briscoe [00:18:46] Yes, I do. I mean, cognitive behavioural therapy is a type of therapy and I think a type of counselling. And I think people typically think of counselling, they’re quite anti it, they think, oh, I’m going to sit down, pour my thoughts out and not going to get any feedback from it. But this isn’t like that. This is much more- I mean, you do obviously have to do a little bit of talking about your feelings, but it is much more active. You’re trying to work out exactly why you’re feeling, how you’re feeling, what exactly is going on in your head, and then thinking of ways of actually changing that thought process.

 

Dr Katy Munro [00:19:16] Yeah. There’s quite a bit of homework, I think, with CBT. So you have to be in a relatively good place to make the effort to keep a diary because it’s about looking at the messages that you’re telling yourself. So I would say to people the example of, if you invite somebody to dinner and your friend is late, if you’re feeling anxious, then your messages to yourself may be, oh, my goodness, my friend is late, maybe they’ve had an accident, oh, what am I going to do? Oh, I shouldn’t ever invite people to dinner, it always goes wrong. If you’re feeling depressed, then your messages may be, oh gosh, I’m so useless, everything I do fails. If you’re feeling fine and your friend is late for dinner, then you may sit down and read the paper and think, Oh, that’s good, I’ve got an extra five minutes. So it’s what we say to ourselves that can affect how we feel and CBT looks at that in much more detail than that simple example that I’ve given.

 

Dr Jessica Briscoe [00:20:11] Not just doing a session here.

 

Dr Katy Munro [00:20:13] No. The other thing is there’s a whole load of kind of negative thought patterns. And normally when I’m talking to patients about them, I give a few examples and I see them nodding and recognising it. So dismissing the positives. Somebody says to you, oh, you look nice today. And in your head you go, they don’t really mean that. Or you spill a cup of coffee and then you say to yourself, oh, I’m so useless at everything, but actually you’ve just spilled a cup of coffee. So, you know, it’s worth kind of looking into that because it can be so helpful.

 

Dr Jessica Briscoe [00:20:42] Yeah. There are also lots of organisations that can support you if you are feeling anxious or depressed. So Mind and Young Mind are two good examples of that. And I think if you’re really struggling to know what would work best for you, it is worth reaching out, having a look at those, reaching out to them, seeing what they can do to support you and help.

 

Dr Katy Munro [00:21:02] They have loads of information on their websites. The other thing, I’m a big fan of books, actually, and there are loads of books out there if you are a book lover like me. There’s books on depression, books on anxiety. Some of them are people’s personal journeys and some of them are just generally very helpful about explaining what’s going on. There’s a whole series called An Introduction to Managing Depression, Anxiety or whatever. So I think what we’re saying basically is there’s loads of help out there.

 

Dr Jessica Briscoe [00:21:35] I think it’s really important not to feel that you’re alone. Not to feel that there’s nothing that can be done because actually there is a lot of help and support. You just need to know where to go.

 

Dr Katy Munro [00:21:45] You may be able to just go to your GP and have a chat to them. And also, as we said, lots of online resources. Hopefully that will be helpful to manage your own feelings and the way that migraine has impacted on you. But also, if you’re supporting somebody else with migraine, maybe have a look into some of these things that we’ve suggested and tell them about it.

 

Dr Jessica Briscoe [00:22:10] We heard from Iain Lee, a broadcaster and writer, who told us his personal struggle with migraine and you’ll be hearing this now.

 

Iain Lee [00:22:19] Hello, my name is Iain Lee. I’m a radio presenter. I host a late night alternative weeknights from 10 on talk radio. And you may have seen me in I’m A Celebrity a couple of years ago stealing some strawberries. I just thought I would briefly- I didn’t spontaneously think- I was asked and I agreed to share some of my experiences with migraines. I’ve had migraines since I was about eight or nine. I’ve been really lucky that I don’t think I’ve had one for a couple of years. But when I get them, they are just the most painful things in the world. I kind of get a little bit of a warning that I’m going to get them in that I get a headache but it’s different from a headache. It’s in a very specific part of my head. It’s kind of just above my left eye to the right slightly of it. And also at the base of my neck, I get this throbbing and I get a very thick head. A headache for me is quite sharp and this is quite thick. And when I get that, I try and drink coffee and eat chocolate. I know it’s counterintuitive. And for some people, those can be triggers for migraines. But if I drink coffee and eat chocolate early enough, that can stop me- stop the migraine developing any further and it will either go completely or it will just become a dull hit. I do also take quite a lot of Nurofen as well if I need to. And if I don’t get that, oh man, I’m in big trouble. The migraines can go on for two or three days, normally about two days. The pain is indescribable. I want to die. You know, that is no exaggeration. I want to rip my head off and die. I throw up a lot. I kind of go blind. It’s a weird blindness where I can sort of see things but I can’t see them. It’s such a hard thing to describe and it’s full of contradictions and it’s so horrible. I tell you something that works really well for me if I do get a migraine, is sitting in my- is being cold. So if I’m home, I will open all the windows and try and get a draught in. The best place for me to sit with a migraine is in my car with the air conditioning on full blast. And I don’t know if that thins the blood or does something, and that can offer me relief, really. My body will contort and tense up and will go into all kinds of awkward positions to try and take the pain from my head and sort of put it somewhere else. It’s really horrible. The relief- there will be a period when I know the migraine is going, I’ll shiver, I’ll get two or three huge shivers that will just cause my body to convulse and they’ll start at the top of my head and shiver all the way down my spine to my feet. And if I get three of those, I know I’m on the other side and I’m coming out. I’ve tried- oh, that’s my phone going. I’ve tried other things. I’ve tried- I remember my neurologist gave me some magnetic pulse thing to try that he said- this is a proper doctor- he said was working for some people. It never worked for me. Touch wood, I haven’t had one for a couple of years. I’ve come close to having one, but I’ve managed to stop it. I think I have taken a lot of the stressful things out of my life that were possibly partly responsible for it. And I just, you know, wish everybody that has them the best of luck coming through them. Thank you very much for listening.

 

Dr Katy Munro [00:25:49] Next up, we’ll be talking to Dr. Kate Barnes, who is a cognitive behavioural therapy practitioner and also does some hypnotherapy in her practise and talking to us about how this can help. Today, I’m talking with Dr. Kate Barnes and we’re going to be talking about the use of CBT and hypnotherapy. Tell me a bit about what you do in your practise, Kate, with these.

 

Dr Kate Barnes [00:26:14] Okay, so I’ve been doing CBT probably for about six or seven years now, and often combine it with hypnotherapy. I thought perhaps I’d start by telling you a bit about what CBT is. It was a treatment that was developed by Aaron Beck, who is an American psychiatrist in the 1960s. CBT is short for cognitive behaviour therapy and in a nutshell, I would say that it’s a therapy that looks at our thoughts and how it affects our feelings and consequently our behaviour.

 

Dr Katy Munro [00:26:52] Yeah, it’s been used in this country for quite a long time, hasn’t it?

 

Dr Kate Barnes [00:26:56] It has been used in this country for quite a long time. It’s become a very popular treatment in recent years, basically, because there’s quite a lot of evidence to show it works and certainly the medical profession have really embraced it. It’s a very logical treatment and people can benefit from just five or six sessions.

 

Dr Katy Munro [00:27:13] Yeah.

 

Dr Kate Barnes [00:27:13] So it’s something that’s been used in the NHS and is quite readily. To say a bit more about it. We all get accustomed to thinking in certain ways. We all get habituated in our thinking. And it’s really about looking at this with the patient and helping them to challenge some of their thinking. We look at aspects that we call NATs and NATs stand for negative automatic thoughts.

 

Dr Katy Munro [00:27:39] So can you tell me a bit more about the negative automatic thoughts? I think there are quite a few different types, aren’t there?

 

Dr Kate Barnes [00:27:45] There are. So one of the most common types is mind reading. And that’s where we think we know what somebody else is thinking, which, of course, when you really start thinking about it is ridiculous.

 

Dr Katy Munro [00:27:57] So that’s when people say things like, well, they must be thinking this…

 

Dr Kate Barnes [00:28:00] Yes, they must think I’m fat. They must think I’m an idiot. That kind of thing. Catastrophic thinking. It’s the end of the world. And clearly, the sky isn’t falling down. Other things, such as generalisations, where we’re using our internal dialogue and saying to ourselves things like, this always happens.

 

Dr Katy Munro [00:28:20] Ok.

 

Dr Kate Barnes [00:28:21] No one ever does this. This never happens.

 

Dr Katy Munro [00:28:24] So when you say internal dialogue, are you meaning the messages we tell ourselves about things?

 

Dr Kate Barnes [00:28:29] Exactly that. Polarised, black and white thinking, where we impose a judgement on ourselves and we use words such as, I should do this, I must do this.

 

Dr Katy Munro [00:28:38]  That’s a common one. I definitely recognise that one.

 

Dr Kate Barnes [00:28:43] Blaming. Either blaming other people or self blame. Emotional reasoning, which is where we understand that our thinking- or helping people to understand how our thinking may be distorted by our present mood state.

 

Dr Katy Munro [00:28:57] OK, can you clarify that a bit more?

 

Dr Kate Barnes [00:29:01] Yeah. So say somebody is going through a period of time where they’re feeling low, then clearly that’s going to cloud their thinking and judgement and it’s helping them to see that and to make allowances for that.

 

Dr Katy Munro [00:29:14] So because they’re low, they are thinking in a slightly different way than if they were feeling in a much better frame of mind.

 

Dr Kate Barnes [00:29:19] Exactly.

 

Dr Katy Munro [00:29:19] So it’s about identifying those sort of thought patterns. But then what can you do about it?

 

Dr Kate Barnes [00:29:24] Right. So it’s about helping people to step back and look at challenging some of this thinking and showing them that they do actually have a choice and that they don’t always have to think in a particular way.

 

Dr Katy Munro [00:29:37] Habits are hard to break.

 

Dr Kate Barnes [00:29:39] That’s right. One of the ways in which you can do that is to get them to do activities where they actually do something different from what they’re accustomed to doing and showing them that they can get a different result.

 

Dr Katy Munro [00:29:51] You’re suggesting to people that they try doing things in a different way so that they get a different result. Can that be simple, practical, physical things like brushing your teeth with the other hand? Or would it be more patterns of behaviour that they’re looking at?

 

Dr Kate Barnes [00:30:05] It depends, actually. I think one of the things that it’s really important to get across to people is that it’s not just about how your thoughts can affect your feelings, can affect your behaviour. If you change your behaviour, then sometimes you can change your thought patterns as well. So it’s like a sort of feedback loop.

 

Dr Katy Munro [00:30:24] I’ve come across that where people are feeling so low and they tell themselves that they won’t enjoy going out and doing something with their family. And then if you can actually persuade them to try going and doing it, they often enjoy it much more than they thought they would.

 

Dr Kate Barnes [00:30:39] Yes, yeah. I mean, I often think of that phrase ‘feel the fear and do it anyway’.

 

Dr Katy Munro [00:30:43] Yes. Yes.

 

Dr Kate Barnes [00:30:43] And sometimes you’ve just got to do it and then you realise actually that the thoughts follow the change in behaviour.

 

Dr Katy Munro [00:30:50] Yeah, it sounds as if there could be quite a bit of homework with CBT?

 

Dr Kate Barnes [00:30:53] There can be. I must admit, the Kate Barnes way of doing it doesn’t necessarily involve a lot of homework. And I think, you know, if you follow the sort of strict protocols that the cognitive behaviour therapists use, it often does involve quite sort of rigid framework of doing homework. But because I tend to combine my cognitive behaviour therapy with hypnotherapy, I probably practise it in a slightly different way from most people.

 

Dr Katy Munro [00:31:21] Brilliant. Tell me a bit about hypnotherapy, because that’s something I think a lot of people are interested in. But then they have worries that they’re going to be controlled or- there’s a lot of myths surrounding hypnotherapy, aren’t there?

 

Dr Kate Barnes [00:31:32] I think you’re absolutely right about that. And that’s one of the things that I’m always trying to dispel with people, because when people come and see me, I think often they are very wary and they’re not really quite sure what I’m going to do to them. And so generally, one of the first things I’ll say is that actually it’s no different from relaxation. What you’re doing is helping to put the person into a relaxed state and by putting them into a relaxed state, you’re bypassing the critical, conscious part of the mind.

 

Dr Katy Munro [00:31:59] So you’re helping them relax themselves. You’re not doing something to them.

 

Dr Kate Barnes [00:32:03] You are helping them to relax by giving them the right cues to help them do it. So you’re doing that and in doing that, you’re helping them to- you’re basically bypassing the critical conscious part of the mind. And then you’re getting into the unconscious part of the mind, which is where all the habits and values and attitudes are stored. And you’re making suggestions to the unconscious part of the mind because that’s where the change really occurs. That does sound quite wacky, but actually it works beautifully. And I think you can teach anybody to relax. But the brilliant thing is, and people often don’t think about this, is that if you can teach somebody to be relaxed then they can’t possibly be anxious or stressed because you cannot have two conflicting emotions at the same time. I think with pain patients, self learning to do self hypnosis can be really, really useful because it removes the stress element of what’s going on.

 

Dr Katy Munro [00:33:02] Yeah. So have you come across using these techniques with people with chronic migraine or with chronic pain?

 

Dr Kate Barnes [00:33:10] I do. I use these treatments for all sorts of different things. I do see patients with pain conditions such as migraine. And in fact, I was just thinking I saw somebody the other week and I thought I’d just maybe give an example. And she was a patient who had come to see me, who was struggling with migraine. She led a busy life. She was a mother of four and she had a part time job. And she was telling me about her experience the week before where she had been given this project to do. And there was a deadline. She had to get it finished by the end of a particular day, the week before. She just had one of those days where her nanny rang up in the morning, her afterschool school nanny, and said that she was sick. So she knew that she had to rush to pick her kids up from school. She then got phoned by a friend during the day saying, would she mind if she picked her child up, which was from another school, which she then did agree to do.

 

Dr Katy Munro [00:34:04] It all happens at once.

 

Dr Kate Barnes [00:34:05] So she found herself having the most crazy day where she was running around like a headless chicken. She got through the day. She managed to fulfil her obligations at work, completed the project, not having had anything to eat or drink all day.

 

Dr Katy Munro [00:34:19] Alarm bells ringing.

 

Dr Kate Barnes [00:34:22] And then she yes, she rushed to pick this other child up from school. She then rushed to drop two of her kids at two different after school activities. Got home and rather unsurprisingly, later that night got a migraine. So we talked through some of this stuff. And this is where the CBT techniques can be quite useful. Just looking at the thought processes behind how she managed her day and how she could look at doing things slightly differently. Of course, she realised when we went through the negative automatic thoughts that there were the sort of thought processes going on, would her boss think she was a slacker if she didn’t get the project done. He might have done or he might not but does it really matter? But to her it was- she extrapolated it further to, if I don’t get this project done then what will he think? I could get fired? And the whole thing was getting out of proportion.

 

Dr Katy Munro [00:35:12] Catastrophised.

 

Dr Kate Barnes [00:35:12]  Exactly. Her friend ringing her up and asking her to pick up the child. She thought, if I say no, it comes across as I’m being really unhelpful. She then felt quite angry about it because actually this friend wasn’t always particularly good at reciprocating, but she didn’t really feel she could say no. And then, you know, we spoke about the kids and their after school activities. Actually, how important was it that they really did them? You know, was it actually fine to miss them on one occasion? Of course, she realised when we were talking about it, well, no, but at the time it was, I’m not being a perfect mother. I’m not getting my child to these after school activities. We realised that actually she hadn’t particularly managed that day well and she’d ended up as a result of not looking after herself, with a migraine. And then she was clearly no good to anybody.

 

Dr Katy Munro [00:36:02] Yes. So it all came tumbling down despite her attempts to keep all those balls up in the air.

 

Dr Kate Barnes [00:36:08] Yeah. So I suppose that’s a kind of example of where CBT techniques can be quite useful at looking at how to manage migraine. Clearly, it’s not a cure for migraine, but these sorts of things are quite useful.

 

Dr Katy Munro [00:36:21] But by changing her priorities, she might have stopped, had lunch and had a more relaxing evening if she had thought about it in a slightly different way.

 

Dr Kate Barnes [00:36:31] Yes. It’s about learning how to manage one’s lifestyle, really, isn’t it? And the stress elements that can trigger migraines.

 

Dr Katy Munro [00:36:38] That’s excellent. Thank you so much for talking to me today.

 

Dr Jessica Briscoe [00:36:45] Charlotte spoke to two of our patients about their experiences with migraine and mental health and here’s what they had to say.

 

Charlotte [00:36:53] Hello, Nathan, thank you for joining us today. It’s migraine awareness week and we are concentrating on migraine and mental health this week. So I just wanted to discuss that with you a little bit.

 

Nathan [00:37:02] OK, great.

 

Charlotte [00:37:03] So have you felt that sort of migraines ever affected your mental health?

 

Nathan [00:37:07] Yes, definitely.

 

Charlotte [00:37:09] And how would you describe that to someone if you sort of how it’s affected your mental well-being in general?

 

Nathan [00:37:14] It’s a difficult question. I mean, I guess migraines really, really does affect most people’s mental health. But especially with myself, I tend to go in a really dark place, especially if I’ve had migraines for a long period of time.

 

Charlotte [00:37:26] Yeah. So you’re going through that sort of cycle?

 

Nathan [00:37:29] Yeah, it’s I guess because you’re in a dark room all the time. It can- and you’re by yourself, there’s no one to really offload and it’s just pain mixed with being lonely. And then you feel like you’re not understood and there’s a whole bunch of emotions that start flying around.

 

Charlotte [00:37:45]  Yeah, that’s one thing we found when we did our survey is that a lot of people feel isolated and alone, like you just said.

 

Nathan [00:37:52] Yes, isolation can be pretty hard to deal with.

 

Charlotte [00:37:56] Yeah. And do you ever feel sort of anxious and get sort of anxiety because of that kind of feeling alone and not knowing when the attacks are going to happen?

 

Nathan [00:38:04] I definitely feel anxious when it comes to- when when the attacks happen like at the moment, I find it really difficult to go out and I enjoy stuff with my friends or family just because if I leave too far from my home, if I have an attack, there’s nothing I can do.

 

Charlotte [00:38:19] Yeah.

 

Nathan [00:38:19] So I get quite nervous about planning. My cousins in a musical and I don’t want to promiser her  that I can go to it because…

 

Charlotte [00:38:26] Then you might have to cancel on her and then you feel guilty and things like that and it just…

 

Nathan [00:38:29] Yeah, I might have to cancel, I might have an attack in the venue.

 

Charlotte [00:38:33] Yeah. It’s that fear, isn’t it, of when’s it going to come? Is it going to come.

 

Nathan [00:38:37] Yes, very.

 

Charlotte [00:38:38] And do you find you get sort of mood changes as well because of it?

 

Nathan [00:38:41] Yeah, I feel sorry for my brother and dad. I definitely have my ups and downs and it’s quite, quite spiky with me. It’s like all of a sudden calm and then one moment I’ll be like ‘oi!’.

 

Charlotte [00:38:56] Well, are they quite understanding though? They must’ve seen you go through it.

 

Nathan [00:38:59] Yeah and after I do it I explain. Sorry, I just I’m in pain. I apologise.

 

Charlotte [00:39:05] And so have you found that anything sort of helped you cope with those kind of feelings?

 

Nathan [00:39:10] I’ve never found anything that could help me personally. I just kind of.

 

Charlotte [00:39:14] Just having people around you that sort of understand.

 

Nathan [00:39:16] Yeah, yeah. Bear with it. And like, hope my friends kind of understand- friends and family understand what my spikes kind of- what the cause is, really.

 

Charlotte [00:39:24] Yeah. And so if you know, the people listening to this podcast, some of them might be feeling very similar to yourself. So what would you sort of say to them if they are having those kind of- migraines are impacting their mental wellbeing? What would you say to them?

 

Nathan [00:39:36] I mean, at the time when you’re having a migraine, you might be in a very dark place, but it’s going to end. Once you come out of the pain period, just try and enjoy yourself as much as possible before your next attack. If it’s coming soon, if it’s coming later, just try to focus on the positives instead of the negatives. So that’s how I kind of cope.

 

Charlotte [00:39:54] I think that’s great. That’s great. Fantastic. Well, thank you so much for joining us. And that was really, really great. And I hope, you know, people out there sort of realise that you’re not alone and that there are people that feel just like you to do.

 

Nathan [00:40:04] Definitely aren’t alone.

 

Charlotte [00:40:05]  Thank you.

 

Charlotte [00:40:09] Hi Abby, thanks so much for joining us on our podcast this week, so it’s Migraine Awareness Week and we’re concentrating on migraine and mental health. So how has sort of migraine affected your mental health? Has it and in what ways?

 

Abby [00:40:24] I think it’s had quite a big impact on my mental health. A lot of it, I think, is because of the impact it’s had on my life as a whole. So I’ve missed a lot of work because of my migraines. I’ve ended up in absence meetings and the stress and anxiety that comes with that, with it impacting on my way of making a living. Yeah, it’s really detrimental. And then obviously the anxiety causes me to have more migraines. I get stress triggers. So it’s kind of self-perpetuating.

 

Charlotte [00:40:56] Yeah, it goes round and round in a circle.

 

Abby [00:40:58] Yeah.

 

Charlotte [00:40:59] I can imagine. That’s awful. And have you found any other ways that it sort of has impacted your mental health or is it mostly that kind of anxiety and the stress of having them?

 

Abby [00:41:10] I mean also the migraine itself obviously causes quite a lot of anxiety.

 

Charlotte [00:41:15] I think it’s having the pain constantly. I mean, are you a chronic migraine sufferer?

 

Abby [00:41:19] I am, yeah, but only as of I think it was March last year, they were episodic before then. And I had medication that was mostly working, but I had a really severe attack at work that was all sound based. I just- intensely sound sensitive. And after that, it took a long time for it to start to sort of even out again. And I was really, really anxious during that time just about leaving the house because I was so easily triggered. I couldn’t go and sit in a cafe because just the sound of the coffee grinder going on would set me off immediately.

 

Charlotte [00:41:56] So, yeah, I can imagine that must be awful then, because you can’t do anything because there’s noise everywhere.

 

Abby [00:42:03] Yeah, I was just going to say that it’s sort of it has slightly improved in that respect over time. But then it does it has a big impact on the way you approach everything, because every time you go anywhere, you have to consider well, what possible triggers are there going to be? What do I have to do to make sure that that is less likely to happen? Or if I do get an attack, what am I going to do? If I’m at a festival or something, how am I going to leave as quickly as possible?

 

Charlotte [00:42:31] Sort of constant fear of when is it going to happen?

 

Abby [00:42:36]  I don’t drive at the moment, but I can imagine if you drive to places and you get a migraine and then, you know, you’re not safe to drive back, that leaves you in this kind of- you’re stuck because you can’t get in the car safely, but you also can’t stay where you are.

 

Charlotte [00:42:50] I’ve actually heard that from some people. And that can be really scary, especially if you get auras when you’re driving as well. Yeah, because that affects your vision.

 

Abby [00:42:58] It affects my judgement and my reaction speed so must that I wouldn’t be safe. I cycle a lot of places and if I do get a migraine and have to leave work early or something, I have to make myself walk because I know I’m not safe. I’ve had a couple of accidents with my bike because I cycled when I had a migraine starting and thought I’d be OK.

 

Charlotte [00:43:17] Yeah, it’s very scary actually isn’t it. So have you found sort of ways that you have been able to deal with things, you know, have as anything sort of helped combat the migraines and also maybe how it affects your mental health? Has anything helped you?

 

Abby [00:43:32] Yeah, I mean, in part, I just over time I’ve developed sort of a routine about how I approach things and what I can take with me to help me, sort of like a migraine emergency kit. But in terms of just processing sort of the feelings and the anxiety itself, I actually found art really helpful.

 

Charlotte [00:43:54] Ok, well that’s nice. So you do a lot of art then? I think you’re doing an exhibit aren’t you soon?

 

Abby [00:43:59] Soon, yeah. I have a degree in illustration and I do a lot of digital art, which when my migraines first went chronic, that was one of the things I found the hardest, was that I couldn’t do that anymore. I could only spend like half an hour on a computer at a time. As I got better and started being able to draw more, I decided to try and channel the way I was feeling through my artwork and started making illustrations about my experiences with migraine. And I found that really cathartic. And then I started connecting with other people online that also had migraines or chronic illnesses and just sort of keyed into this whole online community. And I think that helps a lot with the isolation.

 

Charlotte [00:44:38] Yeah, yeah, definitely. And we actually- I must say that to anyone listening that actually the Heads Up podcast, our logo is actually lovely. You created that and let us use that. So that was really wonderful. And I think the way you do your art is really expressive and I think really helps to- when you can’t visualise what migraine looks like to actually be able to see it is you know, I think that sort of helps people, especially when people don’t suffer themselves.

 

Abby [00:45:07] Thank you very much. It started as just something to help myself process the feelings. But the more I made them, the more positive responses I got about people being able to visualise what it was like and seeing their own experiences expressed in the work. So I’m really glad that I have gone in this direction.

 

Charlotte [00:45:29] Yeah, I think it’s really important for people to know that because it’s such a misunderstood condition. And yes, so thank you very much.

 

Charlotte [00:45:37] If anyone listening is in the Cambridge area on the 14th September, then please feel free to check out Abby’s exhibit, which she’s holding to raise funds for our charity, the National Migraine Centre, which will help us continue our mission, helping those suffering with debilitating migraines and headaches.

 

Dr Jessica Briscoe [00:45:54] So we’ve talked a lot about anxiety and depression in migraine today. Please don’t forget that if you need more support, then you can always contact Mind or Young Minds. And if you are feeling like you’re struggling, there’s always the Samaritans and they can be contacted on 116 123.

 

Dr Katy Munro [00:46:13] There are other resources available out there and we’ve mentioned some of them. The migraine trust has an advocacy service, so it’s well worth looking at their website. And of course, you could always call your own GP or dial 111 if it’s an out of hours time of day. Thank you very much to everybody who’s been involved in this special edition of our podcast for Mental Health and Migraine in this Migraine Awareness Week, a special thank you to our guests and our patients who contributed.

 

Dr Jessica Briscoe [00:46:44] For our next podcast, we will start talking about migraine management. We’ll be discussing some of the interventions for migraines. And if you have any questions on this topic or suggestions for any other topics we might want to do in the future, please email us.

 

Dr Katy Munro [00:46:57] We want this to be useful for you so keep your comments coming.

 

[00:47:02] You’ve been listening to the Heads Up podcast if you want more information or have any comments, email us on info@NationalMigraineCentre.org.uk. Till next time.