Physical therapies and exercise

There is substantial aw'areness about the usefulness of aerobic exercise, particularly for migraine patients. An exercised-based migraine intervention was implemented by one sports psychology programme. Migraine patients participated in 30-minute sessions of either Nordic walking or jogging three times a week for ten weeks. Patients participating in either activity significantly reduced the frequency of their migraines. Negative coping and avoidance of social and other activities was reduced and habituation to migraine triggers and stressful stimuli was increased. Consequently, migraine thresholds and physical fitness were also improved. In addition, the influence of vulnerability factors decreased. Cognitive parameters such as working memory, mental flexibility and attention accuracy w'ere also found to have improved. This could mean that the physiological benefits of aerobic training increased the efficiency of the nervous system, thus also reducing migraine episodes.

Pacing and fatigue management

Daytime fatigue is common with chronic headaches. Following brain trauma, associated disruptions of neurophysiological mechanisms can alter the healthy diurnal pattern, including the cortisol rhythm. A malfunctioning hormonal pattern can increase daytime fatigue, causing exhaustion and sleep problems at night. The perception of danger, especially a “social threat,” is a powerful stressor. Headache sufferers often fear negative evaluation by others as much as pain. Therefore, secondary social consequences of headaches seem to be strongly associated w'ith fatigue and sleep disorders. People who attempt to anticipate and compensate for negative feedback are at risk of “burn out” or “boom and bust.”

Several therapeutic techniques that aim to optimise energy levels as well as pacing and activity management are described in the health management and individual headache therapy sections in Chapter 3.

Positive psychology and flow

Positive psychology, in broad terms, involves focusing on a person’s current skills and resources in order to optimise their use in the future. The focus is on improving healthy functioning for a more fulfilling life. Personal growth following brain trauma can be an encouraging theme for a person with headaches.

The concept of “flow” focuses on a person’s ability to be fully immersed in a meaningful activity. Flow takes the “being in the moment” experience up to a higher level, incorporating new' personal challenges. This process involves the discovery of an exhilarating balance between panic and boredom states. A person who can accomplish this will, thus, move out of their comfort zone towards new' experiences.

Headaches and brain trauma might throw a person off balance involuntarily. The shift of focus from a medical to a self-management approach that requires self-motivation might challenge a person’s comfort zone. This can create a temporarily unstable experience that ultimately opens opportunities for development of the self and engagement with proactive life goals beyond the headache condition.

People experience flow' when they stretch themselves a little further beyond their current limits and attempt new challenges that force them out of their comfort zones. The mastery of an extraordinary and enjoyable activity may lead to the feelings of excitement and exhilaration that are part of the flow experience.

In applying a positive therapy philosophy for patients with persistent headache problems, it is vital to guide patients towards:

• • Awareness of life-traps that maintain their symptoms and hinder them living in accordance with their values.
• • Insight about self-restricting behaviours and the hypersensitivity-trap associated with pain and anxiety symptoms.
• • A graded and paced plan, moving them towards positive possibilities.
• • Courage to apply the new and therapeutic coping strategies whilst letting go of safety-seeking and avoidance behaviours.

Chronic headache patients can feel trapped in their pain and, consequently, the visualisation of exciting life experiences might sound simply impossible. Often, patients have surrendered their ambitions due to their headaches. The paradigm shift in this headache therapy is intended to refocus patients on enhancing their quality of life during headache-free periods, to use available resources in an adaptive way and to explore how their values can be approached by gradually moving towards “possibility goals.”