Migraine and mild brain trauma
Use the migraine and mild brain trauma and energy roller coaster worksheets, Diathesis-Stress model of migraine and mild brain trauma Figure 1.7.
Notes for therapist: The holistic biopsychosocial principles of the proposed headache programme apply to all types of headaches and are equally beneficial for all headache sufferers.
People who experience migraines following mild brain trauma are presumed to have a predisposition to them. It is also assumed that the psy- chophysiological impact of the onset event caused the breach of migraine threshold. The experience of migraine attacks can lead to secondary symptoms that substantially overlap with post-concussion symptoms and stress, which may later manifest in habits or psychological responses that perpetuate the situation.
Psycho-education for migraine patients can, thus, contain the following explanations:
critical events and acquired vulnerability
Pain Gate theory with a focus on Action Systems.
“The body produces symptoms of discomfort when the regulation between internal resources and external demands has become unbalanced. It seems that most people present one kind of vulnerability or another. Some may be prone to stomach ulcers, others asthma attacks or skin eczema, if their body is under certain strain that upsets its self-regulation ability.
“You experience new onset migraines or more frequent attacks than before the accident/onset event. Therefore, it is assumed that your body presents an innate or genetic vulnerability to respond to overwhelming stimuli with a migraine attack. Your body was better able to keep demanding stimuli more or less below threshold before the accident or onset event.
“Stressful events are commonly associated with migraine conditions. The impact of the accident compounded by the impact of migraine pain and the consequences of such episodes stimulates emergency reactions and stress responses. Your body attempts to protect itself from recurring, potentially life-threatening experiences by heightening your sensory as well as generic and physical responsiveness. This results in a cascade of migraine-related and stress-hormonal processes, which make a further attack highly likely.
“In order to restore a manageable balance, it is now important to organise your lifestyle in such a way that bodily activation remains below' the migraine threshold. It might be difficult at first to accept that you have to do things differently yourself. Some people may fear that they might achieve less during their work or daily activities and try to push themselves, especially in migraine-free periods. However, this could have a high price, as much time and energy is lost later on when an attack has been triggered and which might consequently take you out of action.
“Initially, it is important to help the body restore its balance at a lower activity level. This means that your lifestyle requires structure, activities need to be graded and slowed down, just as in the recent homework exercise. This has the added benefit that you can have energy left at the end of your activity or at the end of the day. The feeling of energy is often linked with positive emotion, w'hereas feeling exhausted and worn out with headaches can be associated with disappointment or failure, even if a task has been mastered.
“The energy roller coaster provides a useful analogy. Let’s have a look at this worksheet and hear how this might apply to you.”
“Identify two or three activities that modify your headache. You can record them on the my well-being actions 2 worksheet. ”
“Record your headaches during two days in the coming week in the headache diary. Record headache intensity and duration.”
“Carry on with relaxation practice.”