By Tamara Marzouk, MSW, MPH

I hate migraines. I mean, really hate them. I’ve been getting migraines for the past 18 years, and I still get them. I would love to tell you that this is a story of how I healed and how I never get migraines anymore, but it’s not. This is a story about my struggle and how my understanding of the connection between my mind and body has helped me gain some power and control over the monster that is chronic pain.

If you know someone with migraines or struggle with them yourself, you’ve probably heard the term “triggers,” behaviors or exposures that are believed to play a role in causing migraines. They are different for everyone, and new research shows that some “triggers” may actually just be part of the first phase of migraine itself and not a causal factor at all. Five years ago, I listed out all of my known and potential triggers, and there were thirty-one of them. I stared at the list, which ranged from dehydration to irregular sleep to skipping a meal (and everything in between). Here I was, trying to organize my thoughts and get ready for an appointment with a new migraine specialist, and I just froze with anxiety. How could I possibly control all of these things in my life? I had no idea at the time, but my emotional reactions to that list and to my chronic pain in general had a lot to do with the way my body experienced pain itself.

Fast forward to two years ago, when I sobbed in my therapist’s office about how much pain I was in. I had a really difficult day at work and it was made worse by debilitating pain that radiated from my neck to my temples to behind my eye. My therapist asked me, “What do you think your body is trying to tell you?” As I thought about the question, a part of me really dreaded adding “unresolved emotions” to my list of triggers. I answered, talking about how I felt so anxious about the pain, waiting for it to get more debilitating. Waiting for it to get to the point where I would have to say no to commitments I had already made. I talked about my fear for the day I have my own children and won’t be able to parent them because of a migraine. I was catastrophizing, jumping immediately to the worst-case scenario in my mind.

I had no idea that part of what was happening in my body was related to emotions, both those occurring in the moment and those emotions I experienced historically. Due to my family dynamic while growing up, I was so used to waiting for the other “shoe to drop” or for the “rug to be pulled out from under me.” More often than not, I was living in a fight, flight, or freeze mode. In a dangerous situation, this trauma response in one’s body is really helpful. It’s what makes us survive in times of trouble. But when the body is accustomed to this over and over again, the body stays in a state of heightened arousal or reactivity, making it easier to experience pain and also experience anxiety about the prospect of pain lingering around the corner. Even if I feel a just a small hunger headache coming on, I immediately jump to 24 hours from now, when I will be in bed with the lights off or trying to tough through the day with a terrible migraine.

I never wanted to admit that part of my chronic pain might be psychological. It felt like if I did that, then I would be admitting that it’s “all in my head.” I would go right into all-or-nothing thinking, where I thought of my pain as something completely made up, even though it feels so physically real. It’s taken me a while to admit that it is a mix of both. Many studies have shown that pain has psychological and physical origins and affects. I knew that I felt depressed and anxious as a result of my physical pain, but I didn’t know that the depression and anxiety could have an impact on my pain as well. I knew that a migraine would lead me to search frantically for a reason and for what I did wrong this time to create the migraine. I didn’t know that beating myself up for my physical state served a function in keeping me stuck there.

Part of my healing journey has included mindfulness strategies including breathing, meditation, and yoga. Taking breaks to check in with my body and my mind isn’t always easy, but I notice that when I make time to do so, my pain often lessens. Being in the present moment allows me to recognize that pain in this moment means exactly that, and just that: I am feeling discomfort now. Now, a little more often, I stay in the now—instead of going back to exactly what I ate or how many hours I slept, or moving into the future where I see myself debilitated and unable to help others, I try to stay present.

Increasing self-compassion has helped me to see myself as a friend would—to remind myself that I am human and my body is not always going to feel amazing. Migraines are my way of my body letting me know that I’m not okay. Part of striving to be gentler with myself is reminding myself that this is a process, and that I am practicing, not perfecting, these coping mechanisms. That means that some days, I don’t practice them at all. Some days, I feel frustrated and angry and anxious all at the same time. But one thing is for sure: every day, I am a human going through my own psychological processes while supporting others who are doing the same.

Tamara Marzouk, MSW, MPH

Tamara is, first and foremost, Dr. Sam’s cousin! She is a school-based Mental Health Counselor who works with students ages 11 to 19, and specializes in sexual health education for teens as well. In her free time, she loves to travel internationally, spend time outdoors, and try new foods!