Monday, 25 June 2012

Day 1285 - It's All In Your Head

"Many people know about other contributing factors such as heredity, food triggers, lack of sleep, poor posture, etc., but are not aware of any psychological connection.

Headache specialists report that many of their patients resist any discussion of emotional or psychological contributors to their recurrent headaches. Some people fear that pursuing this avenue could uncover evidence of "mental illness." Others feel that the existence of these factors would make their pain less real because it would then be "all in their heads". In just about all cases, neither of these 2 things is true!

Headache is definitely a biological disorder. However, since the body and the mind are interconnected, your emotional and psychological states can have an effect on your overall health, including your headaches. Here's why:

- When your emotional and psychological systems are in good working order, they help to create a positive environment that contributes to the health of your body.

- When these systems aren't working so well...for example, if you feel anxious, depressed or angry on a frequent basis — and especially if you find it difficult to shake these feelings — a negative environment can be created in your body that may contribute to a specific headache episode or create a fertile breeding ground for headaches to occur.

The relationship between anxiety, depression and headache is not fully understood. However, it is known that the brain chemical serotonin plays a role in all of them. Some headache specialists have theorized that these disorders may share a common mechanism in the brain.

Research has shown that some chronic headache sufferers also suffer from depression and/or anxiety. It is important to note that these sufferers' psychological conditions may not be caused by their headaches. Rather, tendencies towards depression or anxiety may be inherent in their personalities or ways of thinking. Or, they may be the result of an intense and prolonged level of stress which may lead to psychological conditions such as anxiety or depression. Regardless of the cause, having frequent headaches and feeling a lack of control over them may cause an existing condition of depression or anxiety to worsen. This situation can easily snowball, creating a vicious cycle of headache and emotional distress.

Unfortunately, emotional and psychological factors are often not considered in the treatment of headache. Doctors (especially those who are not headache specialists) tend to emphasize medical treatment — and rightly so. This is the traditional "first line of defense" and is effective for most headache patients. So is appropriate to start — and, for most, to stop — there. Also, some doctors today are cautious not to focus on psychological factors during the earlier stages of headache treatment — possibly overcompensating for the days when many doctors treated patients as if the pain was "all in their heads."
Doctors who do bring up psychological contributors as a possibility often find that their patients want to avoid psychological treatment, fearing a "mentally ill" diagnosis or having a concern that the presence of these factors would mean that their headaches are not a serious medical problem. This is very unfortunate because nothing could be farther from the truth!"*

It has taken me over three years to write this post.

When the headache started - which now seems all those years ago - I went to see a psychologist about it. The headache had exacerbated to such a degree that I was unable to work and felt completely depressed about my situation. After telling her about the distress that the headache had caused, she looked at me, arms gently folded over her lap, and stated “It must be such a headache having this pain!” and gave a little chuckle. I brushed aside this silly joke, ignoring it and thinking that maybe she had unintentionally let it out. However, when the very same joke repeated itself over the course of the next sessions, I felt hurt, frustrated and angry that a person contending to be there to help could actually end up aggravating a situation. I could bear it no longer and after a few sessions I left. That was the last of any psychological treatment I have undergone.

The possibility of the headache being related to a close friend’s death which took place a few months before the onset of my headache, has crossed my mind more than once. But nearly four years down the line I do not think the headache is related to this, or at least entirely to this. It is possible that I have not yet recovered from the shock of losing such a close friend. I truly believe there is a strong link between body and mind and that a traumatic event can undoubtedly have consequences on one’s body. The passage above taken from a Headache Centre webpage discusses this in further detail. Just today I also came across an article on the BBC website on a similar topic.

The reason it has taken me so long to write anything on this is that I am unable to draw the line between the “it could be a psychologically caused headache ” to a “it’s all in your head” (i.e. fictional). I am certain, from the manner in which this question is usually addressed to me, that by ‘psychological’ the word ‘fictional’ is intended. Does anyone feel the same?



  2. I have posted to you before, but it's been a while. I was really hoping to see good news when I checked here. I am sad that you still have the headache. My 17 year-old daughter has had her constant headache for two years, four months and one week. (But who's counting!) She is currently being treated for Lyme and other infections/toxins using supplements and diet (via kinesiology). It seems to be helping many of her symptoms, but the headache has yet to budge. (Well, it doesn't spike as high every night, so that's something she's grateful for.) She has done quite a bit of counseling, and gone "deeper" than I think most people are willing to. There is definitely a psychological component to her headache and other symptoms, but there is a physical cause as well. So we continue to address both aspects. I'm hopeful that the next time I check your blog your headache will be better!

  3. 3 years as well. I have had a terrible time with my headache as well. As a male in my mid-twenties, I also have a lot of the same kind of headache going on. Started all at one time and I can almost remember exactly when it started. Its hard because I always think I've solved it with a bit of exercise and some good friends....then comes a sleepless night.

    For me, it had to do something with moving from San Francisco 3 years ago to "save money" and live a normal life. A slight depression and pain caught me into nights of drinking just to get to numb the pain to get sleep. Now after having these headaches day in and out, I also quit my job and won't be heading back anytime soon.

    My docs said at one point I had a low b12 which is also circulation issued, but it was really a goof seeing that it was normal a month later. I usually wear a neck brace at night to help go to sleep. For some reason it helps. No idea why.

    Anyway, I've had a couple crying fits and breakdowns due to the pain and really about my life. I even joined the church which hasn't exactly solved anything either but has helped in one part of my life. The worst is that you always wonder how it is to feel normal again. That's what I have been most concerned with. I can see myself in this blog soooo much and I just really wanted to share that you are not alone in this. I'm actually a bit more reassured that its not just me in this fight for the right mind again.

    I don't know about you, but I have had 3 days without headaches that have shown me again what is normal and I will tell you about them. One was after a 3 day music festival (I love music) with lots of dancing, walking, friends, and drinking plenty of water my headaches were gone and I was so very happy. Then I moved right back into the city and it all came back. Second, was when I visited my beloved San Francisco but it was only one night of the 4 I spent for some odd reason. Last 3rd was whenever I have something goal oriented, it always seems to go away.

    I hope that somehow we can both accept who we are and do the exact thing we love because in the end we have to get over this. I'm with you.

  4. After 7 years of a permanent headache I'm confident I've found my answer in that my upper cervical vertebra were twisted, but the healing process is going to be long and the valleys annoying. An unusually stressful situation recently MIGHT have made my symptoms worse but I reject the "It's all in your head" nonsense unless the person is mentally fragile and very much so.

    If you're good one week and then fall into a chronic headache when your cat dies I can see the mind-body correlation, but when the pain is 24/7 and your mind is strong it can't be psychosomatic.

    I've always felt there was an invisible spike in me somewhere causing my problems and it was up to finding the right specialist to find it and remove it. In the meantime I dealt with every specialist and holistic principle in the book. Too many times my list of symptoms was met with "That's impossible" and an assumption I must be nuts. After a while even I doubted my own mental capacity.

    This round I took two weeks off between seeing my Blair Specialist. This second week hasn't been so good. If my vertebra are out of place again I'll be sure to go back in 7 days. Live and learn.


  5. Thanks Emerson.

    Well the biggest part was that my headaches started with a stressful event (moving into my parents after starting a life in San Francisco) and now I can't sleep much because of it. I agree that when something happens repeatedly with pain it usually has to be because of physical. Being that I want to move on, I have a feeling that it could be physical.

    Sometimes I feel better when I do things like travel or like the festival thing I explained earlier which is what confuses me. I got some doctors lined up and massage therapists that deal with energy fields which I am gonna try.

  6. part 1 of 2...

    My constant headache started on Sept 12th, 2002. I remember it perfectly - I was in graduate school for molecular biology at the time, so of course it was assumed to be stress. That was almost 10 years ago now. There have certainly been moments that I feel better than others - My headaches range from a 3 to 8 on most days - but I have had a severe headache I'd say 28 days a month for 10 years. Sometimes it's bilateral, sometimes on one side or the other. It was the reason I had to withdraw from a whole semester of graduate school, and the main reason I left school with a masters instead of a doctorate. I had to admit that was the reason, but it clearly was.

    I had MRIs, all the tests for diseases anyone can think of, massage and physical therapy, psychologists, neurologists, endocrinologists, etc. Every few years I decided to try and tackle it again, and I get all into it, then nothing happens and I get frustrated with how it is taking over my life, so I quite trying and go back to just dealing with it. I have gotten amazingly good at conducting my life with a bad headache, making it where most people don't realize, especially my two little girls. My husband can always tell, of course.

    I went on super strict diets with no migraine triggers, no luck. I have taken neurontin, keppra, tricyclics, topomax, all pain medicines, and a bunch more, to no affect. I have had acupuncture, a weird electovest thing that zaps your muscles, and more. I quit taking all of it when I decided to get pregnant, and haven't tried that route again, since it didn't work. My girls are 2 and 4 so it's been about 5 years since I've put any real effort into it.

    Ironically, there seems to be a breakthrough starting from 3 weeks ago - and I just found your blog today when I was reading about zinc supplements for a different reason. Two weeks ago, I went to a local spa for a massage, and the lady I normally see was out, and I had someone else. She listened to my story briefly (that all I wanted her to work on was neck, shoulders) and told me she is a nursing student in neurology, and she has a specialty in migraine relief massage. She is young, new, and excited about all of this, and was thrilled to try and help me. I said sure, why not. At this point I'll try anything.

    So she played around for an hour and a half pushing here, there, digging, and asking me to do different things - it was quite painful. She later said she really thought a lot of the problem was in my scalene muscles in my neck - she said they should be flexible, and mind were tight enough she couldn't even budge them. SHe showed me a book about them, and explained her theory about how that is making my upper and lower trapezoids do this and that, and how the muscles around the base of the skull react to that. The nerves that run up from your neck up the side of your face are in contact with the scalenes and attach on the collar bone with them.

    (continuing in next post)...

  7. Part 2 of 2...

    I went to see my primary doc, to see if she thought this was just someone pulling one over on me. She wasn't sure, but like me, said sure, why not. She prescribed Flexeril, a muscle relaxant, to try at the same time and see if that helped. I have actually never tried muscles relaxants (that I can remember) so I did. After the first two therapy sessions with the massages, I felt like I'd been hit by a bus, my headaches floored me, it was awful. But then they went away. I will continue going weekly for awhile, and see what happens. But I will say that after 10 years, I have not had any headache for the past 11 days. That has definitely not happened in years.

    I just want to say - I know this sounds like it was unreasonably simple, and why wouldn't someone else have figured this out...I don't know. I had tried massage therapy in grad school to no avail, but they were students too, so who knows. But, I really want you to believe that I do know exactly what you're going through, and mine were just that bad for all this time. One of my biggest fears in my life was that I would have a terrible one at my wedding or when having my kids. My entire life has been run by these f---ing headaches. Every doctor wanted me to keep journals about when they start and end, etc. I always say "I can't tell. THey don't END. DOn't you hear me!?!?!" This headache has been a HUGE part of my life and had a massive impact on me.

    I woke yesterday and just cried and cried. My husband woke up worried, and I just said, "It's SO amazing to wakeup without a headache." These last two weeks I have felt like I could take on the world. I had almost forgotten what it was like to not have a headache, so I didn't realize how much it was impacting me and my productivity, stamina, etc. I feel so focused and energized, and...wait for it.....HAPPY. It's unbelievable how different I feel.

    TEN YEARS. amazing. I am scared to death that this is like a little window of freedom that will pass and I'll be even more frustrated. I'm scared because I am letting myself get excited that this could be it - I have done that so many times, with each new drug or doctor or therapy, and always my hopes have been crushed. But no one and no drug has ever given me two weeks almost headache free, so I've decided I can be excited.

    Here's hoping it sticks.

    I know what you're going through, and I wish I could help in some way. But all I can do is say - don't give up. Don't decide you can't fix it. I wasted quite a few years in the middle of not trying and trying because I just got tired of being let down, and of paying so much attention to my headaches. But maybe if I'd tried harder this day would have come sooner. Just keep at it, keep looking for your hero - mine sure came from an unlikely place. Just a young girl eager to solve my problem!

    Hope this helps. Best of luck to you.


  8. I formerly had chronic migraine which goes away for years if I take amitriptyline and suddenly stop taking it after three weeks.

    I was having headaches which were uncontrolled by amitriptyline, even in combination a beta blocker. So I knew it wasn't migraine and went to the doctor here in México. She ordered blood and stool tests. I tested positive for typhoid with the widal test. She said this is causing your headache. Headache was virtually the only symptom. I feel better after taking a combination of antibiotics for a week. After the anti-biotics I will take an anti-parasite medication because I had a benign amoeba also.

    Patients describe their symptoms at the end of this article. A lot of them mention headache.

  9. I just passed my 11-year 'anniversary' in June. My headaches started on a Monday after taking a jewelry class the previous weekend. I have no idea if they're related. I've been to many doctors and 'specialists', but so far, no luck. It's amazing how horribly some people in the medical profession can treat a patient. I've experienced everything from a doctor grabbing my head and pushing on the Occipital nerve sites to being accused of drug seeking. It's really demoralizing and humiliating. The normal treatments (procain, lidocain, steroid injections, TENS machine, etc.) either wouldn't work at all or were a very temporary relief. Acupunturists, Physical Therapists and Chiropractors have not been able to help me. I don't even know how many medications and kooky remedies I've tried. I'm currently taking chronic pain medications around the clock. They help with the pain, but they have side effects, which at this point I prefer to the headache pain. I've avoided doing anything to the nerve itself because I've heard the pain comes back, and many times it's even more painful. After one of many doctor appointments, my husband pointed out to me that this is not going to be just about dealing with the physical pain, but also dealing with the psychological pain. I cannot work, but I still try to keep busy. It's hard not to isolate myself because no one I know really understands what ON is, or they think that because I'm not complaining and rolling around in pain I must not feel too bad, or I feel no pain at all. I've even been accused of lying so I can get disability payments! Thank you for writing this blog. It reminds me that I'm not the only one suffering.

  10. WOW - like so many people on here I am so happy to have found this blog and comments. I am beyond frustrated - not just having a headache 24/7 - but with all the people around me who just think it's a headache - get over it. Its been so hard. Now, I see there are many others suffering like me, getting no support, and doctors of no help. And, I am not alone. I just started a new job and already they are tired of my doc appts, and so am I honestly. Every day is a struggle. But I cannot loose my job and so I try my damndest to function.

    I went to see a doc and his reaction was - you are functioning too well to be ill. Really?!?!?! If you only knew.

    Thank you for all the stories and some ideas for different things to try. Like many of you, I am willing to try anything to have just a little relief. And its nice that people do understand what this is like and that it is real. I wish I could offer something more beneficial...but am still searching for something to break this awful headache!

  11. Unfortunately for me I feel in the United States the "conversion disorder" diagnosis is misused by lazy and intellectually challenged diagnositicians in neurology practices. Without fail it is because 1) you take up too much time 2) there is no obvious cause for your problem that can be seen on a blood test or a MRI/CT scan 3) you take up too much time 4) their opinion means more than yours 5) you take up too much time and 6) there are no more high priced procedures they can do to suck money out of you and 7) not only do you take up too much time but you want to be seen more often than once every 3-4 months or twice a year.

  12. Thank you for all your experiences. I got a headache 13 years ago and unfortunately it still has a hold on me. I have tried several methods to relieve it including 3 sinus surgeries. I had neurological testing done showed nothing wrong (cat scan). Had suffered from depression due to OCD. Could the anti depressants medication have does this to me. I have been to chiropractors and acupuncturists, I also went to a dr who only adjusted the neck for several months. One claimed acupuncture would not work for my type of headache. I have tried butter bur and fever few for months with no relief. I was offered anti-convulsive medication which I turned down after learning they can actually cause a convulsion.Since the headache has just gotten worse the last few weeks I have been taking 800mg Motrin on a daily basic just to stop escalation of increased pain. I am now contemplating my next move. I have read that dental work could of played a part. I do notice sometimes a drink will escalate the pain. Ruled out msg but try not to have anything with it in it. I went through allergy testing also. Some people have gluten issues. Just because my attempts didn't work for me doesn't mean they won't help someone else. We are all here to help each and I support all of you sufferers out there. I know there is a cure for all of us somewhere. No one can possible know what it is like to live like this. I do wake up and thank God for another day. At least I am here and do what I can.