Migraine and Mental Health Webinar

0:08 on behalf of migraine canada
0:10 i’m wendy gerhart and i’m i’m happy to
0:12 be
0:13 hosting this with with susan cape this
0:16 evening
0:17 and i’m just going to share a little bit
0:19 of information about migraine canada
0:21 do brief introductions and then pass it
0:23 over to susan for
0:25 the presentation that you tuned in for
0:28 i just want to recognize our supporters
0:30 um without
0:32 uh these supporters the various webinars
0:35 that we are able to hold and the
0:36 resources that we’re able to develop
0:38 wouldn’t be possible so i just want to
0:40 quickly recognize them
0:43 today as i as i just mentioned just a
0:44 brief overview of migraine canada
0:46 um uh susan cape is going to talk to us
0:49 a little bit about
0:51 migraine and mental health regaining
0:52 control over your life post-migraine and
0:55 then of course
0:56 open it up to to your questions and
0:58 answers
1:00 who we are migraine canada is a new
1:02 organization
1:03 uh it was um uh it
1:06 it was inaugurated in 2018 so we’re very
1:10 new
1:11 much to my chagrin when i joined
1:14 migraine canada who i would
1:16 thought that there would have been an
1:17 organization like 25 years
1:20 in the making um supporting patients to
1:22 learn it was two years old i was
1:24 hugely shocked and in dis dismay
1:28 that there there hadn’t been something
1:30 um long term to support patients and
1:33 you might as i talk you might uh sense a
1:36 bit of
1:37 eagerness in me trying to catch up for
1:40 lost time and supporting the community
1:42 we are federally registered as a
1:44 not-for-profit organization
1:46 we are seeking our charitable status
1:50 our our board we are led by a board of
1:53 volunteer individuals comprised of
1:56 individuals living with migraine and
1:58 also some health care professionals
2:00 who who donate a lot of dedicate a lot
2:02 of their their time
2:03 to support the community and really try
2:06 to build this organization
2:08 i represent the organization as their
2:11 executive director
2:12 and we have several volunteers who
2:14 really really
2:15 help pave the path to
2:19 making things happen in the background
2:21 and bringing
2:22 um incredible programs and and
2:26 resources uh to the community
2:29 very quickly um i’ll just go into you
2:32 know our mission is really to improve
2:33 the lives of canadians with migraine and
2:35 to
2:36 and other headache disorders through um
2:38 four
2:39 five five pillars actually awareness
2:41 support education
2:42 advocacy and research um and again here
2:46 are
2:46 our strategic pillars i’m not going to
2:49 go into
2:50 depth we will be posting a
2:54 a a shortened version of our strategic
2:56 plan on our website shortly so i
2:58 encourage you to visit that
2:59 and learn more about really where our
3:01 focus is and our efforts are being set
3:04 to support the community
3:06 um very briefly call to action please
3:10 if you’ve not already signed our
3:11 petition um
3:13 to join our growing community please do
3:15 so it’s
3:16 available off of our homepage of our
3:18 website
3:20 and really with that brings you your
3:23 name into our petition that that gives
3:25 me the ability to
3:27 represent a larger voice of canadians
3:30 living with migraine and headache
3:33 conditions
3:34 and it also gives you the opportunity to
3:38 receive
3:39 updates on new information on our
3:42 website
3:43 the new events that are happening and
3:46 that kind of thing so i encourage you to
3:47 become a part of our community
3:49 um we don’t have a membership so this
3:52 parsee is really our membership
3:54 and we do want to make sure that it’s
3:56 growing and we’re meeting the needs of
3:58 the community and i just encourage you
4:01 to watch our website for
4:03 um more uh more
4:07 more more of our webinar series as we
4:10 launch them
4:11 um we are planning to hold you know kind
4:13 of one
4:14 per month over the course of 2021 with
4:16 the exception of the summer months where
4:18 we hope you’re out enjoying
4:19 some nice time with family and friends
4:22 maybe in our
4:23 depending on covid but uh we’re
4:25 definitely planning to hold regular
4:27 webinars
4:28 so there they will be posted as we
4:29 confirm details on our website
4:32 and just uh just as a disclaimer we
4:35 provide information not medical advice
4:37 the information presented and discussed
4:39 might not apply to your own medical
4:40 situation
4:42 always discuss medical treatments with
4:44 your own health care provider who knows
4:46 your medical history
4:47 and this is also related to
4:50 sort of the mental health piece that
4:52 susan’s going to talk a bit about
4:55 with with regard to mental health so
4:56 always have that conversation with your
4:58 health care provider
4:59 and with that i’m just going to briefly
5:02 introduce susan
5:04 so susan cape is a second year phd
5:06 student at mcmaster university
5:08 in the school of social work she
5:10 research she received her
5:12 ssw diploma from mohawk college in 2004
5:16 after working in the social service uh
5:18 field for many years
5:20 completed a ba in human services from
5:22 alabaska university
5:24 in 2016 and an m.a in gender
5:27 studies and feminist research from
5:29 mcmaster university before pursuing
5:31 doctoral studies while susan has worked
5:34 in various non-profit environments she
5:36 spent most of her career working in
5:38 women’s services
5:39 in the in the area of addiction and
5:41 mental health
5:42 her therapeutic training and trauma
5:44 informed care and feminist
5:46 counseling has led her to question
5:48 traditional forms of service delivery
5:51 of service delivery informed by the
5:52 medical model which she has been
5:54 foundational to her research and
5:56 practice
5:57 susan now operates her own private
5:59 practice
6:00 um in hamilton community and developed
6:04 facilities um a local support group for
6:07 migraine patients
6:08 and with that i will turn it over to
6:10 susan to
6:13 take us thank you
6:17 no problem i’m just gonna share my
6:19 slides here
6:22 hopefully this works okay everyone can
6:25 see that
6:26 yep okay excellent um
6:30 so thank you for that introduction i
6:32 just want to thank migraine canada for
6:34 inviting me to speak tonight
6:35 um if i’m looking down it’s because i do
6:38 i write things out as if it’s a
6:39 conference presentation it’s just
6:41 how i often do these things um
6:45 but i wanted to talk just a little bit
6:47 um
6:48 let’s do an intro sorry this is not
6:52 ah there we go just wanted to do a bit
6:54 of an introduction
6:55 um because i’m speaking to you today not
6:58 just
6:59 as a researcher and not as a social
7:01 service worker
7:02 but as someone who’s been struggling
7:04 with chronic migraine for close to 16
7:06 years
7:07 myself and for at least 14 of those 16
7:10 years and in connection to my migraines
7:12 i’ve also been struggling with
7:14 various emotional challenges which have
7:16 been clinically defined by my physician
7:19 and allied health professionals like
7:21 social workers
7:22 using various labels and diagnoses such
7:25 as
7:25 generalized anxiety disorder and social
7:28 anxiety disorder obsessive-compulsive
7:30 disorder health anxiety disorder
7:32 dysthymia depression
7:34 agoraphobia and panic disorder and while
7:37 i might at different times experience
7:39 symptoms of these many disorders i’ve
7:41 always been a bit troubled by our need
7:43 to
7:44 label feelings behaviors and reactions
7:47 in this fashion
7:48 and i’m also troubled by the idea that i
7:50 have so much disorder because
7:52 when i really lay it out there like that
7:55 um
7:55 like i just did does that make sense do
7:58 i actually have
7:59 all of these disorders i don’t know but
8:02 i like to think that i don’t actually
8:04 have every disorder that makes up
8:06 all the mood disorder section in the dsm
8:09 because that’s just a little ridiculous
8:10 to me
8:11 so the reality is i experienced quite
8:15 suddenly in my mid-20s symptoms that
8:17 often left me somewhat disabled by
8:20 vertigo and visual disturbances nausea
8:23 and in later years pain and these
8:25 symptoms had no warning and they usually
8:27 occurred spontaneously
8:29 they impacted my career and my education
8:32 my family my marriage and my friendships
8:36 sorry i have a dog who’s barking and
8:39 these symptoms
8:40 dictated what i could and couldn’t eat
8:42 and couldn’t couldn’t drink
8:43 what activities i couldn’t couldn’t take
8:45 part in anymore and often left me
8:47 feeling really alone and isolated
8:49 um so over time i went from being a
8:51 young woman who felt healthy and
8:53 confident and extroverted and strong
8:55 to someone whose life was completely
8:58 derailed by
8:59 feelings of consistent shame and guilt
9:01 and chronic fatigue anxiety and
9:03 introversion
9:04 jim sir some of you have experienced
9:06 yourself so while on the surface i might
9:09 legitimately fit the bill as someone
9:10 who’s suffering from concurrent mental
9:12 health disorders
9:14 it became clear to me over the years
9:15 that what i was and still
9:17 am suffering from are the effects of
9:19 trauma
9:21 and so experiencing a traumatic event is
9:24 something
9:24 that has a significant impact on our
9:27 minds
9:28 and our bodies and trauma is really
9:30 subjective so what is traumatic for some
9:32 is not traumatic for other people
9:35 and our ability to work through
9:36 traumatic experiences greatly depends on
9:39 how we’ve been socialized our genetic
9:41 predispositions
9:43 access to resources and supports and in
9:46 general terms people often associate
9:48 trauma with
9:49 poor veterans or people who have
9:51 experienced significant
9:52 harm so we think of those war stories
9:55 but trauma has no boundaries
9:57 the effects and symptoms of trauma often
9:59 occurs in those who have experienced
10:01 illness that has significantly
10:03 impacted their day-to-day life or that
10:05 has caused them
10:06 to fear something in their day-to-day
10:08 life and the spontaneity
10:10 and disability of migraine attacks
10:13 definitely
10:14 conditions a certain level of fear um in
10:17 a lot of patients
10:19 so as i move through this talk you’ll
10:20 notice me trying to get away from the
10:22 medical model of mental health a little
10:24 bit as much as i can
10:25 and that’s not to discount it as a valid
10:28 explanation for categorizing mental
10:30 distress
10:32 i think for some people it can be a
10:33 really useful tool
10:35 and it’s how we understand mental health
10:38 and mental illness
10:39 but it doesn’t mean it’s not without its
10:41 flaws
10:43 so in my practice i tend to use a
10:45 feminist lens
10:47 to guide in how i view and work with
10:49 those experiencing mental health
10:51 challenges
10:53 so instead of viewing those challenges
10:55 in clinical terms as
10:56 illness which denotes that there’s some
10:58 kind of problem with you as an
11:00 individual
11:01 i prefer to view emotional states all
11:04 emotional states
11:05 including the uncomfortable ones such as
11:08 anxiety and panic
11:10 sadness frustration low mood as
11:12 resulting from social environmental
11:14 and systemic sources so what that means
11:18 is that emotions are normal and human
11:21 beings are supposed to have
11:22 a varied repertoire of emotions given
11:25 different circumstances and situations
11:28 that’s how we’re built that’s how our
11:30 brains are wired
11:31 um so your feelings are valid all
11:34 feelings
11:35 and emotional states result from the
11:36 reactions and interactions our bodies
11:39 and minds have with the world around us
11:41 um
11:42 so what that means is that when human
11:45 beings experience something we find
11:46 disabling or disturbing
11:49 or out of our control we react
11:52 and that’s normal it’s normal that we
11:54 have reactions to
11:56 things that we find uncomfortable and
11:58 sometimes those reactions can impact us
12:01 in ways that are just as disabling as
12:03 our migraines
12:04 things like panic attacks are definitely
12:06 extremely disabling in addition to the
12:08 migraine
12:10 so while the medical model of care
12:11 around mental illness is quite
12:13 prescriptive and it has a set of
12:16 diagnoses
12:18 it’s focused on how your doctor sees
12:19 your problem my approach to mental
12:21 health focuses more on trying to
12:23 understand
12:24 how somebody is experiencing a problem
12:26 so how does that problem actually
12:28 come to be and what do they need to do
12:30 in order to improve their functioning
12:33 so i spent a long time being told that i
12:35 have this disorder and that disorder and
12:37 if i were to only take
12:39 this pill or that pill i’d be okay um
12:42 that i’d be happier and all it did was
12:45 invalidate my experience
12:47 as a woman who had as far as i was
12:50 concerned gone to hell and back
12:52 they knew my symptom profile they knew i
12:55 was working
12:56 and a student and a wife and that i was
12:59 trying to get through life feeling like
13:01 garbage all the time
13:03 and of course i was anxious of course i
13:05 have panic attacks
13:06 i don’t think that’s disorder i think
13:09 that’s the normal response to a body
13:12 my body deteriorating and having very
13:15 little support
13:16 no time for rest no space or resources
13:19 to address
13:20 my symptoms i had to work and i had to
13:23 make money and i had to live
13:25 and my disability and those societal
13:27 expectations were completely
13:29 at odds which is why i’ve chosen to
13:31 focus my research on looking for ways we
13:34 can make institutional change
13:36 so tonight i’m going to ask you to shift
13:38 your thinking away
13:39 a bit from i have a disorder which can
13:42 be sometimes self-limiting
13:44 and disabling in itself and i want to
13:47 focus more on our feelings and our
13:49 reactions to those feelings that
13:50 naturally come from experiencing what i
13:53 would categorize as a traumatic event
13:56 so the purpose of my talk tonight um is
13:58 to highlight a couple of things
14:01 number one the link between migraine and
14:03 mental health distress
14:04 is really really strong um so in
14:06 particular if you’re struggling with
14:08 symptoms associated with anxiety or
14:10 depression you’re not alone
14:12 many many migrainers struggle with
14:15 mental health challenges
14:17 and so this talk will hopefully provide
14:19 some insight as to why that might be
14:21 and the second thing that i want to
14:23 highlight and go over with you
14:25 are ways that you can cope with these
14:28 feelings
14:28 and sensations so i’m going to give you
14:31 some concrete tools but
14:33 only a snapshot because we obviously
14:35 don’t have a ton of time
14:37 um but there’s many different strategies
14:40 that you can use to manage
14:42 mental health distress and hopefully
14:44 these start giving you some ideas
14:48 so number one what is the link mood
14:51 disorder specifically anxiety and
14:53 depression are frequently experienced by
14:55 migraine patients
14:56 so some studies have cited depression
14:59 and anxiety disorders to be as high as
15:01 2 to 10 times more prevalent among
15:04 migraineers
15:05 compared to the general population
15:07 however this number is really really
15:10 hard to pin down
15:11 for a lot of reasons overall significant
15:14 emotional distress
15:15 experienced by migraine patients is most
15:18 likely higher than what is reflected
15:20 in most studies if not all if someone
15:23 has chronic migraine
15:25 i would be very surprised if they didn’t
15:28 experience some type of anxiety or
15:31 depression
15:32 or mood dysregulation associated with
15:36 those symptoms
15:38 every migraine patient that i’ve spoken
15:40 to who’s had chronic symptoms
15:42 struggles with those things but not
15:44 everybody reports
15:46 not everybody um speaks to their
15:49 physician about this so that’s why
15:51 sometimes it’s really really hard to
15:52 narrow down in these studies
15:54 management of migraine and migraine
15:56 symptoms becomes really complicated by
15:58 co-occurring disorders
16:00 and it’s often really difficult to
16:01 understand what disorder
16:03 is cause or consequence because
16:06 they’re really biodirectional there’s
16:09 biodirectional features of both
16:10 disorders
16:11 so that means migraines can cause one to
16:14 feel symptoms of anxiety or depression
16:17 and or anxiety and depression can
16:19 trigger the onset of migraine
16:21 so it’s really unclear if there’s a
16:22 third factor as well that might
16:24 influence or cause
16:25 both conditions to happen so for example
16:29 hormone imbalances or nutritional
16:31 deficiencies can affect
16:33 both mental health issues and can cause
16:35 migraines
16:36 it can also be really difficult to
16:38 differentiate between
16:40 some migraine and mood disorder symptoms
16:42 as there tends to be
16:43 quite a bit of overlap between them for
16:45 example
16:47 when i get migraine aura i flush and i
16:49 feel uneasy
16:50 and my heart race rate increases and i
16:53 feel really dizzy
16:55 and these symptoms also occur when my
16:57 anxiety response is triggered by
16:58 something i fear
17:00 um like speaking in front of a large
17:01 audience
17:04 but alternatively low mood and
17:06 withdrawal from daily activities social
17:08 supports and aversion to light
17:10 and dietary changes such as eating more
17:13 or less are common symptoms associated
17:15 with depression
17:16 but they’re also really common symptoms
17:18 that are associated with migraine
17:20 so what does all this mean um it means
17:23 that some patients
17:24 it’s not always clear what came first
17:26 the chicken or the egg
17:28 it also means that there’s a lot of
17:30 ambiguity here in regards to how
17:32 we define what constitutes a mental
17:34 health disorder for migraine patients
17:36 so i know in my case i never struggled
17:39 before with anxious feelings prior to my
17:41 migraines becoming chronic
17:43 my anxiety grew out of the fact that i
17:45 went misdiagnosed
17:47 for well over a year nearly two and i
17:50 had a particularly difficult time
17:52 managing my symptoms in everyday life
17:54 so i felt out of control
17:57 i thought i was having a stroke every
17:59 day and i did
18:00 all that while forcing myself to work
18:03 and pretend to be well
18:04 and eventually that took a toll on my
18:06 mind and body because i
18:08 could not keep that up but how does
18:11 anxiety and depression post
18:12 post-migraine come to be
18:14 if it happens at all and there are many
18:16 explanations for this
18:18 um some are biological and some are
18:20 psychosocial
18:22 meaning the cause is rooted in our
18:24 psychological health
18:25 and how that interacts with our
18:27 environment um
18:29 because of my background in social
18:30 service work and feminist theory i tend
18:32 to focus my attention
18:34 there on the psychosocial realm however
18:36 realistically it’s probably a bit of
18:38 both
18:39 so in terms of biology i don’t want to
18:41 go too far down this rabbit hole because
18:44 i could do an entire talk about this
18:45 alone but from a neurobiological
18:48 standpoint our brains are always subject
18:50 to change
18:52 so neuroplasticity speaks to this it’s a
18:55 term that speaks to the ability of your
18:57 brain
18:57 to form and reorganize synaptic
19:00 connections
19:01 in response to new learning or injury
19:06 and so i’ve already discussed a bit
19:08 about how our minds and our bodies
19:10 might internalize an event or event such
19:12 as having repeated migraine attacks is
19:14 traumatic
19:15 the result of this internalized trauma
19:17 might affect us in different ways
19:20 so i want to give you an example of how
19:21 biology behavior
19:23 environment all play a role in how
19:25 anxiety responses
19:26 might develop over time after migraine
19:29 occurs and this is only
19:30 one explanation of many
19:34 but there is a really famous experiment
19:37 a very unethical by today’s standards
19:39 experiment
19:40 that was done in the early 1900s called
19:43 the little albert experiment
19:45 and it’s conducted by a behaviorist
19:47 named john b watson
19:48 and was an extension of the work by ivan
19:51 pavlov’s work on classical conditioning
19:54 many of you have heard of um pavlov’s
19:57 dog
19:58 and watson wanted to demonstrate that an
20:00 emotionally stable child could be
20:02 conditioned to develop a phobia so
20:06 what he did was him and his research
20:08 assistant
20:09 had albert um who had been exposed to
20:13 several
20:13 furry animals prior with no sign of
20:15 phobia
20:16 sit close to a small rat that he could
20:19 touch and play with and every time
20:21 albert reached out to pet the rat
20:23 watson would create a loud banging noise
20:25 behind him
20:26 and so albert responded by crying out in
20:29 fear
20:30 and this pairing of albert attempting to
20:32 play with the furry animal and the loud
20:34 noise
20:35 continued until every time albert was
20:37 presented with a furry
20:38 animal even in the absence of the noise
20:41 he would cry out in distress
20:44 so what this experiment tells us is that
20:46 we can be conditioned to have anxious
20:48 responses given the right set of
20:50 conditions so classical conditioning
20:52 is one way this can play out and in ways
20:55 that we don’t even notice
20:57 so for example i had never in my life
21:00 feared going to a grocery store
21:02 it wasn’t until my migraines became
21:05 frequent that i began to experience
21:06 attacks in the grocery store almost
21:10 every time that i went shopping and i’m
21:12 not sure if it was the fluorescent
21:14 lights
21:14 or the busyness or the smells or if it
21:16 was just pure coincidence
21:19 but over time my migraine attacks would
21:22 happen
21:22 in these grocery stores and it made me
21:24 fear the grocery store so much that for
21:27 several months there’s a period in my
21:28 life where i made my husband do
21:30 all the shopping i just refused to go
21:33 and my fear also became attached to
21:35 public transportation and walking my dog
21:38 by myself more than 15 minutes from my
21:40 house
21:41 i began to have anxiety responses when
21:43 exercising after a few cardio sessions
21:46 resulted in migraine attacks
21:47 so i started to develop all of these
21:49 associations with activities that never
21:52 used to cause me distress and that used
21:54 to be
21:54 pretty normal and so while these
21:56 associations
21:58 sound irrational and they serve a
22:00 purpose
22:01 our brain makes these connections in
22:03 order to keep us safe
22:05 so sometimes too safe um so while
22:08 neuroplasticity means my brain most
22:10 likely made physical
22:12 changes in response to these experiences
22:14 this new learning in the form of
22:16 synaptic connections
22:18 i also develop behavioral changes and
22:20 perceptual changes
22:22 so trauma conditions us in several
22:24 different ways for example some people
22:26 develop obsessive-compulsive behaviors
22:28 because they feel they keep them
22:30 safe some people might isolate
22:33 themselves or avoid people in places
22:35 that aggravate their anxiety
22:37 and once we have these anxious avoiding
22:39 behaviors it can be
22:40 very difficult to get rid of them but
22:43 keep in mind
22:44 all of these changes whether biological
22:47 behavioral emotional
22:48 resulted from new learning and
22:50 experiences that conditioned you
22:52 a particular way so that means you can
22:55 change it
22:57 you can make new connections you can
22:59 condition yourself
23:00 in ways that put you back in control
23:03 simply through learning and experience
23:05 i know i make that sound super easy and
23:07 it’s not easy it takes
23:09 a lot of work and time and dedication
23:13 but hopefully we can talk a little bit
23:15 about what management look like
23:17 looks like so i can start you down that
23:19 road
23:21 so managing distressing mental health
23:23 symptoms that accompany your migraines
23:25 might take on
23:26 a lot of different forms and while
23:29 medication therapy that treats both
23:31 issues is certainly an option you can
23:33 speak to your doctor about
23:35 i want to focus on strategies that
23:37 anybody can learn to use either on their
23:39 own or in combination with medication
23:42 as mentioned earlier although i’m
23:44 discussing these treatment options
23:46 mainly as they relate to addressing
23:48 mental health symptoms
23:49 some of these strategies can also be
23:52 used to decrease the severity of
23:54 migraine attacks
23:56 cognitive behavioral therapy is the one
23:58 i’m going to start with
23:59 and they’ve actually shown through some
24:03 recent studies i’ve read some papers
24:04 that have talked about how
24:06 cbt has really helped patients
24:10 manage and cope with their migraine
24:12 symptoms
24:14 so let’s start there cognitive
24:17 behavioral
24:18 therapy so cbt is a process to
24:21 teaching coaching and reinforcing
24:23 positive behaviors
24:25 cbt helps people to identify thoughts
24:27 and emotions that are
24:29 linked with behaviors so this approach
24:32 is based on the idea that our thoughts
24:33 and behaviors
24:35 reinforce certain emotional states
24:38 for example as i continue to avoid
24:40 grocery shopping
24:42 and i continually told myself that if i
24:44 walk into a grocery store i will have a
24:46 migraine attack
24:47 this reinforced all of those anxious
24:50 feelings that i was having
24:51 and it didn’t only impact me emotionally
24:53 when i found myself having to enter
24:55 anxiety provoking spaces such as the
24:57 grocery store but at times i truly
24:59 believe that the anxiety triggered some
25:01 of the migraine attacks as well
25:04 so some of the basic principles of cbt
25:06 are
25:07 our thoughts affect our body our
25:09 behavior and emotions
25:10 um once we are aware of our thoughts
25:14 that can be monitored and altered
25:16 and emotional change can be achieved by
25:18 altering our thoughts and behaviors
25:20 so in cbt it’s really understood that
25:23 many of our issues are caused by
25:25 negative
25:25 automatic thoughts centered around how
25:28 we view ourselves
25:29 and others and our future and so for
25:32 those with depression this might
25:33 manifest as
25:34 a negative view of yourself and your
25:37 beliefs might be associated with
25:39 helplessness
25:39 failure incompetence or unlovability
25:42 and for those of you with anxiety
25:44 thoughts tend to focus on the
25:46 overestimation
25:47 of a physical threat
25:50 core beliefs are linked to things like
25:53 risk and dangerousness and
25:54 uncontrollability
25:59 so techniques in cbt for addressing and
26:02 working to change those automatic
26:04 thoughts generally requires a trained
26:06 professional to help
26:07 work through various processes and set
26:10 goals
26:11 however there are strategies used in cbt
26:13 that you can certainly practice on your
26:15 own
26:16 so the first technique requires you to
26:18 have a bit of a conversation with
26:19 yourself
26:20 so writing in a journal can be a really
26:23 wonderful tool for identifying thoughts
26:25 associated with stressful situations
26:27 and the technique would be to practice
26:29 journaling on a day-to-day basis
26:31 in order to describe events that cause
26:33 you distress
26:35 and identify any thoughts and behaviors
26:37 that accompany that distress
26:39 so the cbt work comes from reviewing
26:42 journal entries
26:43 after writing them in an attempt to look
26:45 at your thoughts objectively and make an
26:47 attempt
26:47 to problem-solve through the situation
26:50 differently
26:52 and so this might require you to
26:53 identify problematic thoughts and think
26:55 of alternative ways of thinking about
26:57 the situation
26:59 for those of you who like more structure
27:01 this is an example of a thought record
27:04 which is something we commonly use in
27:06 cbt
27:07 and it helps people to identify more
27:10 clearly thought patterns that are
27:11 associated with certain feelings and
27:13 behaviors
27:14 so the challenge isn’t just about
27:16 identifying these things but to come up
27:18 with alternative ways of thinking about
27:20 the situation
27:20 so it’s really about a process of
27:23 changing your perception around
27:24 something
27:26 another technique useful in addressing
27:28 both anxiety and depression
27:30 associated with your migraines could be
27:32 through a technique called present
27:33 activity scheduling so
27:36 this is where you would come up with
27:39 an individual plan um of activities that
27:43 you could do
27:43 that take 10 minutes or less on a
27:46 day-to-day basis
27:48 and you simply do those things so for me
27:51 i like to focus on small tasks that
27:53 provide a sense of accomplishment
27:55 that get me to engage in exercise um
27:58 and the point is that over time engaging
28:00 in small activities that promote
28:02 positive
28:03 emotions will affect the other areas of
28:05 your life where you’re struggling
28:08 something that really helped me both
28:09 personally and as a clinician
28:12 there’s a little book called the cbt
28:14 journal for dummies
28:15 it’s one of those books for dummies
28:19 um it’s a structured accessible cbt
28:21 workbook
28:22 i like that it’s in layman’s terms and
28:24 it goes through various exercises on a
28:26 daily basis
28:28 for about 12 weeks and it’s a way you
28:30 can do this type of work
28:31 self-directed so you can do it on your
28:33 own um
28:35 but cbt isn’t for everybody it requires
28:38 a lot of homework
28:39 you need to write a lot of stuff down
28:42 and that’s not necessarily for
28:44 everybody so
28:47 um that said
28:51 let’s move on to grounding techniques
28:55 so there are lots of different
28:56 meditation strategies that might be
28:58 helpful for managing both emotional
29:00 responses
29:01 and in some cases migraine symptoms as
29:03 well
29:04 um i’m going to focus on two different
29:07 techniques that help to reduce
29:08 sensations associated with intense
29:10 emotional distress in different ways so
29:12 the first one i want to talk about is
29:14 grounding
29:15 so for those who are struggling with
29:17 increased anxiety or panic
29:19 or even feelings of hopelessness that
29:21 come from depression grounding can be a
29:23 really useful tool
29:25 so browning is relatively simple it can
29:27 be done anywhere at any time
29:29 no one really needs to know that you’re
29:31 doing it i’m actually kind of doing it
29:33 right now
29:34 um so it’s a strategy to distract away
29:38 from and calm intense emotional
29:40 responses um
29:44 so things like physically
29:48 oh wait sorry i was on the right side
29:51 physically you can do things like
29:53 running your hands under cold water
29:55 or putting an ice pack on your neck
29:58 carrying an object with you in your
29:59 pockets
30:00 that you can touch or hold in times of
30:02 stress or engaging and stretching
30:04 exercises
30:06 there are also mental grounding
30:08 techniques that you can use these are
30:09 things that i actually really like
30:11 so going through the alphabet and coming
30:13 up with a name for each letter like
30:15 listing as many tv shows or movies as
30:17 you can or reading the letters off of a
30:20 visible sign
30:21 book or paper backwards or counting the
30:24 tiles on the floor
30:26 um counting anything really one of the
30:28 things that i used to really
30:29 do a lot is i would get anxious on the
30:31 subway so i would
30:33 count the number of people on the subway
30:35 car or i would count the number of empty
30:38 seats on the subway car
30:39 depending on the night or the day
30:43 so when i worked in still in the
30:44 non-profit sector i’d often have clients
30:47 come to my office and distress
30:49 and sometimes they would be having
30:50 full-blown panic attacks and i’d start
30:52 to ask them
30:54 random geography and math questions and
30:56 at first they’d just look at me like i
30:58 was crazy but they’d go with it
31:00 um and after they started to calm down
31:03 they kind of understood what i was doing
31:06 so while grounding techniques bring us
31:08 back to the present moment it has a
31:10 reputation for being a technique that is
31:12 focused
31:12 on lessening intense feelings and
31:15 symptoms through distraction
31:17 and that doesn’t always help so
31:18 sometimes
31:20 you know you’re in the moment and you’re
31:22 having anxiety and you try to distract
31:26 and the fact that the grounding isn’t
31:27 working fast enough
31:29 might actually make you feel more
31:31 anxious
31:33 so mindfulness is another strategy
31:38 and it’s about trying to feel present in
31:41 a given moment and accepting what’s
31:43 happening around you
31:45 in doing so without judgment so regular
31:47 practice of mindful meditation has been
31:50 shown to have a significant positive
31:52 impact on the brain neurologically
31:55 and those who practice it tend to feel
31:56 more at ease with intense emotions
31:59 and even physical distress so for years
32:02 i struggled with two types of panic
32:05 one type of panic was legitimately
32:07 caused by my anxiety and had very
32:09 specific triggers
32:10 and for those situations i would ground
32:13 myself successfully
32:14 reminding myself that adrenaline would
32:16 decrease and all would be well
32:17 in a few minutes but then there were
32:20 other situations
32:21 and some of you might relate to this
32:24 where
32:25 i started to get an anxious feeling and
32:28 it would occur
32:29 before my migraines would start to
32:31 happen so
32:32 i don’t know if any of you have had this
32:34 before stomach flu or before your
32:36 migraines but i just
32:37 i had this feeling that something was
32:39 off and i might
32:40 start to pace and feel fidgety and i
32:44 don’t really know
32:45 why those feelings are happening um but
32:48 then migraine aura would set in
32:50 afterwards and my migraine would follow
32:52 its normal course
32:54 and i have no control over that feeling
32:56 um it’s attached to my migraines
32:58 and it doesn’t matter how much i ground
33:00 myself it goes away in its own time and
33:02 it feels like
33:03 so how do i deal with this so although
33:06 it might seem counterintuitive making
33:08 peace with those feelings
33:10 i found was really really important and
33:12 i remember being on a bus on the way to
33:14 work one day
33:15 and my heart started to race and i had
33:18 that adrenaline feeling in my stomach
33:19 for no reason
33:20 and i tried to ground myself and it just
33:22 wasn’t working
33:24 so i flipped the script and i told
33:26 myself this has happened many times
33:27 before
33:28 and nothing bad has ever happened to me
33:30 outside of feeling uncomfortable
33:32 and i focused on my breathing and
33:34 resisted the urge to think about worry
33:36 clench my body
33:37 or control what’s happening and i
33:39 continually brought myself back to
33:40 focusing on the sensation of my breath
33:43 going in and out of my lungs
33:45 and when needed reminded myself of the
33:47 need to just let go of control
33:49 which is really hard to do so
33:52 mindful breathing and meditation focuses
33:55 on staying present in the moment that
33:56 you’re in
33:57 and it teaches us to focus on the
33:58 process of controlling the breath while
34:01 thoughts are observed at a distance not
34:04 judged
34:05 they’re just allowed to pass um mindful
34:07 meditation emphasis
34:08 um is on letting go of control and
34:11 embracing the current
34:12 feeling even though it feels terrible
34:15 and again this is a strategy that takes
34:17 practice and time to learn
34:19 there’s an app called headspace on em
34:22 from android and um apple that you can
34:26 access and they actually
34:27 go through different types of mindful
34:30 breathing exercises and meditations
34:32 and now they also have a netflix special
34:35 called headspace as well and i believe
34:37 they discuss mindful meditation on there
34:40 if you’re more of a visual person
34:44 um and that brings me to my next slide
34:46 about exposure therapy
34:48 so this one’s interesting to me um
34:52 exposure therapy is really crucial for
34:54 those who train themselves to avoid
34:56 certain situations or places for fear of
34:58 having anxiety or a migraine attack
35:02 so this is really tricky because we
35:04 train ourselves to avoid triggers and
35:06 this can be really
35:08 useful as a strategy for decreasing
35:09 migraine attacks but we can’t avoid
35:12 everything
35:15 and we always risk being triggered when
35:17 we leave our homes
35:19 um you know so whether or not i get
35:21 debilitating migraine depends on various
35:24 factors such as how well my meds are
35:25 working that day and how sensitive my
35:28 threshold is that day
35:29 and there’s always someone wearing a lot
35:30 of perfume or someone who smokes or
35:33 fluorescent lights and i can’t control
35:35 these things
35:36 so true exposure therapy is generally
35:38 used for
35:39 anxiety disorders such as agoraphobia
35:42 and typically operates under the
35:43 principle that the anxiety will be
35:45 extinguished with increased exposure to
35:47 stressful situations
35:49 but with migraine it serves a slightly
35:51 different purpose and therapy is a bit
35:53 more involved and to be honest
35:55 i have yet to find a therapist who has
35:58 or can
35:58 tailor exposure therapy for those who
36:01 have chronic relapsing physical
36:03 conditions that in some people can cause
36:05 agoraphobic tendencies i mean i do
36:09 and if you know of anyone who does
36:11 please maybe write it in the chat or
36:14 let me know because this is a really big
36:16 issue for this community
36:18 so the reality is we have chronic
36:20 migraine
36:21 will experience symptoms in public it
36:24 will always be a reality for us and at
36:26 times those symptoms
36:28 are going to be brought on by something
36:29 going on in our environment or they
36:31 might just happen randomly
36:32 and they might always feel terrible so
36:36 i’ve had to develop my own take on
36:37 exposure therapy
36:39 and instead of the typical goal of
36:41 extinguishing uncomfortable symptoms
36:43 over time
36:44 this adaptation focuses on exposures
36:47 that help
36:47 us to realize it won’t happen every time
36:51 we engage in a particular activity which
36:53 i think was a big
36:54 fear for me um many years ago and also
36:57 even if it does we can handle it and we
37:00 can still live our lives
37:01 and and do the things that we want to do
37:05 so this is something i struggle with
37:07 every day
37:08 um i’ve had migraine or on the way to
37:10 work a few times that resulted in me
37:12 temporarily losing my eyesight or having
37:14 severe vertigo
37:16 and as a result i’ve fallen in public um
37:19 and i’ve been walking my dog it started
37:21 to happen and i’ve had to just sit down
37:23 on the sidewalk
37:23 and the curb and just wait for it to
37:25 pass despite feeling self-conscious
37:28 about sitting on the curb in a
37:29 neighborhood other than my own
37:31 um i avoided the movies for years
37:33 because every time i went i would end up
37:35 getting nauseous
37:36 and i’d get a pounding headache and i’d
37:38 get vertigo
37:40 and so this caused me a lot of anxiety
37:42 so what i found that avoidance though
37:44 only made those feelings worse
37:47 especially the anxiety
37:49 and the more i avoided activities and
37:51 triggered that triggered my migraines my
37:53 anxiety grew and my world became much
37:55 much smaller so exposure therapy taught
37:58 me that i’m much stronger than i give
37:59 myself credit for and it trained me to
38:01 accept
38:02 the belief that my migraine and anxiety
38:05 are symptomatic
38:06 and that they weren’t actually going to
38:07 cause me any real harm
38:10 so while there are traditional
38:11 techniques associated with traditional
38:13 exposure therapy
38:14 honestly there’s really no best way to
38:16 do it you can start small
38:18 and put boundaries around certain
38:20 activities to start
38:21 if you have been avoiding something for
38:23 a really long time
38:25 so for example when i want to start
38:26 going back to the movies again
38:28 i literally just went to the movies and
38:30 i stood in the lobby
38:32 for half an hour and just dealt with my
38:35 feelings of anxiety
38:37 and then i gradually started to go to
38:39 movies during off times when there
38:41 wouldn’t be a lot of people
38:43 and i went to shorter movies and then i
38:45 just kind of jumped in
38:46 and said i’m going to the movies and if
38:49 i have a migraine attack or i feel
38:51 anxious
38:53 i’m just going to sit there and i’m
38:54 going to deal with it um and so i did
38:56 that
38:57 with supportive people um and that’s how
39:00 i managed to get through that situation
39:04 so i mean this is an area as well that
39:07 if you have a therapist
39:08 it would be helpful to do this with them
39:11 however you can do some of these things
39:14 on your own and if you have supportive
39:16 people in your life
39:17 that you can reach out to to help with
39:19 this process
39:21 then you should um so generally a
39:24 mixture of exposing ourselves to our
39:26 fears
39:27 and taking stock of how our thoughts
39:29 contribute to how we’re feeling and
39:30 altering them to be more positive and
39:32 staying present will probably
39:34 offer us the best results which brings
39:36 me to the last point
39:38 um which is around self-care and
39:39 defining what is self-care
39:42 so i think this is probably one of the
39:44 most important pieces of recovery
39:46 and self-care is basically anything you
39:48 do in order to be good to yourself
39:50 sorry i think i missed a couple of
39:52 slides
39:54 it encompasses various practices you
39:56 engage in that help you to cope with
39:58 stress both acutely and preventatively
40:00 um so by engaging in care practices with
40:03 yourself you tend to feel more
40:04 productive
40:05 you have improved resistance to illness
40:07 and better physical health and your
40:08 self-esteem goes up
40:10 and you become more self-aware and tend
40:11 to have healthier relationships
40:13 um self-care falls under these five
40:17 categories and i know often people talk
40:20 about self-care in terms of things
40:22 like i have a bubble bath or
40:26 um you know i like to make sure that i
40:28 eat a proper diet or exercise
40:30 and and that’s usually how it’s
40:32 discussed
40:33 but self-care can also be more
40:36 challenging
40:37 so self-care can be things like setting
40:39 boundaries and saying no to other people
40:42 self-care can be addressing
40:46 things that you’re doing that might help
40:48 you self-medicate in the short term
40:50 but might cause you problems in the long
40:52 term so if you’re using substances
40:55 that aren’t good for you if you are
40:58 self-medicating with certain behaviors
41:00 like gambling or sex or
41:02 other types of addictive behaviors um
41:06 then those are things that you might
41:07 need to address in terms of your own
41:09 self-care
41:11 so that accounts for self-care as well
41:13 um
41:14 and i also think a really big part of
41:16 our recovery
41:18 is to build support
41:21 and in order to be resilient we really
41:23 need support around us
41:25 to help us cope and feel safe so
41:28 i struggled immensely with the fact that
41:30 there were no in-person supports for
41:31 migraine patients
41:32 and when i did find a large community
41:35 online
41:36 that was awesome but i still felt like i
41:39 was missing a deeper connection with
41:41 others
41:42 who could understand what i was dealing
41:43 with and i really wanted to develop
41:45 actual relationships with people that i
41:47 could see in person
41:49 and maybe support each other as we tried
41:51 to get through
41:52 what was going on um so i started an
41:56 in-person support group in the hamilton
41:58 area
41:59 but unfortunately due to covid we
42:01 haven’t really been able to meet
42:03 we’ve tried some virtual groups and i’m
42:05 hoping to try some more
42:07 and hopefully we’ll get back to that
42:09 when all of this coveted stuff
42:11 is over um but in the meantime if you’re
42:15 interested
42:16 in connecting with us we’re on facebook
42:18 at migraine support hamilton
42:20 and area so if you want to stay updated
42:22 about
42:23 you know whether or not we go back to
42:25 in-person groups at st
42:26 joe’s that would be a great place to do
42:28 it and
42:30 also in terms of other supports i
42:33 started a group on facebook called
42:35 migraine support face-to-face
42:37 um hoping to take those virtual zoom
42:41 support groups more globally and we’re
42:43 actually having our first
42:45 support group on thursday afternoon if
42:47 anyone is interested
42:49 but also there are various other
42:51 facebook groups that
42:53 are very very supportive um and can help
42:56 if people want to stay connected
42:59 i also want to talk a little bit about
43:01 counseling and crisis services
43:03 um and this is more within a canadian
43:05 context
43:07 but those of you who have a family
43:09 physician who see your doctor
43:11 they might provide access to a counselor
43:13 that’s covered by your provincial health
43:15 insurance so i know
43:16 in hamilton for example we have the
43:19 family health team
43:20 and usually there’s a social worker who
43:22 works within the health family health
43:24 team
43:25 that you can be referred to there’s an
43:27 employee assistant program
43:29 that many people have under private
43:31 benefits who
43:32 also offers counseling services that
43:35 could be provided to you
43:37 and there are some resources i’ve listed
43:39 here
43:40 that are canadian and ontario
43:44 relevant that are also free um
43:47 and depending on the city or region that
43:49 you’re in there might be community
43:51 non-for-profit agencies that offer free
43:53 counseling and services as well so i
43:55 know
43:55 example again in hamilton
43:59 there is family services and catholic
44:01 family services
44:02 who offer usually free dropping
44:04 counseling
44:06 for those of you who are interested in
44:08 private counseling i do have a private
44:10 practice called mending minds in
44:12 hamilton
44:13 however um i’m doing all of my
44:16 counseling um virtually these days over
44:19 zoom
44:20 and i am licensed to work with anybody
44:23 in ontario um so if anyone is interested
44:26 in connecting with me
44:27 that way um i’ve also listed my
44:30 information
44:30 but if you’re also looking for a private
44:32 counselor
44:34 um in canada and the u.s psychology
44:36 today is a really good resource
44:38 and they have a great listing of many
44:40 different therapists
44:42 um that do lots of different types of
44:44 therapy
44:45 and the on the ontario association of
44:47 mental health professionals also has a
44:49 really good directory
44:51 as well um
44:54 and for those of you who want to stay up
44:55 to date about my research i’ve started
44:58 an instagram page called
44:59 migraine scholar canada and on this page
45:02 i’m posting
45:03 you know my publications i’m talking
45:05 about the research
45:07 process that i’m doing i’m talking about
45:09 my journal
45:10 my journey as a migraine or trying to
45:14 do all this stuff and what that’s like
45:17 for me and how do i manage it how do i
45:19 get through it
45:20 um and also if anyone just wants to
45:22 connect after this presentation and have
45:24 a conversation about anything informally
45:26 um you could send me a dm through um
45:29 instagram as well
45:32 so um i spent a considerable amount of
45:36 time working in addiction care like when
45:38 you were saying
45:39 and something that’s often said in
45:41 12-step programs is
45:42 you’re not responsible for your
45:44 addiction but you are responsible for
45:46 your recovery
45:46 and that always really sat with me um so
45:49 i feel that really translates well in
45:51 our circumstances
45:53 that it’s not our fault that we have
45:55 migraines and it’s not our fault that we
45:57 might develop coping or emotional
45:59 responses
46:00 along the way resulting from having to
46:02 deal with migraine but
46:04 i do think it’s our responsibility to
46:06 find ways of working through these
46:07 challenges as best we can
46:09 so that we can get the most out of life
46:12 um and that recovery will look
46:14 different for different people it’s a
46:16 very individual process
46:18 and i really hope this talk has provided
46:21 you some useful information that you can
46:23 take with you
46:24 um as you start your own journey
46:28 and that’s all i have for tonight i’m
46:30 i’m happy to answer any questions
46:33 great thank you very much susan