Webinar on Mental Health and Migraine

0:00 i think that’s it is that okay that also
0:02 works yeah go ahead okay
0:04 so
0:05 they’re in the room
0:06 um i’m really honored to be here
0:09 presenting to this audience um about two
0:12 things that are near and dear to me
0:16 because both mental health
0:20 and migraine have really been the
0:23 foundation of my own
0:27 professional practice for 20 years i
0:30 would say
0:31 and i have found it a very rewarding
0:35 career
0:37 and a very rewarding
0:40 population to work with and to work in
0:42 the field of chronic pain
0:44 as a psychologist as a health
0:46 psychologist it’s really wonderful so i
0:48 really
0:50 love that i’ve been invited here and i’m
0:52 really happy to share whatever i can
0:56 to be helpful to the efforts of migraine
0:58 canada
1:00 so i think uh randa we have a survey i
1:02 think i would move to our own little
1:04 survey it is a little bit of a repeat
1:06 from what uh rando started with which
1:09 was if you join the call can you please
1:11 just you know tell us where you’re from
1:13 we have a question about where you are
1:15 from want to see where people are from
1:17 where are you joining us from and we
1:19 have all of the canadian provinces
1:21 covered and then we have other
1:24 to account for anybody who’s outside of
1:26 canada or maybe in one of our
1:28 territories
1:29 so
1:31 if you can just take a moment fill this
1:33 out this helps me also know who i’m
1:36 speaking to where at least you are from
1:40 the people that are here
1:42 yeah okay i guess i should
1:45 i’m not sure if i answer that i don’t i
1:46 don’t think i’m answering
1:48 a host and panelist cannot vote okay i
1:50 tried to click mine but it won’t matter
1:52 yeah okay we’re getting um
1:56 we got about 31 86 participation percent
2:00 participation that’s great
2:03 i’m gonna end that
2:04 so we can see
2:09 okay ontario and then alberta
2:12 how interesting so we’ve got
2:15 and then the other so we’ve got quite a
2:16 few from outside as well
2:19 all right well wherever you’re from
2:21 welcome here
2:22 um our second question randa let’s
2:25 load that one up
2:27 is
2:27 are you someone that has migraines
2:32 so here comes the second survey one
2:35 second i’m launching that go ahead okay
2:38 are you a person with migraine
2:40 yes or
2:48 no and
2:52 we’ll see randa i’m sure you’re getting
2:54 quick responses very quick very quick we
2:57 got 94 participation that’s really great
3:01 let’s see with the prevalence of
3:03 migraine is among this group okay
3:07 74 i mean 76
3:09 yes
3:10 24 no so
3:12 when i speak about migraine i am talking
3:15 to people that know what i’m talking
3:18 about from personal experience
3:21 all right that’s really really uh
3:23 helpful those statistics for me to know
3:27 i’m gonna
3:29 now switch over to just a few more
3:34 opening remarks oh
3:38 doesn’t that look like
3:43 my slides you’re not advancing
3:47 oh there we go
3:49 okay
3:50 maybe
3:51 my my technology deficit was concerning
3:54 me there for a moment okay so just a few
3:58 opening remarks i think that my goals
4:01 for this talk are really aligned well
4:03 with those strategic pillars that randa
4:05 was talking about for migraine canada
4:08 particularly around awareness and
4:10 education
4:11 so i want to bring some education and
4:13 information about migraines and mental
4:15 health to you
4:17 i want to review the signs and symptoms
4:20 of a mental health problem
4:23 tools for improving mental health
4:26 what options there are available for
4:28 help
4:29 and then some tips for taking the next
4:32 step whatever that might be for you
4:35 and ultimately my last point here is i
4:38 want to provide
4:39 people that are on this
4:41 zoom meeting some hope and encouragement
4:44 this is my ultimate goal i want you to
4:46 leave this time being encouraged and
4:49 with some renewed hope that you’re not
4:51 alone
4:52 particularly if you are struggling with
4:56 a mental health issue or a problem
5:00 all right so
5:01 before we jump into the convergence of
5:05 migraine and mental health i just want
5:06 to do a bit of a step back and let’s
5:08 look at just some basic
5:10 statistics of both migraine as well as
5:14 mental health so
5:16 migraine prevalence in canada fifteen
5:18 percent roughly for women and around six
5:21 percent for men it’s a really common
5:24 health problem
5:27 um for those that are from the us i
5:30 think the us is pretty equivalent
5:33 uh sitting at around 12
5:35 overall and that’s combined men and
5:38 women so really really similar stats
5:40 and i suspect that the industrialized
5:42 countries are all very similar
5:45 um with those prevalence rates now let’s
5:48 maybe look at mental health problems and
5:51 i did include these as pre-pandemic
5:53 statistics because i’m going to show you
5:55 the pandemic
5:56 statistics in a moment but pre-pandemic
5:59 what about mental health problems
6:02 in canada depression
6:04 prevalence ranges between anywhere
6:06 between five
6:08 point four percent and eleven point
6:10 seven percent
6:12 and this is up to you get this this is
6:14 up to three times higher among young
6:17 adults so the 18 to 29 year olds
6:20 we know that not just for depression and
6:22 anxiety but for a whole host
6:25 of mental health problems that young
6:28 adulthood is a really vulnerable time
6:31 it’s that transition between adolescence
6:33 and adulthood that seems to be
6:35 particularly
6:37 significant in in people’s development
6:40 of a mental health issue
6:43 so anxiety prevalence a little bit less
6:46 than depression prevalence
6:48 anywhere between 4.6 and 10.8 percent of
6:52 canadians and the onset of an anxiety
6:55 problem predates or comes earlier than a
6:58 depression problem
6:59 and this makes sense developmentally
7:02 because we know that anxiety
7:05 often over time if it’s untreated or
7:08 doesn’t resolve
7:10 it makes a person more vulnerable to
7:12 depression which then comes in later so
7:15 it does seem like anxiety is a bit of a
7:18 precursor to depression it’s not unusual
7:21 you talk with people who have depression
7:23 and they will talk about it starting
7:26 with an anxiety issue
7:28 and depression anxiety
7:31 go together
7:33 far more than they exist separately
7:36 so even though these are two distinct
7:39 problems more often than not they’re
7:42 like a double whammy and they occur
7:44 together
7:45 which makes it really difficult
7:48 um i am going to be focusing most of my
7:50 slides just
7:52 as another kind of caveat here i’m going
7:55 to be focusing most of my slides on
7:57 depression and anxiety and not some of
8:00 the other mental health disorders or
8:02 problems
8:03 just because depression and anxiety are
8:05 the most common and so i felt that we
8:08 couldn’t really include that umbrella
8:10 for
8:11 you know everything so we’re just taking
8:13 the ones that are the most typically the
8:15 most salient and i think especially now
8:18 because if we move on to looking at the
8:21 pandemic pandemic statistics this is
8:25 where we start to see some of the things
8:27 that probably people have already
8:29 suspected
8:30 or
8:31 have experienced which is mental health
8:34 problems are more prevalent now
8:37 in the midst of this pandemic than they
8:40 were before the pandemic so
8:43 this information is kind of
8:46 hot off the presses from statistics
8:49 canada
8:50 which
8:51 they they are equipped to do these very
8:54 large national surveys of the general
8:57 population and they did a survey of
8:59 canadians between september and december
9:02 2020
9:03 and they discovered that
9:06 one in five which is 21 of canadians
9:10 has a mental health problem
9:12 the depression
9:14 prevalence is 15
9:16 anxiety 13
9:19 and then this um this
9:23 phenomenon that we saw before the
9:24 pandemic is still present with those
9:27 young adults still
9:28 the most vulnerable and having the
9:30 highest prevalence of all so young
9:33 adults up to three times higher
9:35 prevalence of a mental health problem
9:37 than
9:38 older
9:39 adults
9:40 if we break it down simply by gender
9:43 with women and men being
9:46 considered we have one
9:48 in four women 24 of women having a
9:51 mental health problem in canada
9:53 17 of men almost one in five men having
9:56 a mental health problem in canada so
9:59 this is a substantial leap
10:02 from uh where we were in canada
10:04 pre-pandemic with those other uh
10:07 statistics i showed you earlier
10:10 so this is significant the pandemic has
10:13 really been difficult
10:15 um for a lot of people and this seems to
10:19 confirm that
10:21 how about migraine prevalence in canada
10:23 in this pandemic
10:25 that’s a question mark but i’ll tell you
10:28 my suspicion because
10:30 um
10:31 migraine
10:32 and and mental health are actually
10:35 quite linked
10:37 i would suspect that because we see a
10:40 rise in mental health problems
10:42 we probably if we did a national survey
10:45 we would also see that prevalence of
10:47 migraine going up as well so i think
10:50 that
10:51 i think we can safely conclude that both
10:54 migraine and mental health problems
10:56 are more significant in the pandemic so
10:58 if you’ve been struggling in this
11:00 pandemic with more frequent migraines
11:02 more severe migraines
11:04 as well as more
11:06 um
11:07 struggles with your mental wellness
11:11 you are not alone you’re not alone
11:15 there’s a lot of people in that same
11:16 boat
11:18 so let’s keep on going
11:20 now we’re going to turn our attention to
11:21 what i’ll call the convergence between
11:24 migraine and mental health this is where
11:25 we start to specifically hone in on
11:28 migraineers
11:30 with and mental health difficulties what
11:33 is this relationship like
11:35 so
11:36 not a surprise there is a higher
11:39 prevalence of mental health problems
11:41 among people with migraines
11:44 how big is this difference how much more
11:48 prevalent is someone with migraine to a
11:50 mental health problem
11:52 than someone else who doesn’t have a
11:53 migraine and this is the discouraging
11:56 statistic if you have migraine your risk
11:59 of developing depression and anxiety
12:02 doubles and that’s a conservative
12:04 estimate
12:06 some studies show
12:07 up to four times more likely to develop
12:10 a depression and anxiety problem
12:14 at the chronic pain center when we
12:15 looked at our
12:17 our
12:18 clients our patients in the chronic pain
12:21 center
12:22 those getting referred to that program
12:25 at least 50
12:27 had a significant depression or anxiety
12:31 problem so that’s how high that
12:33 prevalence was
12:37 so what we call longitudinal studies so
12:40 these are studies that follow
12:42 individuals for for a long period of
12:45 time
12:46 they do show that there is this
12:48 relationship between migraine and mental
12:51 health that works in both directions
12:54 so we know that the presence of migraine
12:58 increases risk for developing something
13:00 like depression and i would say anxiety
13:02 can go there too we can make that
13:04 correlation as well but it works the
13:06 other way around too the presence of
13:08 depression or anxiety
13:11 increases the risk of then developing
13:13 migraine
13:14 so it’s kind of like that double whammy
13:16 that also goes together
13:18 where
13:20 they are one makes the other worse
13:23 and then
13:25 one perpetuates
13:27 the other
13:28 and it’s this awful reciprocal uh
13:30 relationship going on between mental
13:33 health problems and migraine
13:35 and often at the chronic pain center the
13:38 question would be well which one came
13:39 first was it the migraine or was it the
13:41 mental health problem and that
13:44 over time that’s actually
13:46 often a mood question
13:48 because really what’s most important is
13:51 that both of these problems are given
13:54 their
13:54 own validation as issues that should be
13:57 addressed in their own right
13:59 so
14:01 increased screening has been recommended
14:03 because of this bi-directional
14:06 relationship between migraine and mental
14:07 health problems with treatment focusing
14:10 on both problems and that’s why having a
14:13 team approach
14:15 for addressing migraine and mental
14:17 health is often very very good
14:19 because we won’t if you can have someone
14:21 that helps you with your mood and
14:23 anxiety and then have a physician that
14:25 helps you with
14:26 your migraines and then maybe have
14:29 another practitioner i’m thinking of a
14:31 physical therapist or an occupational
14:34 therapist i worked in team-based
14:36 healthcare for
14:37 many many years still do and so i’m a
14:40 big believer in a team now if you can’t
14:42 go to a chronic pain center where you
14:45 have this team available
14:47 um i’m just throwing this in this isn’t
14:49 even in my recommendations or later
14:52 you can build your own team and i think
14:54 that can be really helpful is devise
14:56 your own team of people because you may
14:59 need more than just one
15:01 particularly if your migraines are
15:03 severe frequent and you’ve also got
15:05 mental health issues that are emerging
15:07 there too which wouldn’t be a surprise
15:10 all right so let’s keep on going i’ve
15:13 thrown around these words anxiety and
15:15 depression mental health problem but i i
15:17 i’ve been really remiss and not actually
15:19 defining them now i don’t want to spend
15:22 a lot of time going over
15:24 the clinical definitions of these things
15:27 but i do think it warrants just a little
15:29 bit of clarity around what i mean when i
15:32 say anxiety so what is what exactly is
15:35 anxiety
15:37 so when i say anxiety it’s not just
15:40 normal fear and nervousness nervousness
15:45 fear and nervousness
15:48 these are normal
15:49 experiences and i don’t want to
15:51 pathologize them um we actually do well
15:55 when we have a little bit of stress in
15:57 our lives actually our productivity goes
16:00 up we’re motivated to do things when
16:02 we’re just a little bit nervous
16:04 or a little bit
16:06 uncertain these things can be healthy
16:09 and good in our lives
16:12 um
16:13 when i’m talking about anxiety moving
16:16 into an anxiety problem think of anxiety
16:18 as having three components
16:21 and i’ll call them the cognitive this
16:23 has to do with your thoughts
16:25 often related to danger or harm
16:29 the affective which is like the emotions
16:32 such as fear or panic
16:35 and then the somatic
16:37 and that has to do with the body
16:38 symptoms of anxiety so you can think of
16:41 panic
16:42 symptoms in the body which is like a
16:44 rapid heart
16:46 shallow breathing muscle tensioner just
16:48 general restlessness and agitation
16:51 feeling on edge so think about anxiety
16:54 from the perspective of these three
16:56 components
16:58 so
16:59 when it becomes a problem we can
17:01 describe it as excessive so that means
17:05 any of these three components can be
17:08 disproportionate
17:09 to the situation that’s being
17:11 encountered so a person’s thoughts about
17:13 danger or harm can be excessive or
17:17 magnified much bigger than is warranted
17:20 by the situation
17:21 their emotions such as fear or panic can
17:24 also be excessive like they’re much
17:26 bigger or magnified than what’s
17:28 warranted by the situation
17:30 or their body symptoms can become
17:33 magnified
17:34 and excessive disproportionate
17:39 another characteristic is the
17:41 persistence so it’s not only that these
17:43 symptoms are excessive or magnified
17:47 but they last longer than is also
17:49 warranted by the situation so
17:52 um you can think about me giving this
17:54 talk i’m a little bit nervous
17:57 but let’s say that i was so nervous that
17:59 i couldn’t speak or i was paralyzed that
18:02 would be
18:03 an example of excessive
18:05 anxiety
18:06 or let’s say i after we’re done our zoom
18:10 meeting i hang up and then you know
18:12 tomorrow i’m still feeling
18:16 anxious and i’m still feeling nervous
18:19 and all that that would be a sign of
18:20 it’s persisting much longer than it
18:23 should be persisting so those are both
18:25 characteristics of what we would call an
18:27 anxiety
18:28 problem
18:31 so anxiety usually involves perception
18:34 of a threat
18:37 and it’s usually future oriented
18:41 i often characterize the students the
18:43 difference between anxiety and
18:45 depression anxiety is typically future
18:48 oriented it’s all about what’s
18:51 bad that’s going to happen to me
18:54 and depression is typically past
18:58 oriented it’s ruminating about how
19:02 i’m a failure
19:04 i’ve done bad things in my life i’ve got
19:06 shortcomings that i can overcome and
19:09 it’s more of a ruminative past oriented
19:13 way of being so this is one way to
19:15 distinguish between anxiety
19:18 and depression and so if you think about
19:19 anxiety and depression going together
19:21 it’s sort of like the past as well as
19:23 the future
19:25 are are both um
19:28 pretty difficult
19:30 uh and impacting in negative ways all
19:32 right but let’s now move on to
19:34 uh depression what is depression so i
19:36 gave you a little teaser there
19:38 depression just like we can feel normal
19:42 fear and nervousness
19:44 same thing with depression i don’t want
19:46 what’s called over pathologized
19:49 depression
19:50 feelings of sadness
19:52 grief
19:53 loss
19:55 feeling down these are normal human
19:57 emotions so that’s not what i’m talking
19:59 about when i say depression
20:01 when do these feelings though become a
20:03 problem
20:04 so depression you’ll see i’ve got nine
20:07 symptoms listed here
20:09 and in order to be identified as having
20:12 a what we call a major depressive
20:14 disorder you have to experience at least
20:17 five of
20:18 these and you’ll notice that there’s two
20:21 um with little
20:24 asterisks that means one of those first
20:27 two has to be present
20:30 it’s required in order they have to be
20:32 one of the five
20:35 and you have to have these uh
20:37 consistently for most of the day every
20:40 day
20:41 the starting point is two week period of
20:43 time which actually in my mind is quite
20:45 short typically when i’ve seen someone
20:48 who’s struggling with a depression it’s
20:50 been much longer than that but two weeks
20:52 is that entry point
20:54 if these things have been going on for a
20:56 significant in a significant way
20:59 for more than two weeks that’s a sign
21:01 that probably some help is needed
21:04 all right
21:05 i’m not going to go over each of those
21:08 i’ll hopefully i’ll let you see those
21:10 i’m just conscious of our time
21:12 i’m going to keep going
21:15 all right
21:16 so anxiety and depression become
21:18 diagnosable problems so this is where
21:20 we’re getting into what we would call a
21:22 disorder
21:24 beyond that normal fear sadness
21:28 they become a problem when they cause
21:30 significant distress
21:33 and or they cause significant impairment
21:36 in an important aspect of your life
21:39 and that can be school work
21:41 relationships
21:43 and they’re ongoing they’re pretty
21:45 typical of your experience on an ongoing
21:48 basis
21:49 these would be the key characteristics
21:52 to show that this is a significant or
21:55 diagnosable
21:56 difficulty is when you have those
21:59 symptoms but that they also cause
22:01 significant distress and impairment in
22:04 some important way in your life and it’s
22:06 not getting better it just keeps on
22:08 going
22:11 so here’s a natural question why
22:14 why are mental health problems more
22:16 prevalent
22:17 among migrant nurse for those people
22:19 that have migraines why is it that these
22:22 mental health problems are more
22:23 prevalent at least double that they are
22:26 in individuals without migraine
22:29 and i think there’s lots of um reasons
22:32 why and i’m just i’m not going to be
22:33 exhausted on them but let me give you
22:35 the ones that come to my mind
22:37 so the frequency and severity of
22:39 migraines
22:41 increases the frequency and severity of
22:44 your of a negative life impact
22:46 so look at look at these stats that
22:49 have emerged 85 percent of people with
22:52 migraine
22:53 reports substantial reductions in their
22:55 ability to do household working chores
22:58 not that we really enjoy doing those
23:00 things but
23:01 85 of people with migraines say they
23:04 have substantial reductions in their
23:06 ability to do these just normal
23:09 daily tasks
23:11 45 percent miss family social and major
23:15 activities
23:17 it’s pretty significant
23:19 and 32 percent of people with migraine
23:22 avoid making plans for fear of canceling
23:25 because they’re going to get a headache
23:27 so you can start to see how migraine has
23:30 a significant impact
23:33 on people’s basic daily lives and
23:36 functioning
23:38 and the frequency and severity of that
23:41 headache is going to mean
23:43 a greater amount of life impact it’s
23:46 like a proportional impact
23:50 people with migraines have worse mental
23:52 health although better physical health
23:55 than people with other chronic
23:56 conditions so people that have
23:58 osteoarthritis or other
24:01 chronic difficulties
24:03 people with migraine are similar but
24:06 they have worse mental health than those
24:09 and i
24:10 i would muse and wonder about that some
24:12 of my musings are that
24:17 migraine has been called an invisible
24:19 disability chronic pain and invisible
24:21 disability
24:23 and when you have a difficulty that
24:25 can’t be seen so the rest of your
24:27 physical body looks fine you don’t look
24:29 disabled at all you can walk you can
24:32 even go run into a race
24:35 or go work out you can you know when you
24:38 don’t have a migraine you are
24:41 you look
24:43 normal and even when you do have a
24:45 migraine you also can look
24:47 normal i think um it can lead to all
24:50 kinds of expectations both of the self
24:52 and from other people around
24:55 that
24:56 because of its invisible
24:58 people will have these expectations that
25:00 i shouldn’t have this level of impact in
25:02 my life i should be i shouldn’t miss so
25:04 much i shouldn’t
25:05 you know i shouldn’t
25:07 be doing more in my house
25:09 you know there’s all these expectations
25:11 that can come in there and it can really
25:13 undermine
25:15 that mental health because the distance
25:17 between reality
25:20 and expectation
25:22 is exactly the proportion of distress
25:24 that people will feel
25:26 and so i kind of i’m not surprised that
25:28 individuals with migraine will have
25:30 worse mental health than individuals who
25:31 have a more observable disability
25:36 all right maybe enough said there so
25:38 overall people with migraine and a
25:40 mental health problem have substantially
25:42 lower quality of life than those with
25:45 neither condition
25:47 so if you’ve got that double whammy
25:48 you’re going to have a really
25:50 significant impact
25:52 and
25:53 i think that that is pretty
25:55 understandable
25:58 okay so how do i know i have a mental
26:00 health problem that’s a key question how
26:02 do you know if you’ve got a mental
26:04 health issue
26:06 um maybe if you’ve been paying attention
26:09 as i’ve been talking you might be asking
26:11 yourself that question
26:13 or maybe you’ve got a suspicion about
26:15 yourself or maybe someone you know and
26:17 care about who has migraine
26:20 so let’s go back to that
26:22 criteria for it being a diagnosable
26:24 problem
26:26 personal distress so if you’re
26:28 experiencing a feeling or
26:30 you have this experience i just i feel
26:32 like i can’t cope
26:34 i feel overwhelmed i just feel like i
26:37 can’t go on
26:39 i can’t even plan
26:41 you know or think about
26:43 the day after tomorrow because i can
26:45 barely handle today
26:48 that kind of personal distress
26:51 is a pretty good characteristic of a of
26:55 a mental health problem it would fall
26:57 into this category i think of personal
26:59 distress
27:02 then that other hallmark interference in
27:04 an important aspect of life so if you
27:07 have found
27:09 that
27:11 your feelings of fear or anxiety or
27:14 stress or you’re
27:17 feeling down or sad or other symptoms
27:20 that come along with depression if
27:22 you’re finding that that’s actually
27:24 starting to interfere in your life
27:27 with an important relationship with work
27:29 with school you’re not going to school
27:32 or you’re calling in more sick to work
27:35 or
27:37 you’re avoiding people in your life
27:39 because you just don’t feel up to seeing
27:41 anybody because you just feel bad those
27:43 would be signs
27:45 in indicating a possible mental health
27:48 difficulty
27:49 and then let’s look at that other
27:51 hallmark the duration
27:53 so how long has this been going on for
27:55 you now remember i said that for a
27:57 depressive episode it’s two weeks which
28:00 is pretty short often the duration
28:03 before people go and seek help is
28:05 actually much longer
28:07 so if you’re thinking to yourself i’ve
28:09 been struggling a long time
28:12 and it’s just not getting better
28:14 that would also be another sign of a
28:17 possible mental health problem
28:22 another one i want to throw in there is
28:24 are there observable changes in your
28:26 behavior so if people noticed that
28:29 you’ve changed you’re not your usual
28:32 self
28:33 either in your demeanor
28:35 or in how you act and behave
28:40 and here’s another one the emergence of
28:43 what i might call maladaptive coping
28:46 strategies and that’s a pretty technical
28:47 word
28:49 uh unhealthy coping strategies might be
28:52 another better word
28:54 um
28:55 it’s not unusual that when people’s
28:57 usual coping strategies have been
28:59 exhausted
29:01 and maybe they’re not helping as much as
29:03 a person expects or hopes they might
29:07 start using
29:09 other
29:10 strategies often out of some desperation
29:13 for some relief or just escape and that
29:16 can include
29:18 alcohol
29:19 drugs or
29:21 other types of behaviors
29:23 and and
29:24 i threw avoidance in here because i
29:26 think about the avoidance behaviors
29:28 being withdrawing from people either
29:31 because you you’re just not motivated to
29:33 be there you’re just scared to go out
29:35 and see people those would be examples
29:37 of some
29:38 negative coping if you’re doing that
29:42 so these would be some of the clues for
29:44 you to consider if you’re wondering
29:46 about a mental health problem
29:51 do you need more clarity so here’s some
29:53 tools there are some screening tools for
29:55 depression and anxiety the most common
29:58 ones in use today are the phq-9 and the
30:01 god7 phq9 is for depression gad7 is for
30:05 anxiety
30:07 um
30:08 these you can easily google if you want
30:11 to look on the internet and these are
30:13 available to the public so they’re just
30:15 freely available in the public domain
30:18 lots of family physicians use them in
30:20 their offices to screen for depression
30:22 and anxiety problems so you can actually
30:25 find those tools yourself online you can
30:28 download them or feel it fill in a
30:31 questionnaire online about them and get
30:33 a score and you can bring that to your
30:35 family doctor to have a conversation
30:37 um you can self-monitor using those same
30:41 um questionnaires and track over time if
30:44 you’re getting better getting worse
30:46 staying the same you can start to see
30:49 you know
30:50 where am i at here with these with these
30:53 symptoms
30:54 another thing you can do is just ask
30:56 someone ask someone who knows you well
30:59 and cares about you
31:02 often people
31:03 if given permission to give you feedback
31:06 uh and you’re willing to receive it
31:09 often people have lots of really great
31:11 insights
31:12 on either confirming that yeah i’ve
31:15 noticed you’ve changed or disconfirming
31:18 and and say no i don’t think you’ve got
31:19 an issue
31:21 whatever but you can involve some other
31:23 people that you know and care for uh in
31:25 your own assessment
31:29 all right so this is uh one a
31:31 downloadable form i found on the
31:33 internet uh and it is both it is a phq
31:37 and a guide seven all in one sheet and i
31:39 actually use this with my clients in
31:41 counseling uh when we’re treating
31:44 depression or anxiety and we just
31:46 administer this at the beginning of
31:48 every session i see them so that we can
31:49 track over time how they’re doing
31:52 and this is something that you can do
31:54 too so that’s one
31:56 you’ll find other versions online too
31:59 so mental health struggles if you have
32:02 migraines and you struggle with your
32:04 mental health you are not alone
32:08 pain is not just a negative physical
32:11 experience it is a negative emotional
32:14 experience and i really wanna i might be
32:16 saying this in a way that people haven’t
32:18 really heard before but
32:20 pain by its very nature
32:23 is both physical and emotional
32:26 so when you are experiencing a migraine
32:30 you have the physical experience of the
32:32 pain
32:33 but you also by very nature of that pain
32:37 you have a negative emotion that’s going
32:39 on at the same time so pain by its very
32:43 nature is an emotional experience as
32:46 well as a physical one
32:47 so people with migraines i think will
32:50 have more frequent negative emotions
32:53 directly related to their pain
32:56 so it’ll be
32:58 the more frequent or severe your
33:00 migraines are the more frequent
33:03 and negative those emotions are going to
33:05 be that accompany that headache
33:08 now not only that people with migraines
33:10 also have all of this life impact from
33:14 their headaches so it’s not just the
33:15 negative emotions happening during the
33:17 headache
33:19 it’s all of the life impact around the
33:22 headache
33:23 that then has an emotional um
33:27 and an emotional response or it causes
33:30 an emotional response so think about all
33:32 the ways that migraine impacts your life
33:35 or a person’s life and i’ve
33:37 i’ve listed a bunch here and i can list
33:39 more so it’s a lot that people cope with
33:42 when they’re living with migraine
33:45 migraines are just an additional life
33:48 stressor
33:49 and sometimes they’re very significant
33:51 so if you think about the amount of
33:52 stress we’ve been living with in the
33:54 pandemic
33:56 start to throw on top of that
33:58 the stress of living with a migraine in
34:00 the midst of that too or lots of other
34:02 chronic conditions it’s like these are
34:04 cumulative things and the more you have
34:07 the more it’s going to be taxing on your
34:09 mental health
34:12 okay so let’s talk about some reasons
34:14 for resistance
34:18 and relaxed reluctance to seek help i
34:20 think i’m gonna maybe rifle through
34:22 these because i bet we may have some
34:24 questions to ask and i want to leave at
34:25 least 10 minutes are we really already
34:28 that close to being done okay so reasons
34:30 for reluctance to seek help sometimes
34:33 people are not ready and i just want to
34:35 normalize if you’re not ready it’s okay
34:39 uh if change is a process it doesn’t
34:41 happen overnight people go through
34:43 stages until they reach the point when
34:46 they’re ready
34:47 to reach out and get some help
34:50 there are lots of reasons why there may
34:52 be some reluctance
34:54 the one on the very bottom is migraine
34:57 specific
34:58 which is people with migraine people
35:00 will think
35:02 the typo there people will think my
35:04 migraines are psychogenic or
35:06 psychological so i think that sometimes
35:08 can affect people with migraines because
35:10 they may have been told in the past that
35:12 their migraine is just a psychological
35:14 problem
35:16 and then if they actually do develop a
35:18 psychological problem
35:20 then they may not want to go get help
35:22 because then that would just reinforce
35:25 that misconception that they have felt
35:27 and
35:28 and that’s really unfortunate i think it
35:30 can keep people with migraine maybe from
35:32 seeking help sooner
35:34 so some tips for improving mental health
35:37 lots of things so these are just
35:39 these can basically all be summed up
35:42 with uh stress management in lots of
35:44 ways managing stress so positive health
35:46 behaviors and they’re also really really
35:48 good for migraine they’re good for
35:49 mental health they’re good for migraine
35:51 exercise diet sleep reducing or
35:54 moderating your alcohol use
35:56 substances be kind to yourself
36:00 do activities that give you a sense of
36:02 achievement pleasure
36:04 have a routine
36:07 get support from others
36:09 and then finally reconnect with sources
36:12 of purpose and meaning in your life so
36:14 this can be reconnecting with faith or
36:16 volunteering giving back
36:18 having that outside
36:20 connection with something more
36:22 meaningful than ourselves can actually
36:24 do really really good things for our
36:27 mental health
36:28 and some tips
36:31 these are basic questions for
36:33 self-reflection
36:34 what are your fears what are your
36:36 beliefs
36:40 what are the pros and cons for seeking
36:42 help versus not seeking help
36:45 and what would be my advice to someone
36:47 else if they were telling me all this
36:48 stuff
36:49 that can also often be a good question
36:52 and then assess your readiness maybe set
36:54 a time frame if i still feel like this
36:56 in two weeks then maybe that’s my
36:59 trigger point
37:00 so setting a time frame can be helpful
37:05 and there are a bunch of resources
37:07 that are probably available in your
37:09 community do some research on those i’ve
37:12 listed some here public health care
37:14 your family doctor i think is probably
37:17 number one
37:19 when it comes to
37:21 looking for treatment for a possible
37:23 mental health problem
37:25 i think that
37:27 a primary care provider someone who
37:29 knows your medical history and is
37:31 already treating you maybe with other
37:33 medications this is a really good first
37:36 first line person to go and see but as i
37:38 said earlier develop a team
37:41 and that can include other people too
37:42 like counselors mental health therapists
37:45 people like me like a psychologist and
37:47 finally here’s some conversation
37:49 starters for reaching out
37:52 can i talk with you about something
37:54 sometimes it’s hard to initiate
37:55 conversation about a mental health
37:57 problem
37:59 or even if you’re not sure if you’ve got
38:00 one or not but here
38:02 our possible conversation starters
38:06 this pandemic has really taken a toll on
38:08 me
38:10 start with that or
38:11 i’ve been having trouble with my mood
38:13 lately
38:15 i’ve begun to think i might need some
38:17 help with my mental health so these are
38:19 all ways you can enter into
38:23 a conversation
38:25 and then these other resources are also
38:28 available
38:30 i’m not sure if people have access to
38:32 these slides later will they randa
38:35 um for sure okay great great because
38:38 then i can make sure people just can see
38:40 these and if they want they can access
38:42 this info later okay but we are done now
38:47 that’s great so thank you everybody for
38:49 allowing me to speak at length about all
38:52 these things i really appreciate it so
38:54 uh maybe randa i’ll turn the floor over
38:56 to you if there are any uh
38:58 questions maybe i’ll stop sharing yeah