I was sixteen or so and had absolutely no idea what was wrong with me. Laying face-down on the couch in my parents’ living room with the lights out, I remember stuffing my throbbing head between the cushions. Nothing could kill the pain.
I was half convinced that my brain and my heart had temporarily switched locations. My newly-transplanted heart, I imagined, had gotten cozy behind my right eye and it stabbed my optic nerve with each beat.
Put simply, migraines aren’t just painful — they can be scary. I’m about halfway through Dr. Carolyn Bernstein’s The Migraine Brain, and even after 11+ years of suffering from at least 2 or 3 migraines per month, my storehouse of migraine-related knowledge has increased threefold thanks to this book.
Migraines aren’t just bad headaches — they’re a complex neurological disorder that involves far more than just head pain. They’re something like a four-act play.
A four-act play that, in my case (and perhaps yours), can invite anxiety and panic.
ACT I: PRODROME
Eerily, this stage can start up to two days before the migraine pain even hits. It’s full of weird and disconcerting bodily symptoms that can easily trigger anxiety and/or panic: unusual fatigue, stomach upset, difficulty finding the right words to use, and — get this — slurring your words.
Slurring. How uncomfortably stroke-like, right? (My heart just seriously palpitated as I typed out that last line.)
My big prodrome symptom is a creepy-crawly tingly sensation on my scalp. It comes in waves, repeats every few minutes or so, and freaks me out every time.
ACT II: AURA
Some people get visual or other sensory changes about a half hour or so before the migraine pain hits. I’ve gotten visual auras only two or three times, but I can liken my own to a squiggling paramecium-esque artifact filled with black-and-white television snow. You know, from back in those analog broadcasting days, like this:
If you’re really unlucky, you’ll also experience tunnel vision, mosaic vision, or Alice in Wonderland-style distortions in this phase. Or allodynia. Or tingling in your scalp or skin. Or, worse yet, partial paralysis of your limbs.
Not only are these symptoms alone uncomfortable enough to cause panic in sensitive individuals, but if you know that a migraine is about to start (and you’re not in a good location for a migraine, like at work or on a sunny beach), that can raise your anxiety level as well.
ACT III: PAIN
This is the stage that most people consider to be the actual migraine. The headache, the pounding, the nausea, the sensitivity to light and sound, the vertigo — yeah, that classic stuff falls right here.
Depending on what your triggers are, this stage can potentially orchestrate panic, too. If your panic triggers include pain, nausea, or vertigo, then this stage has the power to set a panic attack into motion. (Nausea does it for me.)
ACT IV: POSTDROME
This is the “migraine hangover” stage. It can last a few hours or it can last a few days. Biochemically, Bernstein notes, postdrome occurs as the body resets itself from the electrical abnormality of migraine.
Unlike a hangover from too much booze, a migraine hangover can produce both uncomfortable effects and very satisfying ones. The bad effects: fatigue, depression, tender skin, and a bladder that constantly wants to be emptied. The good effects: a sense of elation, freshness, or renewal.
So, what can you do to reduce the chance that a migraine will trigger a panic attack?
If you’re working with a therapist, make a list of your panic triggers on one piece of paper and a list of your migraine symptoms on another. Circle the items that appear on both lists, and tell your therapist that you want to make coping with those symptoms a big priority in your treatment.
After all, a panic attack is bad — but a panic attack while in the midst of a migraine is worse.
Check out Dr. Carolyn Berstein’s interview on NPR’s Fresh Air here.