The Brain’s Pain

I experienced my first migraine in preschool. It was my turn to be “student of the day,” which involved wearing a special sash and delivering the day’s show-and-tell — but I barely made it to lunchtime. When my mom picked me up, I told her, in tears, that a “circle” on my forehead was hurting me. Thus began a barrage of appointments, headache journals and the eventual diagnosis: chronic migraine.

More than 20 years and numerous treatments later, I’ve found a medication that works well if I take it at the first hint of an oncoming migraine. This should be simple. I’m a veteran migraineur, after all. Alas, I have trouble noticing a headache’s onset.

So, when I found a TedX talk by Casey Berglund, ’11 BSc(Nutr/Fd), something clicked. Berglund is an author and founder of Worthy and Well — a company offering business coaching centred on the mind-body connection. In her talk, she addresses two broad categories of sensation: expansion and contraction.

She explains that we experience expansion when we do things we enjoy. Expansion, she says, feels weightless and easy. It feels like growth. But contraction happens when we do things we dislike, require healing or hit a growth edge. Contraction feels heavy and difficult. It makes us feel small. Our natural reaction to feelings of contraction is to get rid of them quickly. I can relate.

Every migraine is a kind of loss. As a kid, a migraine meant I couldn’t finish my favourite TV cartoon or stay over at a friend’s house. As an adult, a migraine can mean I’m stuck in a hotel on a vacation, or I fail to fully engage with work or friends. So I’ve spent a lifetime pouring my energy into not feeling a migraine — into not listening to my body — so that life could go on. Of course I can’t tell when a migraine is starting.

Berglund suggests that surrendering to the sensation of contraction — not ignoring it — better informs your next steps. Her talk gave me a new perspective on migraines, about what it means to nourish my body by paying more attention to it, rather than feeding my chronic pain by ignoring it.

Hepatologist and U of A professor, Puneeta Tandon, ’07 MSc, addresses chronic illness holistically. While her expertise is liver disease, her research addresses the importance of “the whole person.” She and her team created Empower, a free 12‑week program for people with chronic conditions that offers online videos by medical experts, coaching and classes in meditation, tai chi and yoga, and tips on coping skills such as pacing, sleep hygiene and self-compassion.

Tandon explains that chronic illness disrupts life, causing stress, and stress feeds illness. She says there’s a lack of professional resources to manage those parts of chronic illness, and Empower fills that gap. “Empower is the best of the East and the West. People learn from these evidence-based strategies,” says Tandon. “Studies have seen significant reductions in stress, depression and anxiety, and improvements in fatigue.”

Right now, she’s running a clinical trial of the program that includes participants with conditions from digestive diseases to the side effects of cancer treatments. Participants report the value of practices they’ve learned in managing pain and stress.

Those practices bring to mind my early migraine years: my mom telling me that crying makes it worse, to try to calm down. But I was a kid, and in moments of severe pain, all I could comprehend was that it was too much. So I cried and panicked. In Berglund’s parlance, I reacted to pain with fear and rejection. Instead of working through it, as Tandon might prescribe, I pushed it away and, in doing so, fed it.

So recently, I’ve been working on some rewiring: trying to take my body’s cues seriously. That rewiring is called neuroplasticity — the ability of the brain to form and reorganize synaptic connections, especially in response to learning or following injury.

Eleanor Stein, ’84 BMedSci, ’87 MD, a retired medical doctor and psychiatrist, knows the power of the brain. She has lived with myalgic encephalomyelitis, chronic fatigue syndrome and environmental sensitivities. “As a child and teen, I was healthy and active, but I always suspected something was off,” says Stein. “I got dizzy and motion sick often, and I couldn’t do anaerobic exercise to save my life. I needed more sleep than my friends.” Her symptoms worsened until she found out about neuroplasticity, which played a part in her recovery.

“In 2014, I desperately wanted to take a trip and had no idea how I’d manage with all the chemicals and fragrances I’d be exposed to,” says Stein. “I registered for a neuroplasticity-based program, followed the instructions, and was able to increase my exposure without symptoms.” 

While Stein had already spent decades pacing her activities, improving sleep and finding the right diet, adding daily neuroplasticity practices, such as active redirection, changed her experience with chemical sensitivities and chronic pain significantly.

“To rewire the brain, you have to change how you think, feel and act,” says Stein. “This takes advantage of the first law of neuroplasticity: ‘what fires together, wires together.’ If you start consistently firing neurons in ways you want to gain strength, by reacting differently to your pain signals, the brain can learn that those signals aren’t dangerous. This calms the nervous system so new learning can take place.”

Knowing this, she changed the language she used when talking about chronic illness. She emphasized “the power of lifestyle choices like diet, pacing, sleep regimes and mindset,” and after experiencing its success, she created science-based, customized programs and resources for other people with chronic pain. 

“Patients who’d plateaued for years began to improve,” Stein says. They reported fewer crashes, less pain and an improved mood.

While there’s no magic bullet, I welcome any gain. Today, I’m better at documenting and acknowledging triggers — a practice I left in adolescence as a riddle I’d never solve. Anxiety and excitement are up there (no surprise to this former preschool “person of the day”) along with unusual triggers, like wind! I’ve taken steps, including medication, to manage anxiety and improve sleep. My lists, trials and errors, and mind-body attentiveness may always be works in progress, but I’m learning. There’s value in feeling negative sensations such as pain and stress. They help us better understand ourselves so we can better nourish ourselves.