Can Mindbody Medicine Relieve Migraines? A Q&A with Dr. John Stracks
Mindbody medicine is a treatment approach that ties together the physical, emotional, and psychological components of pain. For decades, mindbody medicine has been successfully used to treat chronic pain conditions like migraines. Recently, Dr. John Stracks sat down with us to go over the basics of this treatment option and how he uses it in his practice at Northwestern Memorial Hospital.
What is mindbody medicine, and what does it have to do with migraines?
Mindbody medicine, to me, is understanding the connection between what’s going on in our brains and what’s going on in our bodies. As human beings, we tend to express in our bodies what isn’t getting expressed in other ways, and that can come out in a variety of physical symptoms. That includes migraines and other health conditions such as back pain, neck pain, overall body pain, and sometimes anxiety and depression.
From a scientific perspective, can you explain to what’s happening in the body during a migraine
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From a scientific perspective, migraines tend to be almost an electrical storm in the brain. What we think is that when people get migraines, the nerve pathways in the brain kind of go haywire for a while, and those connect with the pain pathways, and produce the pain. Now, it turns out that there are a variety of emotional and psychological reasons that those pain pathways can get activated… and those include current stressors that are going on in our lives, strong emotions that either haven’t been expressed or haven’t been expressed completely, or memories of past experiences. When those things start, and the pain pathways get activated, it feels like all the symptoms of a migraine.
What kind of migraineurs should consider mindbody medicine as a treatment option?
Mindbody medicine can be applied to just about anyone who has migraine headaches. The limiting factor that I’ve found is that people have to be willing to accept this idea that our bodies and our head can express what’s going on in our lives. And for those who are interested in taking this mindbody approach, I’ve found that it is one of the more effective, or even the most effective treatment that I am able to provide to people for their migraines.
In your practice, do you ever recommend other treatment options for migraines? How do you see mindbody medicine ranking against those options in terms of effectiveness?
My main role at the hospital is in the integrative medicine center. So people often come to me to talk about cures for migraines when they’ve tried lots of different medications, or other standard treatments. And oftentimes when I see people for an initial evaluation, I’ll give them a ‘menu’ of options that I know can be helpful. We’ll talk about whether changing diet may be helpful, herbs and supplements, we have an acupuncturist in our office, and I’ll also talk about mindbody medicine. As long as people are generally interested in the mindbody medicine idea, I say to them “though the other types of treatments can be effective maybe 10-20% of the time, my experience has been that people who use mindbody medicine ideas and work through the program and the various exercises tend to get significantly better than any other type of treatment that I can offer."
What is your own history with this approach?
I first learned about mindbody medicine 20 years ago, because I had my own health issues that no physician could understand or cure. I had neurological symptoms in my hands and feet for about 9 months, and ended up discovering that the symptoms were there because there were significant stressors that were going on in my life at the time. After sorting that out and doing some reading and writing about the stressors, over the course of 2-3 months, those symptoms went away and went away completely. That was almost 20 years ago, I’ve never had a recurrence of the symptoms. That was before I went to medical school, so I made a vow at that time that I was going to learn everything I could about mindbody medicine so that I could use my knowledge to help other people heal from whatever kind of pain issues they were experiencing. I never had terrible migraines, but had some migraines when I was younger. Once I learned about mindbody medicine, those went away. Occasionally, I will still get the aura that goes along with a migraine, occasionally I’ll get the beginning of a migraine, but I’ll ask myself what’s going on in my life - where’s the stressor? And usually within a few minutes, whatever sensation was there has gone away.
My wife also suffered from migraines for many, many years, and spent several years dating me and several years being married to me before being willing to look at the mindbody connection. But when she did, I would encourage her whenever she got a migraine to think about what she was mad about, or what she was stressed about. And for years and years, she told me she wasn’t stressed about anything or mad about anything. But one day finally, just to appease me, she said “I’m not mad about anything, I’m not stressed about anything, but if you insist that I write it down, I will write this down on a piece of paper.” So she took out a piece of paper and on the front side started to list everything she was stressed about, and ended up going down through the whole paper and onto the back side. Then, she got another piece of paper and wrote down everything she was mad about, and once again filled up the entire side of the paper. And by the time she finished that single exercise, the migraine was gone. And that was the first time she recognized that there is a connection between stress and emotions and migraine headaches. Over the years, she has used that technique successfully many times, and so went from getting migraine headaches every few weeks to, at this point maybe once a year, if that.
What evidence do you have that this is what’s actually happening in the body?
There have been a number of studies over time that show how the mindbody connection is happening in our bodies. The evidence that I normally point to includes the fact that significant past traumas in people’s lives predict migraine headaches in adults at rates of up to 33% of the population. There are studies that have shown that various emotional aspects of the brain connect with pain pathways and can activate pain pathways and keep them active over time. There’s been a number of studies that have shown that though we try to predict who will have pain based on MRIs, we can’t predict that very well. There are a number of placebo studies that have been done showing that if we give patients sugar pills and tell them it’s real medicine, the pain pathways will deactivate just as if we had given them actual medication. There are a number of studies that show that pain pathways that go from various parts of our body to the sensory areas of our brain are significantly influenced by our emotions, and how we think and feel about the symptoms that we are experiencing.
Some people think that migraines can sometimes be a distraction from what’s going on in our lives. Can you expand on this concept a little?
As human beings, we tend to be more comfortable with physical symptoms than with psychological or emotional ones. Humans are fairly good at managing stress when it’s there, but not perfect. If the stress gets to be overwhelming for people, then oftentimes we will, at least temporarily, place the stress in our bodies (or in this case in our heads) and experience the pain. I’ve got a colleague who talks about how mindbody medicine is about making choices between what hurts and what hurts more. And there are times when the stress of the current situation is actually harder to deal with than the pain of the migraine. As you learn more about mindbody medicine and go through the exercises and take the program, you can find that it’s easier to accept the stressors, figure out ways to deal with them, and then once they’re dealt with there’s no reason for the body to express it in the terms of a migraine anymore.
How can it be that the body is creating this intense physical distraction, when on the surface it might not appear that there’s anything for me to be all that stressed out about?
Fairly regularly, people will say “well I’m not really that stressed, so how can stress be causing my symptoms?” And my thought, and what I explain to people, it’s oftentimes not the stresses that we can see that are causing the pain, but the stresses that tend to be further under the surface and harder to get at. As an example, I will frequently see people in my office with spouses or partners, and I always ask people if there’s stress going on in their lives. Normally patients will look at me and say “no, not really” and their spouse or partner will start laughing, or choke on their water and say “you’ve been unbelievably stressed for the past two years, what are you talking about?” And so that’s what I find. That we try to minimize the stressors and not see them clearly, so it takes a little bit of digging with writing exercises and other techniques to find out where those stressors are and how they’re affecting us.
What’s the toughest question you get from patients about this treatment, and how do you answer it?
The toughest question I get asked about this treatment is whether this will make the migraines go away right away. And I tell people that this is a different type of medicine - it’s not like taking a pill, it’s not like somebody doing something to you. This is a treatment that really relies upon your ability to do the exercises, to understand the concepts, to make internal changes. And that’s much harder than having somebody do something to you. The hardest part of the treatment is that it takes the cure out of my hands and puts it in your hands. And this can be a difficult concept for people. But I also find that there are a lot of patients who like the fact that the treatment ends up in their hands… that they can do things and make changes that lead to the relief of migraines.
Do you believe that people can find relief from their migraines through an online program?
I absolutely think that migraine sufferers can find relief through an online program. The information in the Curable program is very similar to what I will talk with people about when I see them in my office. The exercises are similar to the ones that I recommend. The knowledge and the evidence that’s available is similar to what I talk with patients about. The interaction in the program is similar to what I would suggest people think about when they’re trying to figure out what’s causing the migraines. So whether people are getting the information directly from me in my office or using a well-designed online program, I absolutely think that people can use that material to get better and find relief from the migraines.
What’s been the most meaningful migraine recovery story that you’ve seen in your practice?
I have a patient who came to see me many years ago with migraines that were so bad they had kept her in bed for 5 years, and she was taking 17 migraine medications. And I talked with her the first time I saw her about the mindbody connection and how she could use that to heal the migraines. She took that to heart and she did a lot of work over a number of years. She worked with me in my program, she did the writing exercises, she worked with psychotherapists, she signed up for a gymnastics class, she took a number of other program. And over several years, she weened off all 17 of the migraine medications, she got out of bed, she got back into the workforce, and ultimately decided that she wanted to go to medical school so that she could teach people about this. So now she’s finishing her 3rd year of residency at the University of Indiana and plans to do what she can to help people understand the mindbody connection and use that to help them heal.