Chronic Migraine in College Students
Casey, a 20-year-old college co-ed, majoring in computer science, is soft-spoken, petite with straight red hair and black-framed glasses. She appears self-composed and calm.
“How can I help you?” I asked.
“I don’t care if I never see my parents again,” she replied. I steeled myself for a troubling story of abuse, rejection, and neglect.
“Tell me about it.”
“My mother had open-heart surgery when I was 10. I knew there was a possibility she would die. I convinced myself I could live without her. After all, like my dad, she had been more interested in work than me for my whole life.”
The details may be idiopathic but the basic foundation for the transformation of migraine from episodic to chronic (15 or more headache days per month) occurs in 2% of migraineurs. Research has found that migraineurs have a hyperexcitable nervous system. For college students with migraine, certain stressors may challenge their nervous system to a greater extent than those without migraine. Most college students struggle to gain independence while at the same time recognizing their financial dependency on their parents. But migraineurs commonly have certain psychological traits that may produce problems with coping with college life. These traits include a tendency toward perfectionism, being detail oriented, living up to the expectations of others, an inability to say “No,” and being unaware of taking on the negative feelings of others. Once migraineurs become aware of these traits, strategies can be planned that help them cope which can prevent the transformation of migraine from episodic to chronic.
A migraineur usually does very well in high school, excelling with A’s and B’s. But in college, the classes are more difficult, more is expected of a student, there is greater competition among classmates, and there is less social support. The student may feel like an outsider in an alien world. The strategy is to accept imperfection as part of the human condition.
Being detailed oriented, the migraineur may be accustomed to taking detailed notes with plenty of time to study for exams. College life is more fast-paced. The student is required to focus, learn quickly, retain the information, and answer exam questions that ask for application of information rather than rote memory of the subject matter. The strategy is to focus on the practical application of the information; observe the larger picture that is formed by minute details.
It is common for a migraineur to develop a relationship with a teacher where the student is motivated to live up to the teacher’s expectations. In college, tests are often standardized, not created by the professors, who are usually aloof to relationships with students. When a student receives a C or lower, the migraineur senses personal failure, fearing that the parents will be very disappointed in just average achievement. The strategy is to set one’s own expectations. If the class is important to a student’s major, a C grade can be discussed with the professor concerning extra work or other suggestions for improving the grade. Parents need to be assured that the student is working to achieve the best possible grade. Parents are usually not as concerned about the grade as the student, unless of course the student is failing.
Living in a dorm or apartment with other students, the migraineur may not be able to say “No” to going out to a party rather than stay in the room studying for an exam. Colleagues may ask the student for copies of classroom notes or answers to tests or help writing a term paper. This social pressure weighs negatively on the person’s ability to cope and function at an acceptable level. The strategy is to begin saying “No” and notice that friends accept “No” without rejecting the migraineur.
Many migraineurs are highly intuitive. Those with problems are drawn to migraineurs who listen to their problems and offer solutions. In exchange, the migraineur may unknowingly take on the negative feelings of those around them in a misguided attempt to help their friends but instead, these feelings worsen the burden of migraine by increasing the frequency, duration, and intensity of the attacks. The strategy is to become aware of the migraineur’s tendency to take on the negative feelings of others and to stop this maladaptive practice.
It is easier to prevent chronic migraine than it is to treat it. Each college campus has a counseling center that can help students regain a sense of confidence by finding solutions to these problems. Often the fault of the student’s sense of failure is projected onto the parents. It is difficult for parents to give their children the distance and support for them to work out their own problems. When a college student is having problems, parents need to express their love, support, and confidence that this is another important step in achieving adulthood and independence.
Casey formed a partnership with her older brother who is attending the same college. Together they have strategized about how to approach and cope with their parents who they believe are too demanding, smothering, and unaccepting of their preferences and direction in life. With time these differences may be resolved. Both parents and children need to be willing to compromise and work toward a solution that keeps the family together.
By Kathleen Farmer, PsyD
Dr. Farmer is a neuropsychologist who specializes in behavioral tools that help individuals cope with health issues and specializing in Migraine Headaches. www.StartTalking.io
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