Chronic conditions that result in lasting, physical pain—such as migraine—can pose unique emotional challenges as well for those that have them. Pain acceptance is often recommended to help people overcome these negative emotional consequences associated with these conditions. We explore both the positives and negatives of this coping strategy for people with chronic pain conditions, with a particular emphasis on migraine.
Pain acceptance is generally defined by two criteria: 1) Acknowledgment that avoidance of pain is an ineffective strategy and 2) participation in activities regardless of pain is considered beneficial for people with chronic conditions. Many prominent voices within the migraine community—both patients and doctors—have spoken out about its benefits. For instance, people with light sensitivity due to migraine may be encouraged by their headache specialist or neurologist to eschew wearing sunglasses inside in favor of tinted lenses so as to not hide from light and further dark adapt their eyes. Others believe that acceptance has allowed them to stop blaming themselves for the pain as well as better identify and manage the limitations of the condition.
Medical research also seems to support pain acceptance as an effective coping mechanism for patients. Countless studies have shown that lower pain acceptance is associated with increasing levels of depression and headache-related disability with migraine.(1)(2) More recently, researchers found that activity engagement did not necessarily improve symptoms or pain management, but they did conclude that general acceptance translated to better outcomes for patients.(3) This coincides with prior research in which the fear of migraine-related pain was linked to more frequent and intense attacks as well as a negative cycle of avoidance and disability.(4) Similarly, those who are given strategies for acceptance by trained professionals are more likely to reduce migraine severity, decrease use and reliance on medication, and decrease the probability of experiencing work- or leisure-related disability.(5) Ultimately, these findings suggest accepting pain can make people feel better, improve their productivity, and reduce the likelihood of developing other emotional disorders.
Although there have been many encouraging results, there may also be some downsides to pain acceptance in migraine.
One of the most common misconceptions surrounding migraine is that it is a simple episodic headache that can be easily managed or treated with minimal loss of productivity. Unfortunately, this has the potential to be further stigmatized when engaging in the pain acceptance process. It may appear as though you are able to deal with the physical ramifications or “work through” a migraine, and thus the pain must not be that bad. This could create unrealistic expectations from friends, colleagues or employers regarding how you experience an attack, especially if they are already unaware that they can vary in duration and intensity. It is also possible that they might look down upon you for past incidents where you were unable to “deal” with the pain. The reality is it is perfectly okay to have days or moments where the pain is too much, but others may not view it the same way.
In addition to stigma, a core component of migraine prevention surrounds the concept of “trigger management,” whereby a patient strives to identify and reduce the impact of internal or external stimuli that could lead to an attack. Unfortunately, trigger management can be confused with trigger avoidance. Some may believe, for example, that they should avoid going outside during the day or hide themselves in a dark room if sunlight is a prominent trigger. Certainly, avoidance may be the best option in very specific situations, but it should not be the sole approach. Conversely, managing triggers is predicated on the understanding that a patient cannot avoid all possible disturbances for their attacks. As a result, it may involve behavioral / lifestyle adjustments or the use of products or medications to minimize their negative effects.
Lastly, acceptance can be a lengthy process. A person rarely just wakes up with a new perspective on chronic pain; instead it can take months and years to cultivate. Many migraineurs talk about the dozens of failed treatments and other disappointments that subsequently lead to a re-examination of their thoughts. And the truth is accepting the pain often requires these experiences. However, that does not mean it is not exhausting either, and it is perfectly acceptable to feel frustrated or upset in any given moment; the key point is that acceptance is about not letting those feelings dominate your attitudes and behaviors.
What does it mean for you?
There is substantial evidence showing that the process of pain acceptance—particularly when facilitated by trained professionals—is beneficial for people with migraine. It can help patients feel better and also reduce the likelihood of onset of other emotional disorders. Although acceptance comes with its own challenges and often takes time to fully achieve, it is worth considering as an effective coping strategy for migraine.
1 Dindo L, Recober A, Marchman J, O'Hara M, Turvey C. Depression and disability in migraine: the role of pain acceptance and values-based action. Int J Behav Med. 2015 Feb;22(1):109-17. doi: 10.1007/s12529-014-9390-x.
2 Foote HW, Hamer JD, Roland MM, Landy SR, Smitherman TA. Psychological flexibility in migraine: A study of pain acceptance and values-based action. Cephalalgia. 2016 Apr;36(4):317-24. doi: 10.1177/0333102415590238. Epub 2015 Jun 10.
3 Lillis J, Graham Thomas J, Seng EK, Lipton RB, Pavlović JM, Rathier L, Roth J, O'Leary KC, Bond DS. Importance of Pain Acceptance in Relation to Headache Disability and Pain Interference in Women With Migraine and Overweight/Obesity. Headache. 2017 May;57(5):709-718. doi: 10.1111/head.13058. Epub 2017 Mar 13.
4 Black AK, Fulwiler JC, Smitherman TA. The role of fear of pain in headache. Headache. 2015 May;55(5):669-79. doi: 10.1111/head.12561. Epub 2015 Apr 22.
5 Dindo L, Recober A, Marchman J, O’Hara MW, Turvey C. One-Day Behavioral Intervention in Depressed Migraine Patients: Effects on Headache. Headache. 2014;54(3):528-538.