Anyone who has ever experienced a migraine will tell you that it is nearly impossible to think clearly or communicate effectively during an attack. Many will attest to residual problems during the postdrome as well as preliminary problems during the prodrome. For patients with chronic migraine, the ability to think and speak coherently can appear to never end. I have even talked to migraineurs who are skeptical of current research that claims there are no lasting cognitive deficitsresulting from white matter lesions so often found on the MRIs of long-term patients. To be fair, the research has produced conflicting results. It’s just too soon to know for sure.

What is known is that stress and pain can significantly impact our mental functioning. Our bodies go into a type of “high alert”, favoring action over manners or political correctness. Live with pain and stress long enough and it’s bound to take its toll on your brainpower. Part of the reason may be environmental. I’m not suggesting there is not a biological explanation for migraine-related cognitive impairment. Instead, I’d like to suggest that it is possible to do something to offset that “migraine brain”.

You can learn to compensate for what the mind fails to do (i.e. word loss, forgetfulness, etc.). People with irreversible cognitive damage are often taught how to use specific strategies to compensate for their disabilities. These same strategies are taught to children with ADHD to help them stay on task. They will work equally well for migraineurs.

There is one catch. The professionals who teach these skills are not medical doctors. Most are counselors, therapists, social workers, and psychologists. I realize that some patients have been referred to mental health professionals as a way to “patient-dump” or because their doctors believed their pain was psychosomatic. The topic of mental health can be a very raw subject for a lot of us. If you will indulge me, I would like to try to redeem the reputation of my profession.

The therapies employed focus on compensating for cognitive deficits called Executive Functioning Skills. These are eleven skills that govern our behavior, regulate our emotions, and set and achieve goals. Depending on genetic, organic, and environmental factors we each develop a unique blend of skill strengths and challenges. Apparently, migraines impair our ability to use these skills, too.

Take a look at the list of skills and see if you can identify with any particular skills. You can also download a brief questionnaire to help you discover your strengths. In future posts, I will introduce a variety of strategies you can use to compensate the next time “migraine brain” takes over.

Executive Functioning Skills

Response inhibition: the ability to think before you speak.

Working memory: the ability to remember lists, dates, phone numbers, and tasks.

Emotional control: the ability to prevent your emotions from interfering with a task until it is complete

Sustained attention: the ability to focus on one thing at a task until it is completed

Task initiation: the opposite of procrastination, particularly when the task is unpleasant or boring

Planning & prioritization: the ability to identify and commit to priorities when there are many competing tasks

Organization: the ability to keep things organized and neat

Time management: the ability to accurately estimate the time it takes to complete a task in order to meet a deadline

Goal-directed persistence: the ability to delay pleasure in order to achieve goals

Metacognition: the ability to be objective about oneself accurately

Flexibility: the ability to handle surprises and make adjustments ‘on the fly’.