How the Unpredictable Nature of Chronic Migraine Impacts My Mental Health – and What Helps Me Cope

Migraines are not just painful; they can also be very unpredictable. For Laura McKee, who has over 15 migraines each month, this unpredictability affects her mental health. The constant worry about whether her day will be manageable or overwhelming often leaves her feeling emotionally exhausted.

Despite these challenges, Laura has discovered ways to handle the instability of living with chronic pain. Today, she shares the strategies that help her cope and feel more in control.

Chronic migraine interferes with every aspect of my life - work, family, and relationships. I hate missing out on social activities, so I would overcommit and then have to cancel. But I've lived with this condition for over 10 years. Over that time, I've sought a lot of support and developed coping strategies for dealing with the unknown every day.

How the world looks to a chronic migraine patient

Living with chronic migraine has made the world a lesser-known place for me. Not knowing how I'll feel from one day to the next has led to fear about the future. In turn, this fear has affected how I view the world and my role in it.

At the beginning of my journey with this illness, I didn't receive the support I needed from my medical team. I was left feeling overlooked and alone, especially since I was unable to work. Many of my friendships were tested from the very beginning, so the friends who stood by me were precious.

Later, I was diagnosed with another chronic condition - idiopathic intracranial hypertension (IIH). IIH symptoms feel like migraine but even more severe. Both leave me with constant head and neck pain, sensory disturbances, severe fatigue, and brain fog.

Living with unpredictable chronic conditions severely affected my mental health. I felt like I was in a permanent state of anxiety and despair.

I was so ill that I became confined to my bed. The lack of specialist support and treatment options led me to catastrophize my situation. I was more isolated, which led to depression and a vicious cycle of physical and mental pain. My relationships with my husband and children became strained.

Thankfully, my primary care physician was supportive of my mental health. Over time, I started taking better care of myself. I worked through my dark thoughts with a counselor and learned to put self-care as my main priority for the first time in my life.

Through self-care, I began to understand how chronic migraine impacts my daily life. This awareness led me to create long-term plans for managing my condition. By focusing on both my current and future needs, I developed stronger coping strategies, including:

1. Prioritizing rest

At the top of my priority list was understanding how much rest I needed and listening to my body. I learned to assess my needs on an hourly basis and develop a routine to balance my energy levels.

2. Keeping a journal

Using a journal has been key in helping me do this. I keep a symptom and pain diary to arm myself with knowledge of what support I require from my medical team. I can spot patterns and balance my activity time and rest.

3. Setting realistic goals

Since my understanding has improved, I've set self-care goals that accommodate my fluctuating health. I've gradually reintroduced exercise, a needs-based diet, and social activities into my daily life.

4. Practicing gratitude

Alongside planning, I reflect on the positives I find every day. Practicing gratitude improves my mental health and capacity to cope with migraine. Having this more mindful approach has led to a better quality of life.

How change impacts how I cope with chronic migraine

I've had to accept how much effort is needed to manage the constant pain and sensory symptoms that are part of living with chronic migraine. Just when I think I've sorted it, it can fluctuate again, so understanding grows with experience.

Living with chronic pain brings constant change. When that’s combined with my urge to stay in control, the pressure to cope can feel overwhelming. For example, after a medication change or surgery, it takes time for both me and my caregivers to adjust to a new routine. To handle these shifts, we rely on clear communication and a flexible mindset.

Improving the coping strategies that I've built for living with chronic migraine is essential as I navigate the world. When treatment changes feel overwhelming, I make it a point to seek support from my medical team, pay attention to my body, and practice mindfulness and self-care.

As I engage in more exercise and socializing, I must be mindful of striking a balance between activity and rest. Increasing these activities is great for my mental health, so I set my goals around this.

Accepting and communicating my physical and emotional needs during change is crucial. I'm clear about what practical support I need during a migraine attack. This, in turn, helps stabilize my mental health.

What support is available for chronic migraineurs?

To develop coping strategies, we must accept that chronic migraine isn't "fixable." Constantly searching for migraine cures and niche triggers can lead to excessive research and information overload, which may cause anxiety.

Anxiety may make it harder to seek support and manage chronic migraine. While feeling anxious doesn’t outright cause unpredictability with migraine attacks, it can heighten our sensitivity to changes and make it feel harder to cope. It often leads us to overanalyze or try to find patterns in something that may simply be random.

I've also learned about the intolerance of uncertainty (IU), which refers to how well someone can handle the unknown. People with chronic pain and high IU are often more affected by pain because of fear and negative thinking.

"Individuals who find uncertainty intolerable may be particularly threatened by the experience of having a [long-term physical health condition] and fearful of its implications, and thus engage in behaviors and cognitions aimed at controlling, reducing, and/or avoiding uncertainty."

~ The role of uncertainty intolerance in adjusting to long-term physical health conditions: A systematic review 01

This can hinder our ability to build the mental strength needed to cope with long-term conditions like migraines. Attempting to control the situation may lead to poor self-management. IU lowers our quality of life, but taking steps, such as CBT, can help us better handle the uncertainty of migraines.

“High levels of IU are associated with increasing efforts to regain control of the uncontrollable situation, which can result in dysfunctional coping strategies.” 

~ Acceptance of Mobile Health Apps for Disease Management Among People With Multiple Sclerosis: Web-Based Survey Study 02

Accepting that you need support is the first step to building mental resilience against chronic migraine.

Next, you need to identify the barriers that prevent you from getting that support. Once you recognize the barriers, it is much easier to find ways around them.

The takeaway: Coping with the unpredictable nature of migraine

• A long-term condition like migraine can improve with the right resources and support.

• Understanding our physical health is crucial for managing our mental health. This is especially important as we face the unpredictability of chronic conditions.

• Developing a treatment plan that focuses on self-care and exercise, as well as prescribed medicine, is essential for managing migraines. It should also consider the uncertainty that comes with the illness.

• Focusing on what we can control when an attack hits or threatens is key. I've found mindfulness helpful in tuning into what my body needs "right now." Daily meditation helps me relax tense muscles and let go of expectations.

  

• Migraine flares can often contribute to unpredictability, so recognizing our triggers is essential. Keeping a migraine diary can help identify triggers such as certain foods, stress, and exercise. How well we cope with living with a chronic illness depends on our ability to manage that unpredictability.

• Communicating our physical and mental needs is vital for dealing with chronic migraine.

I've spent time understanding my pain, the unpredictability of my symptoms, and how they impact my mental health. I've worked hard to identify self-help strategies that support my treatment plan.

The key to coping with chronic pain's unpredictability is trust. We can only build trust through clear communication. This includes trust between me and my caregivers, so they know when to assist me, and trust in myself to understand and respond to my own needs.

Sources

1. Back to contents.

   Gibson B, Rosser BA, Schneider J, Forshaw MJ. 2023. The role of uncertainty intolerance in adjusting to long-term physical health conditions: A systematic review. https://pmc.ncbi.nlm.nih.gov/articles/PMC10237456/. Last accessed June 26, 2025.

2. Back to contents.

   Apolinário-Hagen J, Menzel M, Hennemann S, Salewski C. 2018. Acceptance of Mobile Health Apps for Disease Management Among People With Multiple Sclerosis: Web-Based Survey Study.https://pmc.ncbi.nlm.nih.gov/articles/PMC6334710/#abstract1. Last accessed June 26, 2025. 

NPS-ALL-NP-01583 AUGUST 2025