Hi everybody, I am Dr.Scott. I am a Stanford-trained neurologist and headache specialist. I show people how to use functional medicine and biohacking tools to relieve headaches, and today I want to talk about something that is often going on under the surface in people who have chronic headaches that they may not even realize is there, and that is PTSD, post-traumatic stress disorder.

Common Misconceptions About PTSD

Now, I think that our first reaction to the idea of PTSD can sometimes be that it is something that only affects soldiers coming home from war or situations like that, but PTSD can actually affect people who have never been in any kind of a combat situation. It can happen to people who either directly experience an event or to people who simply witness the traumatic events.

Underrecognized Link Between PTSD and Migraines

So, I’d like to talk a little bit more about this today because I think that this is underrecognized, and I’ve got some really interesting statistics to share with you about this. I’d like to start by sharing with you an article that talks about the incidence of PTSD in people with migraine.

Article Reference on PTSD and Migraine

So, here’s the article. Let me scroll up to the top so you can see the title, and you can just Google this if you want to look at it: PTSD and migraine epidemiology, sex differences, and potential mechanisms. And what I really want to point out here is this section.

PTSD Prevalence Statistics

It says that the lifetime prevalence of PTSD is approximately five to eight percent—that’s over everybody, whether you have headaches or not. However, if you look at the subset of people in tertiary clinic-based studies, approximately 22 to 30 percent of headache sufferers fulfill PTSD criteria—a third of people with chronic headaches. That’s a lot.

Why PTSD Is Often Missed in Headache Patients

Why are we missing this? Why is this thing that we don’t talk about very much? I think we’re all pretty addicted to the idea that panic and depression can contribute to headaches; a lot of those circuits overlap in the brain, but we are not nearly as fluid  into the prevalence of PTSD and migraine.

PTSD Diagnostic Criteria: Avoidance or Numbing

And I think that one of the things that happens for people who have PTSD is actually part of the indicative criteria; let me explain. So, one of the indicative  criteria for PTSD is what we call avoidance or numbing.

Example of prevention in PTSD

So, let’s say that you were in a very serious car accident where somebody got hurt, maybe someone that you love, and it incensed a very bitter nervous reaction in you—feelings of weakness or horror. You may find that you tend to not drive down that street anymore; you’ll trip around the block in order to avoid going to the field where it happened.

Avoidance in Thoughts and Conversations

You may avoid it in your own thoughts; you may tell yourself, “I’ve handled it,” and yet you still don’t want to talk about it. I’m not saw that you need to talk about it all the time or that it has to bring you cheer to talk about it—that’s not what I’m getting at—but it may be something that still triggers you, that makes you feel upset, that will carry on nosy thoughts or dream when you think about it. Do you look  what I saw?

Intrusive Thoughts and Dreams in PTSD

So, because of the humor of PTSD, it can be something that we bear to dismiss, and one of the things that’s important to recall about this is that an practice that causes PTSD will cause what we call intrusive thoughts or dreams.

The Brain’s attitude to PTSD Memories

So, every time you think of it, maybe your brain just keeps running  back to it all day, and every time you do, you kind of get that limited epinephrine rush, or maybe you’ll start having bad dreams about it when you start reasoning about it again.

Suppressing Thoughts and Its Impact

So, it’s perfectly natural that we sort of want to suppress thinking about it or tell ourselves that we’ve already handled it, but if you find yourself where you have something in your life that’s like that for you—you’re avoiding it, you’re numbing to it—then that could be something that is part of the fabric of what’s causing migraines for you.

Sexual and Physical Violence as PTSD Causes

Another example that’s unfortunately all too common is the experience of sexual violence or physical violence. This very, very often causes feelings of numbness or avoidance in women.

Effects on Intimacy After Trauma

Women may actually have a decreased capacity to love, a decreased interest in physical intimacy after experiences like that, which makes a lot of sense, but if you find yourself in a position where that’s going on and on and it doesn’t go away, it may mean that that experience has not yet been fully processed.

How PTSD Memories Are Stored

So, why are PTSD memories so nosy? Why do they cause us to avoid or numb? Well, it’s because of how they’re saved in our brain.

Part of the Amygdala

So, memories that are firmly related with emotion are fixed to what’s called the amygdala. The amygdala is a deep, deep part of our brain that is guilty of forceful affections like fear, anger, and when emotions are tied to that amygdala, then when we relive the event, those emotions get cause as well because the thoughts are linked together in your brain.

Interpersonal Trauma and PTSD in Women

So, some of the more common causes for PTSD in women are what we call interpersonal trauma—that means physical abuse, that means sexual abuse—and it’s very common for women who have experienced sexual abuse to go into this avoidance or numbing type of behavior.

Symptoms of Avoidance and Numbing

They may have a reduced capacity to love; they may have very little interest in intimacy for a good reason, right? But if those are things that you’re currently experiencing, it could be a clue that PTSD may be part of the underlying fabric of migraines for you.

Hyperarousal Feature of PTSD

There’s one more diagnostic feature for PTSD that I think will resonate with many, many people with migraine, and that’s what we call hyperarousal—that is the fight-or-flight state as opposed to the rest and digest state.

Biological Overlaps Between PTSD and Migraine

So, there are studies looking at the biology of people who meet diagnostic criteria for PTSD, and it overlaps a lot with what we see in people who have chronic migraine.

Multiple Experiences, Same Physiology

So, you know, multiple underlying experiences can result in the same physiology in our body.

Heart Rate Variability Explained

One of the things that I talk to my students a lot about is what’s called heart rate variability. Heart rate giddiness is a measure of where you’re at on the seesaw of the nervous system.

Fight or Flight vs. vacation and brief

So, let’s say that this joint being high means you’re in fight or flight; let’s say this hand being high factor you’re in rest and digest. It’s a seesaw, right? Heart rate dizziness is a way of scaling where you’re at on that.

Low Heart Rate Variability in PTSD and Migraine

If your heart rate variability is low, then that means you’re more in fight or flight; if your heart rate variability is high, that means you’re more in rest and digest.

Heart Rate Variability Drops in PTSD and Migraine

So, one of the things we see in people with a history of PTSD as well as chronic migraine is that heart rate variability drops. It can drop to very low levels, and just to put this in context, have you ever had that feeling of your heart beating out of your chest?

The timer pulse pleasure

It’s like really, really going. It’s like a timer, right? It’s just great, strong, regular, consistent, and while we do want our heart to keep defeat regularly, we don’t want it to be like a metronome.

Stress Nervous System’s Effect on Heart Rate

What that means is that the stress part of your nervous system has taken over. All right, that is going to lower your heart rate variability.

What Heart Rate Variability Means

Why? Because heart rate variability means the amount that the heart rate varies from one beat to the next. It’s minuscule—minuscule milliseconds—but when it’s not varying at all, that means that your stress system is there, it’s regulating, it’s making your heart beat like a metronome.

Heartbeat Experiences in Different States

You’re having that heartbeat pounding out of your chest experience. Whereas when you’re in rest and brief mode, you don’t notice that, right? When you’re just chill, relaxed, everything’s fine, you don’t really notice your heart beating, and it is having normal moment-to-moment variations, which is hinting a healthy heart rate giddiness, meaning that your heart rate does vary a little bit, tiny bit, from one beat to the next.

Cortisol Abnormalities in PTSD and Migraine

Another finding that we see both in people with chronic migraine and in people with PTSD is abnormalities in cortisol.

Prolonged Cortisol Elevation

Now, this can actually go on for months; I’ve seen it, but what it means is that your body’s working really hard to keep up with the demands of whatever’s going on.

Causes of High Cortisol Levels

It could be a physical trauma like being sick; it could be an emotional trauma; it could be chronic stress because you hate your job, you’re in a bad relationship, whatever the reasons are.

Cortisol Levels Over Time

So, cortisol levels can be high early on.

Adrenal Fatigue Explained

When you’re in this space over here, we call that adrenal fatigue, and people just feel tired all the time. I know that resonates for so many of you.

How EMDR Works

And part of the reason it’s so strong is that it helps detach those memories from the emotion centers in the brain. So,recognize how I said that any nervous thought  is related to your amygdala? That’s literally how it’s wired inside your brain. You kind of want to detach it from the amygdala and store it in other parts of your brain, like the part of your brain that remembers how to drive home, the part of the brain that remembers two plus two is four—not a lot of strong emotions associated with those memories, right?

EMDR Process Description

The way we do that is that the therapist works with you in a very safe and supported setting to do what’s called re-sensitize you. That means they’re going to walk you back through some of those memories. Okay, now you’re there, you’re supported, and one of the ways that it seems to help to detach those memories from the emotion is to have you do something with your eyes. So, it may be as simple as the therapist saying, “Look at this finger, look at this finger.” There are a lot of different far they can do this. I don’t want to go too deep into that. I just want to say that they’re doing something with your eyes at the same time, and that helps the brain rewire those thoughts so that they’re in a more intensely neutral part of your brain instead of being so closely linked to those nervous centers.

Accessing EMDR Therapy

And EMDR is fairly easy to access. You can Google “EMDR therapy near me,” and you will probably be able to find somebody who can do that for you.

Summary and Encouragement

So, just to compile the highlights: number one, PTSD is much more common for people with headaches than we think; number two, you can fool yourself and think that you don’t have PTSD about an event in your past when you actually do because part of the diagnostic criteria is prevention or numbing; third thing you need to know is that it is very treatable. There are very valid protocols that can work on those underlying PTSD issues that may be related to your headaches. Hope that helps, and if any of this resonates for you, please go get treatment. It will help your body in more ways than just reducing your headaches.