Family Issues: When one person has a headache problem, often the whole family suffers. In a recent national survey of 4,000 households, 350 (9%) had at least one adult with migraine. In over 60% of these homes, migraine suffers said that their headaches had a significant negative impact on family life, affecting activities, plans, and relationships (see "Migraine's Impact on the Family" by Dr. Robert Smith in the Summer 1997 issue). In addition to dealing with their own pain, people with frequent or severe migraine often struggle with how to lessen the negative impact of their headaches on their family life.
Families need to strive to create a positive emotional atmosphere despite the illness. Taking control of headache involves taking steps to increase functioning and to reduce emotional suffering, even when the headaches themselves are not well controlled. When headache takes control of the family, the family can lose sight of any goals that extend beyond pain and its relief. Family members start to over- or under-function. The emotional atmosphere changes to one of unhappiness with each other's behavior.
Sometimes family members may go out of their way to do things for the person with the headache, taking over household chores, canceling personal plans, and minimizing outside activities. While the person with headache may at one level feel grateful for this support, he or she may also come to feel guilty about the effect of the headaches on the family. Resentment can build in both the patient and the overly helpful family members.
For example, Tim would come home from his work and take over all the cooking and cleaning from Ellen, his wife. He knew these activities aggravated Ellen's headache and did not want to see her in more pian. He also believed he could take care of these chores more efficiently, in less time. Tim said he took Ellen's protests as an effort to ease the burden on him, so he would ignore them. At the same time, he became so irritable with the children for not
making a greater effort to help their mother that they began to deread his arrival home from work. The family atmosphere became increasingly negative.
Ellen became more depressed. She felt that she was contributing less and less to the family, that she had become "only a burden." She was angry at her husband for taking away from her those things that she could accomplish, even if they took her longer as she paced herself to keep her headaches at a minimum. She also felt responsible for Tim's growing anger and resentment, even when he said he was angry at the headaches and not at her. They both felt trapped by their situation, and thought that the only solution was for her doctors to find a more effective treatment.
Positive change took place when Ellen explained to her husband that it was important to her self-respect that she participate in hosuehold chores, even if she did them more slowly or her headaches became worse. She emphasized that the sense of satisfaction she felt from completing even limited household tasks was worth the risk of intensifying her headache. She told him she wanted him to treat her as a partner, and not as if he were the coach and she were a second-string team memer assigned to the bench.
Ellen also asked Tim to try harder to master his anger, because she couldn't help but feel blamed, even when he said his frustration was at her headaches not at her. She told him that although she might not be able to control her headaches completely, she could control her efforts to function and pace herself. And he could learn to control his anger and irritability, if he set that as a goal.
The timing of this communication was critical to its success. Ellen chose a time when Tim was in a good mood and they were getting along well, with no immediate demands or time pressure. If she had raised the issue when one or the other of them was upset, Tim might well have felt attacked and reacted accordingly. She was also careful to be fair, saying in effect, "This is what I need to do to make things better between us, and here's what I think you need to do too."
As a result, Tim was able to listen without becoming defensive. On reflection, he realized that some of his take-over behavior might even have been a way of expressing his anger, and that he really did not feel good about handling his feelings that way. They reviewed their goals as a family, including scheduling positive time with their children. They assigned weekly chores and responsibilities that were appropriate for their children's ages, and agreed to calmly insist on their completion whether Mom had a headache or not.
Of course, one positive discussion did not change things overnight. Both Tim and the children made some initial changes, and then began to fall back into old habits. But with the encouragement of her psychologist and support group, Ellen kept talking about these issues. Ellen improved how she communicated with her husband and felt better about herself. Their discussions of personal and family goals helped them both remember that their life together had meaning beyond headache.
There are a number of other common and difficult headache-related family issues. However, making a plan for direct discussion at the right time and in the right place can be of significant help in lessening the family impact, regardless of the problem. Reviewing family goals can be a key to increasing function and minimizing suffering for the whole family.