Stress!

It is a fact of life for all human beings. Stress is a normal reaction — psychologic and physiologic — to the everyday demands of life. When your brain perceives a threat, the body reacts with a fight-or-flight response, releasing hormones, increasing heart rate, and blood pressure. When the situation is over, your body returns to a normal, calm state. But sometimes, in our overly-stimulated world, the stress response button gets stuck in the “on” position. This may lead to a chronic stress state that’s not easily overcome by your body’s usual methods.

For kids and teens, stress often occurs in the school setting, striving to achieve good grades or dealing with being bullied. It can be related to sports achievement, trying to be the best. It can happen in the home setting, dealing with discord between family members, financial stressors or even abuse. Kids are more stressed out then they used to be. There has always been stress associated with growth, development, social, and physical maturation. But the impact of social media, cultural, environmental, and financial stressors has dramatically increased the sources of stress for the average teen.

Unfortunately, being under stress can lead to more headaches and migraines.

For migraineurs, feeling stressed is a significant migraine trigger — both during the stressful time and afterward, during the “letdown” period after the stressors have passed. Migraineurs need to be aware and vigilant with their self-care, especially sleep, to help decrease the incidence of migraine.

Stress can also trigger tension-type or stress headaches. Many of us carry our cares and worries in our neck and shoulders. During stressful times, the trapezius and paracervical muscles tense up around our heads, squeezing the occipital nerve in particular bilaterally, and triggering headache. Relieving the pain involves getting these muscles to relax.

So learning to manage stress is an important aspect of self-care for everyone, especially people with headaches and migraines. When I ask my teenage patients about how they manage their stress, the usual response is that they talk with friends/family, nap, play with a pet or watch Netflix and relax. I rarely hear that they exercise or do meditation or relaxation exercises.

Stress management has become one of the things I always ask my patients about, by saying that we all have stress in our lives, and if we don’t learn how to manage it, it can cause even more headaches than they already have. While doing “relaxing” activities can be helpful in the moment, it’s not the same as “turning on the relaxation response,” which is the key to managing stress. It can be challenging to talk about this subject, hard to get the kids to listen and take action. But we can get creative and try.

I usually talk about the autonomic nervous system, and how it gets activated with stress and pain and is not under our voluntary control. The activation of the ANS can be turned down by turning on the relaxation response. This is an intentional activity meant to induce real relaxation, turn down the mind chatter, and improve focus.

There are a variety of ways to turn on the relaxation response, such as yoga, meditation, guided imagery, breath counting, acupuncture/acupressure, progressive body scan, cognitive behavioral techniques (CBT). There are many ways to access these activities, such as with a therapist, in a wellness/health class at school, in a yoga class, or on YouTube videos. There are some great phone apps which can be helpful and give guidance, such as my favorite, Insight Timer.

But how do you get a kid to do this? It can be tough, since teens don’t feel they have a lot of time. We are not talking about spending one hour on a cushion contemplating the universe. I always emphasize that 5 to 10 minutes is enough time to do an exercise, and everyone has that kind of time. We talk about when to fit it into the day and what would it be helpful for, such as just before bed to help with sleep, or in the library during study to help with focus and anxiety. I urge them to find what they like (accented voice, music or not, etc.) and then bookmark what works for them in the app. Doing a relaxation exercise frequently can help reset their stress response. Then when they do get stressed, it won’t be so intense.

CBT exercises work best when kids are relaxed so they can be more effective at using them when feeling stressed. I hear a lot of parents and kids say “it doesn’t work” when the kids are stressed. In reality, it is exceedingly difficult to engage in a new skill when your nervous system is on high alert. Practice allows children/teens to feel more adept at the exercises so they can more easily engage appropriately during stressful moments. The worst time to try out an app for the first time is when you really need it.

Trying to get kids to engage in a relaxation activity can be a hard sell. It often involves me actually taking out my phone, showing them how to use the app and having them download it. If an app doesn’t work, then they can consider working with a trained therapist for six to eight sessions of CBT training. There is often resistance about seeing a therapist; I always emphasize that they are going to learn coping- and stress-management skills, not to talk about their “feelings,” and that seems more acceptable. Some schools offer stress management or mindfulness classes for teens and parents.

In whatever way we can get our young people more in touch with how stress feels in their bodies, and how to manage it, the less it may affect them. Again, I always say the best strategy is the one you like and the one you will actually do. In the end, it will help them be more resilient and have fewer headaches and migraines.

Victoria Karian is a nurse practitioner and can be reached at HeadFirst PNP.

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