What migraine does to relationships: cancelled plans and an invisible illness

Friday, 5.40 pm. A message in the group chat with her friends: “Sorry, I won’t make it again. It’s starting.”

Over the next few minutes a few hearts gather beneath it, and one “Oh no, get well soon!”. Then silence. Nobody writes anything unkind. But lying in a dark room with her eyes closed, she still knows what they are thinking, or at least thinks she knows: again. The third time this year. The hearts are kind, but somewhere in them there is also tiredness. And the next time she is invited — if she is — she will wonder whether to say yes at all.

Migraine is an illness that hurts in the head, but its consequences reach far beyond it: into partnerships, parenting, friendships, family holidays and summer plans. And because it cannot be seen — no plaster cast, no scar, and between attacks the person looks perfectly healthy — misunderstandings gather around it that the pain itself would never cause. In this article I will write about what migraine does to relationships, why guilt and resentment so often settle into them, and how you can talk with the people close to you differently.

First: migraine is not “all in your head”

Because I am writing as a therapist, I need to say this at the start. Migraine is a neurological disease, not a psychosomatic symptom. It is not the result of a weak character, poor willpower or unresolved emotions, and it cannot be “thought away”. It has a hereditary component and its own mechanisms in the brain. I explained how it differs from an ordinary headache in Migraine is not just a bad headache: what the difference is and why it matters. Diagnosis and treatment belong with a doctor and a neurologist.

My work lies elsewhere: in what happens between people when one of them disappears into a dark room every so often. This is the psychological and relational side of the illness — and it is talked about far less than it should be.

Migraine is roughly three times more common in women than in men, and it is most common between the ages of twenty and fifty — precisely the years when people are building partnerships, raising children and are most caught up in work. An analysis of the global burden of disease ranked it first among the causes of disability in young women. This is the period when cancelled plans cost the most.

An illness you cannot see

Invisible illnesses have a particular problem: other people know them mainly through absence. They see an empty chair at lunch, a cancelled trip, a partner who goes to a birthday party alone. They do not see the hour someone lay with an ice pack on their forehead, the nausea, the sensitivity to every sound, nor the day after an attack, when they felt wrung out.

So with migraine it often happens that those around you judge the illness by what it costs — by the cancellations — rather than by what you go through. And when people build their picture only from absence, doubt can creep into it: is it really that bad? Couldn’t it be pushed through somehow?

Research by Young and colleagues on the stigma of migraine showed that people with migraine experience marked stigma, especially those with the chronic form — in comparison with some other chronic illnesses, even more. Part of that stigma comes from outside, and part of it people internalise and say to themselves.

What happens in a partnership

The CaMEO study, in which Buse and colleagues surveyed people with migraine and their partners, showed what many couples know from experience: migraine does not burden only the person who has it, but the whole household. Partners reported cancelled shared activities, extra work at home and the illness affecting their relationship. People with migraine, for their part, often expressed the belief that without it they would be better partners and parents.

In practice this shows up in a few recurring patterns:

• Quietly taking over roles. During attacks, the partner takes over the children, the cooking, the shopping. At first it goes without saying, but over time tiredness can build up that they do not mention, because “she’s the one who’s ill”.
• Anger at the illness that lands on the person. The partner is disappointed because the concert has been cancelled again, and that disappointment is entirely justified. But you cannot say anything to an illness. So sometimes it slips out in a tone, a sigh, a “sure, as always”.
• Planning in the conditional. The couple start arranging everything with a caveat — “if you’re all right” — which is sensible, but can mean that over time they stop looking forward to anything.
• Closeness that withdraws. Attacks, fear of attacks and tiredness afterwards can also affect sex and tenderness. If no one talks about it, each interprets it in their own way: “she’s not attracted to me any more”, “he doesn’t understand that I can’t”.

Much of this is similar to what happens in relationships where one partner has depression or is burnt out — I wrote about that in Depression in a relationship: what happens to the couple and what you can do and Burnout and partnership: what happens to a relationship when one partner breaks down. The difference is that migraine comes in waves: between attacks everything is “normal”, and precisely because of that it can seem there is no need to talk about it.

Guilt on one side, doubt on the other

The hardest feeling people with migraine describe is often not the pain itself but guilt. Guilt for spoiling plans yet again. Because their partner had to go to the seaside alone with the children. Because their daughter performed at the school concert while her mother lay at home.

That guilt can turn into something more insidious — shame, the feeling that something is wrong with me as a person, not just with my head. I explained the difference between the two in Guilt and shame are not the same — and the difference matters. With migraine, the difference is very practical: guilt drives a person to “make up for it” — and on good days they often do too much, overload themselves to catch up on what they missed. Shame drives them into withdrawal — fewer promises, fewer invitations, fewer people.

On the other side, those close to them often carry a doubt they do not voice: “Can’t she really?” That doubt is not necessarily malicious. It comes from not seeing the illness, and from the fact that someone who looked fine yesterday is completely unable to function today. But if it stays unspoken, it grows into resentment — on both sides. One resents not being believed; the other, having to carry the consequences alone.

Children and the wider family

Children experience a parent’s migraine in their own way. Young children may learn to be quiet and “not disturb Mum”, which is understandable, but if nobody explains what is happening, they may build their own story in which they are the ones who did something wrong. Older children sometimes take on a caring role — cooking, looking after younger siblings, switching off lights. Some of this can be good and strengthening. Too much of it means the child is looking after the parent more than the parent is looking after the child.

With children, a simple, age-appropriate explanation helps: “Mum has an illness called migraine. When it comes, her head hurts a lot and she has to lie in the dark. It’s nobody’s fault. In a few hours or tomorrow she’ll be all right again.” And it helps for the child to know who will look after them when Mum can’t.

The wider family — parents, in-laws, siblings — often most needs basic information. Many people still think migraine is “a slightly stronger headache”. You don’t have to convince everyone. Sometimes it is enough to send one person close to you a good description of the illness and say: “This is what I have.”

How to talk: from reproach to need

Most arguments about migraine are not really about migraine, but about unspoken needs. The partner with migraine needs to be believed and not to have to prove, every single time, that they cannot manage. The partner without migraine needs to be allowed to be disappointed without being a bad person for it, and not to be the only one carrying the consequences. Both needs are legitimate — and in an argument both hide behind reproaches.

How it might sound (a composite, not a real person):

“I’m at your parents’ on my own again. As always.”
“You think I chose to be in pain?”
— and a few weeks later, on a good day —
“When I went on my own, I was disappointed. Not in you. In being without you again.”
“And I was lying at home thinking you saw me as a liar.”

The first two lines are a reproach and a defence. The second two are needs put into words. The difference is not that they were kinder the second time, but that they spoke about themselves rather than about the other. I wrote about how a couple learns this kind of language in From blame to needs: how a couple learns a new language. And in the knowledge base there is a short explanation of what a need actually is and why it is so hard to say out loud.

Timing matters too. Disappointment is not a good thing to discuss during an attack, when one of you is in pain and the other is angry. The best time is a good day, when you are both rested and nobody is on the defensive.

Exercise: a plan for the day an attack comes

A lot of tension arises because every attack means renegotiating everything at the worst possible moment. It helps to talk about it in advance. Like this:

1. Choose a calm time. A day without an attack, when nobody is tired. Tell each other that the purpose of the conversation is a plan, not a reckoning.
2. Agree on a signal. A short message or word that says “it’s starting” — without explanations or apologies. The person with migraine sends it; the other does not question it.
3. Divide the tasks. Who takes the children, who cancels commitments, what can wait. Write it down so you don’t have to work it out every time.
4. Set a plan B. For important events, agree in advance whether the other goes alone, whether the event is postponed, or whether you call someone else in. The decision during an attack is then just a choice between options you have already agreed.
5. Agree to talk afterwards. When the attack has passed, take ten minutes: how it was for you, how it was for me, what was hard. Not so that anyone has to fix anything, but so that disappointment does not stay unspoken.

A plan does not take the illness away. But it takes away some of its power over the relationship, because an attack no longer opens the question of who owes whom what.

When a couple start talking about migraine as something that happens to them, not just to one of them, the tone often changes too. The illness becomes a shared opponent, not a reason for conflict between them.

Where this view falls short

It would not be honest to claim that every tension in a couple where one partner has migraine is caused by migraine.

Not every argument is about migraine. Sometimes migraine becomes a convenient stage for old, unresolved things — an unequal division of work, old resentments, differences in how each of you understands care. When a couple keep arguing about the same thing, it is worth looking at whether something else is hiding beneath the migraine.

Migraine can become an excuse — on both sides. Rarely, but it happens, the illness becomes the reason something difficult is never discussed: “Not now, my head hurts.” It also happens that a partner attributes every one of their own withdrawals to the other’s migraine. This does not mean the illness is made up. It means another topic has moved into the relationship and needs to be talked about separately.

Good treatment comes first. If attacks are very frequent or getting worse, the first step is with a doctor and a neurologist, not in conversations about communication. No conversation replaces preventive treatment when it is needed. And if depression, marked anxiety or thoughts that nothing makes sense are part of the picture, turn to your GP or a psychiatrist. If you are in distress in Slovenia, you can call Klic v duševni stiski on 01 520 99 00 (every day from 7 pm to 7 am) or the Samarijan helpline on 116 123 (24 hours a day), and in an emergency 112.

The person close to you has a right to help too. A partner who carries more than they can for a long time can burn out, even if they never say a word. Their tiredness is not a betrayal. It is a sign that they need support as well.

How therapy can help

Psychotherapy does not cure migraine and is not a substitute for treatment. For some approaches — relaxation techniques, biofeedback and cognitive behavioural methods — there is evidence that, as a complement, they reduce the burden of the illness. But what remains in relationships often needs a space where both of you can speak.

In relational family therapy, in which I am training as a therapist in training under supervision, we are interested in what the illness sets off between people: who in the family has always been the one who cares for others, who is the one who must never be a burden, how illness was talked about in the family of origin — whether it was acknowledged or hidden. Christian Gostečnik describes how patterns from early relationships repeat themselves in partnerships. With migraine, this often means the illness gets caught in a role that one or the other already carried before. When that becomes visible, the conversation moves from “who is right” to “what is happening to us”.

If you recognise yourselves in this article as a couple, couples therapy can be a space where you talk about it without an attack in the background. I also work with English-speaking clients in person in Ljubljana. How to live with migraine in the long term without giving in to it is the subject of Living with migraine: acceptance that isn’t giving up. And if you find yourself withdrawing more and more and ending up alone, the knowledge base has a short entry on what loneliness is and how it differs from solitude.

What to remember

• Migraine is a neurological disease — but its consequences are relational too: cancelled plans, guilt, doubt and resentment.
• Because the illness is invisible, others often know it only through your absence. Tell them what happens when you are not there.
• Both partners experience a loss. The disappointment of someone close to you is not an accusation, and the guilt of the one who is ill is not a debt.
• A plan in advance helps: a signal, divided tasks, a plan B and a conversation after the attack.
• If attacks are frequent, see a doctor first. If the same argument keeps going round in the relationship, there may be something other than migraine behind it.