Migraine can be debilitating — not just in the physical sense, but in an emotional sense, too.

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I’ve had migraine for as long as I can remember. My mother tells me the attacks started when I was 7, and ever since I’ve experienced them with regular frequency.

Sometimes I’ll have 3 or 4 migraine days in a 10-day period, and sometimes I’ll be migraine-free for 4 weeks before suffering an attack that lasts for days. Either way, migraine attacks are a guarantee in my life.

While I’ve developed an arsenal of tricks and tools to help me manage the pain and lessen nausea, one thing I continue to struggle with is the emotional side of it.

While the physical symptoms of migraine are well documented, the emotional side effects aren’t as often discussed.

I’m often fending off feelings of guilt, shame, embarrassment, and resentment while trying to manage nausea and pain that come with an attack.

In a social setting, I’ve also dealt with feelings of panic at the onset of a migraine attack and fretted about how being sick might upset someone else’s plans.

For example, at a recent wedding, I spent the reception running to the bathroom to get sick, while downplaying just how unwell I felt to the rest of the guests.

I’ve often felt shame and embarrassment that something as simple as not drinking enough water, overdoing it on alcohol, or indulging in too much sugar can leave me suffering.

I’ve felt resentment and frustration when an attack has forced me to cancel plans or has shown up in the middle of an event I was looking forward to.

Instances like these may be familiar for people who experience more episodic migraine attacks, but people with chronic migraine, exhibiting symptoms on 15 or more days per month, are even more likely to experience anxiety and depression.

Yuko Nippoda, psychotherapist and spokesperson for the UK Council for Psychotherapy (UKCP), confirms that people with chronic migraine can often experience anxiety, depression, and other emotional impacts.

“You can feel anxious about when an attack will come next, how you will manage it, and if the migraine could cause other illnesses,” she explains.

Many people also worry about canceling plans or not being uphold their commitments, which can cause anxiety about the loss of friends or jobs.

“This anxiety can lead to a fear that everything could go wrong in your life,” Nippoda says.

If you’re regularly unable to participate in day-to-day life as a result of migraine, you could also experience feelings of depression.

“You might question why you [have this condition], and you might feel anger or blame yourself that you are not managing well,” says Nippoda.

Feelings of isolation and loneliness are also common, as it can be difficult for others to understand what you’re going through if they don’t have migraine.

Nippoda says all of these feelings are normal, and you shouldn’t beat yourself up about it, as this can make you feel worse.

“Migraine is an unseen chronic condition, and [this] can be easily misunderstood by other people, which can lead to feelings of shame and guilt,” she explains.

If you notice that you are experiencing any of these emotional symptoms as a result of migraine, there are ways you can manage it.

Start with kindness

Physical pain can be hard to manage — and it is not your fault.

“You do not need to feel embarrassed,” says Nippoda. “On the contrary, you should praise yourself for dealing with difficulties.”

Try switching your self-talk to a voice that recognizes how well you’re doing.

I’ve found repeating the words “it’s OK, I’m doing my best, this isn’t my fault,” very helpful.

Address social pressure

If you’re worried that your condition may hinder someone else’s plans, Nippoda says it’s important to not let others pressure you. Having an honest conversation about how debilitating migraine can be may be helpful.

“It might be useful to tell others you have a chronic physical condition and that you need to pace yourself,” she suggests. “This could then diminish the fear that you might need to cancel plans.”

Consider a support group

Feeling like no one in your life has had similar experiences or that no one understands you can lead to feelings of loneliness and worthlessness, says Nippoda.

“When you can share your experience with others, you feel accepted and you can accept yourself more,” she says.

If joining an in-person support group isn’t for you, there are many online migraine support groups and forums you can join.

Practice mindfulness

Research suggests that mindfulness meditation may reduce the stress-related effects of migraine.

Nippoda says prioritizing relaxation is a good place to start.

“Relaxation, mindfulness, soothing music, or yoga can help to calm you and ground you,” she explains. “This can be helpful because many negative feelings can come into your head.”

Look out for patterns

Tracking your symptoms may help you find patterns. For example, you might notice that weather, certain foods, or particular stressful situations always trigger an attack.

“When you know these factors, you gain confidence in managing the condition and you can reduce anxiety,” Nippoda says.

I’ve found looking for patterns in my emotional response can be helpful, too. When I can identify the negative emotions I tend to experience during an attack, it makes it easier for me to unpack them, and in turn, lessen their control on me.

Migraine can be debilitating — not just in the physical sense, but in an emotional sense, too.

People who manage chronic migraine may experience guilt, shame, embarrassment, resentment, frustration, and even anxiety and depression.

Experiencing these emotions is a normal reaction to pain and discomfort, and in some cases, they can be managed by practicing self-kindness and mindfulness, identifying patterns, and lessening social pressure.

If you’re having trouble managing your mental health and these strategies aren’t helpful, find someone to talk to. There are therapy options for every budget, and no one should have to go it alone.

In some cases, a healthcare provider may recommend medication for the anxiety or depression you are experiencing alongside migraine.

Victoria Stokes is a writer from the United Kingdom. When she’s not writing about her favorite topics — personal development and well-being — she usually has her nose stuck in a good book. Victoria lists coffee, cocktails, and the color pink among some of her favorite things. Find her on Instagram.