Sometimes our doctors will recommend cognitive behavioral therapy for Migraine. At first, this suggest may be confusing. We may even think our doctors don’t believe our experience with Migraine is genuine. Sometimes we interpret the referral as an assessment that we are “crazy.” Let’s take a step back for a moment to understand what cognitive behavioral therapy is, how it works, and what it can do for Migraine. Most importantly, let’s clear the air. Migraine is not a psychiatric illness. It’s a neurological disease that requires medical intervention.
Thoughts affect behavior
Successful Migraine management depends, in part, on how resilient we are to the challenges of living with migraine. We may be asked to make behavioral changes, such as trigger avoidance. Our ability to change is strengthened or weakened by many factors, such as…
- our thoughts and opinions about disease, pain, medicine, and health,
- our confidence in our ability to cope with the challenges of life with Migraine,
- our trust in others, particularly our health care providers,
- our ability to modify our behaviors to accommodate necessary lifestyle changes,
- the way we interpret our symptoms,
- and many more.
The way we view ourselves in relation to Migraine also has an impact on the relative success or failure of treatments. Sometimes, we feel helpless in the face of changing symptoms. That helplessness can grow, sapping our willpower to try new treatment options. When we have the necessary skills and confidence to respond to symptom changes, our experience is very different.
According to a study published in the June 2017 issue of Headache, amitriptyline plus cognitive behavioral therapy for Migraine reduces the frequency and severity of attacks better than medication alone. When used in addition to medical treatment, cognitive behavioral therapy can
- teach us proactive coping skills to respond to Migraine,
- challenge and change counterproductive thought patterns
- teach us to recognize and change subtle bodily responses through biofeedback
- help us develop healthy habits that protect against future Migraine attacks
- give us a greater sense of control over Migraine, and
- offer strategies for faster, more effective response to Migraine attacks.
Link between pain and emotion
- Mind-body connection
According to a May 2017 study published in Neurological Sciences, there is an overlap between brain structures and neurological processes involved in both pain perception and emotional response. We may feel depressed or anxious as a result of pain. It is also possible to feel physical pain in response to emotional distress. This intersection between pain and emotion can contribute to an increase in both pain perception and emotional distress.
- Coping with physical and emotional pain
The way we think and talk about Migraine can impact the frequency and severity of attacks. Have you ever wondered why some people seem so strong while others struggle? That’s because we all have unique responses to pain. A 2015 study published in Current Neurology and Neuroscience Reports explains this concept, “A substantial body of evidence suggests that patients’ cognitive, emotional, and behavioral coping responses to their pain play a significant role in determining their long-term health. Resilient pain responses, which are shaped by both qualities of the individual and his/her social environment, can be learned and thus hold promise as targets for treatment.”
- Mental illness can affect Migraine
A December 2016 article appearing in the Journal of Neurology states that when Migraine is comorbid with anxiety or depression, psychological interventions should offered in addition to medication.
Cognitive Behavioral Therapy for Migraine is different
When cognitive behavioral therapy for Migraine uses several treatment modalities. Some interventions focus on thoughts or behavior alone, while others take a more holistic approach. Practicing new skills between sessions is often expected. Treatment is focused on creating long-term behavioral and cognitive change.
Cognitive behavioral therapy for Migraine may also include:
- Biofeedback increases awareness of autonomic responses (muscle tension, heart rate, respiration, temperature, etc.) and teaches conscious alteration of these responses in order to reduce the perception of pain.
- Mindfulness-based relaxation therapy increases situational awareness and retrains the body to respond to stressful situations with physical and emotional relaxation
- Cognitive restructuring improves recognition of dysfunctional thinking patterns, challenges these patterns, and offers healthier alternatives to affect long-term change in thoughts, beliefs, and emotional responses.
- Behavioral modification creates long-term behavioral changes through specific goal-setting, identification of barriers to change, reinforcement of desired behaviors, and extinction of undesired behaviors.
- Dialectical Behavior therapy involves social and interpersonal skills training and training in distress tolerance strategies.
Access to CBT is changing
One of the complaints about CBT has been the time and expense involved in treatment. Finding a qualified therapist with training in Migraine and other headache disorders is even more challenging. With a shortage of qualified therapists, many patients are unable to access treatment. Recent studies have tested short-term cognitive behavioral therapy for Migraine using electronic, self-paced programs. This reduces costs and improves accessibility. In the coming years, we can expect to see more options for online or telemental health services. As the technology for secure, HIPAA-compliant platforms improves, we may one day be able to access mental health services anywhere, anytime they are needed.
- Dahlke, L, Sable, J, Andrasik, F (2017). Behavioral therapy: emotion and pain, a common anatomical background. Neurological Sciences, 38(S1), 157-161. doi:10.1007/s10072-017-2928-3
- Kroner, J, Peugh, J, Kashikar-Zuck, S, et al. (2017). Trajectory of Improvement in Children and Adolescents With Chronic Migraine: Results From the Cognitive-Behavioral Therapy and Amitriptyline Trial. The Journal of Pain, 18(6), 637-644. doi:10.1016/j.jpain.2017.01.002
- Morgan, M, Cousins, S, Middleton, L, et al. (2016). Patients’ experiences of a behavioural intervention for Migraine headache: a qualitative study. The Journal of Headache and Pain, 17(1). doi:10.1186/s10194-016-0601-5.
- Stonnington, C, Kothari, D., Davis, M (2015). Understanding and Promoting Resiliency in Patients with Chronic Headache. Current Neurology and Neuroscience Reports, 16(1). doi:10.1007/s11910-015-0609-2