Catastrophizing in Chronic Migraine

Patient Expert & Health Professional
Medically Reviewed

You feel an attack coming. What thoughts race through your mind? Are you filled with a sense of dread, imagining the worst? Do you struggle to suppress your fear? Are your days filled with anxious worry and intrusive thoughts about Migraine disasters?

You’re not alone. An estimated 25 percent of patients with chronic Migraine struggle with catastrophizing1. That’s a lot of suffering people!


So what is catastrophizing? The term comes from the cognitive model of psychotherapy. In this theory, catastrophizing is one of several cognitive distortions that can negatively impact emotion and behavior. In simple terms, catastrophizing is a pattern of thinking that promotes negative feelings and self-sabotaging behaviors. It is imagining the worst possible outcome from any unpleasant experience.


• You don’t have Migraine. You really have some life-threatening brain disease.

• You’re going to die from this Migraine attack.

• The ER is going to treat you like a drug-seeker.

• All the meds give you intolerable side effects.

• All the meds fail.

• Everyone thinks you are just faking.

• Everyone thinks you are crazy.

• No doctor can help you.

Are you getting the idea? Sometimes our fears of the “worst case scenario” do really happen. So not every negative prediction that pops into our heads is a problem. The trouble comes when we get stuck in the habit of thinking the worst every time we are faced with an unpleasant experience. Let’s face it, Migraine attacks are seriously unpleasant, downright painful, and sometimes excruciating. There’s a big difference between a realistic assessment of potential outcomes and obsessive worry that everything will fall apart all the time.

Why it matters

This mental anguish is linked to many negative outcomes for Migraine patients. Two recent studies1,2 have shown that a long-term pattern of catastrophizing is associated with:

• Higher attack frequency

• Longer attack duration

• Higher prevalence of allodynia

• Poor treatment response

• Increased rates of depression

• Increased rates of anxiety

• Decreased self-efficacy

• Greater levels of disability

• Poorer doctor-patient relationships

• Higher body mass index (BMI)

• Lower quality of life

• Four times greater risk of developing chronic Migraine

It’s not your fault

Catastrophizing is not a character flaw or moral weakness. It’s simply a pattern of thinking that can create misery in our lives. The thoughts come racing in, no matter how hard we try to suppress them. We may have tried to stop on our own and failed.

What you can do about it

The good news is that there are effective treatments to break the cycle of catastrophizing and give us a greater sense of control over Migraine. By seeking treatment, we lower our risk of worsening Migraine and improve our quality of life. The best treatment for catastrophizing is cognitive behavioral therapy (CBT). Almost any licensed mental health provider can offer CBT. However, the best results are achieved by working with one who specializes in behavioral pain management and understands Migraine. Ideally, our therapists should work closely with our Migraine specialists to coordinate our care.

Where to find a therapist

American Migraine Foundation Find a Doctor

American Psychological Association Psychologist Locator

Association for Behavioral and Cognitive Therapies

See More Helpful Articles:

Migraine and Depression – Increased Suicide and Mood Disorder Risks

Anxiety Disorders Associated with Migraine Disease

Migraine and Depression May Be Linked Genetically


1 Bond; D, Buse; D, Lipton; B, et al. (May 2, 2015). Clinical Pain Catastrophizing in Women with Migraine and Obesity. Headache. 2015; (7): 923-933. doi: 10.1111/head.12597

2 Holroyd; K, Drew; J, Cottrell; C, et al (May 26, 2007). Impaired functioning and quality of life in severe Migraine: the role of catastrophizing and associated symptoms. Cephalalgia, 2007;(27): 1156-1165, doi:10.111/j.1468-2982-2007-01420.x.