Migraine is a genetic neurological disease, not a mental illness. Given that, why do Migraine specialists recommend cognitive behavioral therapy (CBT) for Migraine?
CBT involves changing the way we think and behave. By recognizing the impact our thoughts have on emotion and behavior, we can learn new ways to think about our experiences, including Migraine. Our ability to cope with the challenges of living with Migraine is directly influenced by our thoughts, opinions, and beliefs.
Effective Migraine management involves behavioral changes such as trigger avoidance and making in-the-moment treatment choices. These are greatly influenced by the way we think about our experience with Migraine. Someone who views themselves as a victim of circumstance will have a very different experience than someone who believes they have power over Migraine.
When used in addition to medical treatment, CBT can give us a greater sense of control over Migraine. That change in mindset is proven to reduce the frequency and severity of Migraine attacks. According to a study published in the June 2017 issue of Headache, amitriptyline plus CBT reduces the frequency and severity of Migraine attacks better than medication alone.
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.
A multi-faceted approach
When CBT is used to treat Migraine, several treatment modalities may be involved. 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.
Treatment may also include:
- Biofeedback: This 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: This increases situational awareness and retrains the body to respond to stressful situations with physical and emotional relaxation.
- Cognitive restructuring: This improves recognition of dysfunctional thinking patterns, challenges these patterns, and offers healthier alternatives to effect long-term change in thoughts, beliefs, and emotional responses.
- Behavioral modification: This 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: This involves social and interpersonal skills training and training in distress tolerance strategies.
Making treatment more accessible
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 interventions 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.
See more helpful articles:
1 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
2 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
3 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.
4 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
Headache disorders advocate and patient expert, blogger, and mental health therapist, Tammy Rome maintains a private practice specializing in behavioral pain management, as well as writing for her own blog, Brain Storm. She also volunteers as vice chair of the American Headache and Migraine Association and as president of The Cluster Headache Support Group. You can read more of Tammy’s work on her blog and follow her on Facebook, Twitter, StumbleUpon, Pinterest, LinkedIn, and Google+.