The Basics of Cognitive Behavioral Therapy for Migraine
Cognitive behavioral therapy (CBT) can help improve our Migraine management by teaching us to recognize and change thinking and behavior patterns that block our path to personal satisfaction. CBT has been the subject of numerous double-blind, placebo-controlled studies. It has a proven track record of success for a variety of conditions, including the prevention of migraine.
A study in the March 2017 issue of Headache demonstrated that CBT was clinically effective in preventing pediatric Migraine. CBT isn’t just for kids, though. Adults with Migraine benefit from CBT in many ways. Study author Buse and colleagues describe some of these benefits:
"Cognitive behavioral therapy is an empirically tested method that helps patients identify behaviors that may increase or maintain headaches (eg, triggers, stressors, unhealthy lifestyle or habits) and maladaptive or dysfunctional thoughts (ie, cognitions) regarding their headaches. Cognitive behavioral therapy can aid in headache management by making patients more aware of triggers, including the association between stress and headache, and identifying and challenging counterproductive or self-defeating beliefs and ideas. Cognitive behavioral therapy is also effective in managing depression, anxiety, panic disorder, obsessive-compulsive disorder, eating disorders, sleep disorders, and other common comorbidities in patients with headache. ”1
Cognitive behavioral therapy
• focuses on the present
• is problem-solving oriented
• teaches specific skills
• is scientifically tested and shown to be effective
The cognitive model
CBT is based on a theoretical model known as the cognitive model. Its premise is that the way we perceive situations influences how we feel emotionally, which in turn influences how we behave. A CBT therapist may use a variety of interventions borrowed from other disciplines, but the core assumption is the same.
CBT helps us identify our distressing (and often subconscious or involuntary) thoughts and then evaluate how realistic those thoughts are. These thoughts are called cognitive distortions. These “thinking errors” happen automatically, almost like a reflex or instinct. They can have a negative effect on our mood and behavior. CBT teaches us to recognize our cognitive distortions, challenge them, and gives us tools to correct our bad thinking habits. In CBT, we learn to improve our mood by changing our thinking patterns. CBT also focuses on solving problems and helping people make lasting behavioral changes.
Treating Migraine with CBT
Almost everyone can benefit from CBT. Our migraine specialists may recommend CBT as part of our treatment plan. That does not mean that doctors think we are “crazy” or that our pain is “all in our heads.” Because CBT focuses on problem-solving, it can be used to help us find solutions for a number of migraine-related problems:
• difficulty with self-advocacy
• difficulty with treatment compliance (i.e. forgetting to take meds)
• struggle with overusing acute medications
• intolerance to medication side effects
• inability to find an effective preventive
• difficulty identifying and/or avoiding triggers
• difficulty with stress management
• lack of social support and/or social isolation
• difficulty with interpersonal relationships
• problems at work or school
• problems coping with stigma
• insomnia or other sleep disorder
• history of childhood abuse or neglect
Goals for Migraine CBT
• Reduce frequency and severity of attacks
• Reduce migraine-related disability
• Reduce reliance on poorly tolerated or unwanted pharmacotherapies
• Enhance personal control of migraine
• Reduce migraine-related distress and psychological symptoms
1 Buse; D, Rupnow M, Lipton R. Assessing and Managing All Aspects of Migraine: Migraine Attacks, Migraine-Related Functional Impairment, Common Comorbidities, and Quality of Life. Mayo Clinic Proceedings. 2009;84(5):422-435.
2 Ng; Q, Venkatanarayanan; N, Kumar; L (2017). A Systematic Review and Meta-Analysis of the Efficacy of Cognitive Behavioral Therapy for the Management of Pediatric Migraine. Headache: The Journal of Head and Face Pain, 57: 349–362. doi:10.1111/head.13016.