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Mental health therapies that work

When someone suggests you seek psychotherapy for Migraine, what comes to mind?  It might be something like…

“You don’t believe I’m in pain.”

“You think I’m making this up.”

“You think I’m crazy.”

Skeptical of therapy?

Many will have difficulty believing that psychotherapy can actually reduce your suffering.  Suffering is not the same as pain. Lots of people experience pain, but not all of them are suffering. Suffering happens when we fight against the pain, refusing to accept its reality in our lives. This isn’t to suggest that we shouldn’t try to reduce our pain. Rather, it is an encouragement to acknowledge the truth of our experience with Migraine without trying to change it. After all, Migraine is incurable. No one knows how to get rid of it.

What works?

Psychotherapy helps us change the way we think about Migraine and its many symptoms. It helps us improve our relationships with others to lessen the impact of stigma. And in some cases, it can actually teach us new skills for reducing symptoms. Not every method of psychotherapy is beneficial for Migraine.  Stereotypical psychoanalysis (think Freud) is not likely to result in pain reduction. Neither will therapies that are problem-focused. What we need are practical, solution-focused, strengths-based therapies. Here is an overview of the types of therapies most beneficial for Migraine.

Behavioral therapy focuses on what we do and creates rewards or incentives to eliminate unwanted behaviors (i.e. skipping meals, staying up late, missing doses of medicine, etc.) and reinforce positive change. Behavioral therapy is great for those who are motivated and ready to make a change, yet struggle to make the change without support. This type of therapy provides the structure and accountability required to make lasting positive change.

Cognitive behavioral therapy (CBT) focuses on what we do and how we think. By changing both our behaviors and thought patterns, we change our emotional experiences. CBT is widely accepted and nearly all therapists are trained to utilize it. Instead of focusing on our emotions (i.e. depression, anxiety, shame, etc.), a CBT therapist will ask us to rate and track our emotional symptoms and then examine what behaviors and/or thoughts trigger the emotion or keep it going. Over time, the therapist guides us to challenge our thinking, develop new thought patterns and behaviors. This process redefines our experiences and ultimately helps us change the way we feel.

Dialectical behavior therapy (DBT) is a relatively new type of therapy that is a combination of CBT and Buddhist philosophy. It is a structured program of weekly therapy plus a skills development group. Learning the skills of DBT allows us to distinguish between situations we can change and those we cannot. It also teaches interpersonal skills which can be valuable when dealing with doctors, loved ones, and co-workers who have trouble understanding our experience with Migraine. An finally, DBT gives us strategies that can help reduce our sense of suffering by addressing ways to ease strong, negative emotions or physical pain.

EMDR (Eye Movement Desensitization Restructuring) is a unique type of therapy that is ideal for those of us who have difficulty with verbalizing our pain. There isn’t much talking in this type of therapy.  We are asked to focus on a distressing situation. While we are thinking, the therapist will guide us through a series of eye movements and tapping movements on our own bodies. These movements are thought to retrain the brain to heal emotional trauma. EMDR is ideal for migraineurs who also have PTSD.

Emotion focused couples therapy (EFT) is an experiential therapy based on Attachment theory.  It is ideal for couples (migraineur and caregiver) who need help addressing each other’s unmet emotional needs. EFT views a couple’s arguments as a normal response to feelings of insecurity in the relationship.  Couples are encouraged to share details of their arguments in session. The therapist asks questions and makes observations in order to discover the source of each partner’s core emotions. The therapist then connects these emotions to unmet needs and coaches the couple on how meet each other’s emotional and physical needs more appropriately.

Narrative therapy engages migraineurs in the process of telling our stories. Through this process, we are encouraged to challenge the way we tell our story and “rewrite it”. In this process, we can be transformed from helpless victim (or hypochondriac, “crazy one”, “weak one”, etc.) to the powerful author of our own fate.

Solution-focused brief therapy (SFBT) avoids addressing emotions or problems. When we start discussing these issues, the therapist will redirect us, giving alternative ways to describe the situation using solution-focused vocabulary. This new way of communicating retrains the way we think about the issues that brought us to therapy. This type of therapy is time-limited (usually 2-6 sessions) and creates specific, measurable goals in collaboration with the client. SFBT is ideal for discovering triggers, improving medication compliance, or improving sleep hygiene.

Art therapy engages us in processing our experiences through various art mediums. Some techniques are structured, while others allow the client more freedom of expression. Like EMDR, art therapy is effective when verbal expression is difficult or impossible.

Music therapy engages us in expressing our experiences through our choice of music. Additionally, we are taught how to alter our moods by the music styles we choose.

Play therapy isn’t just for kids!  However, children often process their emotions and the impact of difficult situations through play.  By engaging us in play, we reconnect with our younger self and can also resolve issues not easily addressed in talk therapy.

Sand tray therapy is a specific type of play therapy that taps into the unconscious. It can be particularly useful for migraineurs to process when faced with the cognitive deficits of migraine.

Finding a good therapist

When shopping for a good therapist, consider your particular Migraine goals and challenges. Ask what types of therapy can be provided and whether the therapist understands chronic pain. Don’t be afraid to terminate therapy and move on to another therapist if it isn’t working out. Successful therapy requires a good match between client and therapist. The greatest predictor of a positive outcome is the quality of the client-therapist relationship.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.



  • labwhisperer
    5 years ago

    After failing on multiple preventative medications and getting 5 to 12 migraines a month, I needed to find other ways to deal with the pain. On a recommendation of a friend, I went to see a therapist who specializes in hypnotherapy. She works with people who have chronic pain.
    We are working on ways to relax and decrease the pain through various techniques. I have to say it’s working.
    I am also working with a CBT therapist and that too is helping.
    For me, acknowledging that I have chronic pain and how to cope from there is helping me live my life as normal as possible.
    This does not replace my abortive mess during a migraine, but is adding another tool in my toolbox to decrease their interruptions to my life.

  • Tammy Rome author
    5 years ago

    So glad to hear you are getting results, labwhisperer. As you said, mental health treatment isn’t a cure. Meds and other treatments are still necessary. What it will do is help you change the way you think about Migraine so that you can respond more effectively (and calmly), thereby reducing your suffering during an attack. Keep up the good work and may you have many more pain-free days!

  • labwhisperer
    5 years ago

    Should say “abortive medications”, not mess….. Thank you spell check

  • Tammy Rome author
    5 years ago

    That’s such good news that you are feeling better. It can take up to 3 months at the optimum dose to see results from any treatment, so keep at it.

    Honestly, very few psychiatrists are qualified or willing to offer psychotherapy. For good therapy, you need to find a psychologist, social worker, counselor, or mental health therapist. These practitioners often have Master’s degrees and licenses to diagnose and treat mental health issues. A rare few will have a PhD or PsyD.

  • Ruth Swain
    5 years ago

    I went to a psychiatrist to help me #1 get off Fioricet w/codeine, and #2 seeking therapy for my depression, secondary, I suppose to my chronic daily migraine. I’ve been on/tried at least 100 meds, failed topomax twice, and this shrink, gave me Neurontin, (gabapentin) start one twice a day for 2 weeks then up to 2 twice a day. I feel totally different, not goofy, not losing my words, but almost, dare I say it, NORMAL. I’ve had migraine since age 23, I’m 63 now. Maybe the combo of not working much at all as a RN and the new med, IDK. but it’s an unexpected change for me. I have had 2 migraines since, but they were mildish, I still took a relpax (tripan) and they went away quickly without all the after effects I usually have. He was an older man. He told me to come back in two months and we’ll “see about talk therapy”. I couldn’t even buy it there. Maybe when someone tells me that I am very sane, and gives me a new drug, and I have almost no responsibilites as a RN any longer……could this be a magic drug for me, or will my migraines return when my brain figures this drug out, like so many times before. Is this the placebo effect? I never expect anything to work after 40 years, and here I am with more energy, and feeling calm and positive. I’m losing the thoughts that creep into my head daily…”suicide would end this agony, but I have 2 kids, one only 22 and they would never ever understand” Suicide passes the pain onto the ones you leave behind. Knowing this I don’t act on it, but every day until the neurontin the thoughts were there. They are GONE.

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