Treating migraine with talk therapy
Many of us are reluctant to accept a referral for mental health services. In the past we have been told that migraine “is all in your head” or that migraine is a mental illness. I have been on the receiving end of that garbage, too.
It might surprise you to know there are some forms of talk therapy that actually have merit when it comes to treating migraine. They involve interventions that improve the way our brains respond to stress. Most of us will admit that a migraine attack is stressful. According the 2012 Migraine in America study, stress was also listed as the second most common trigger among Migraine.com readers.
Certain types of talk therapy are especially good at teaching stress management skills. The trick for getting good results from talk therapy is to clearly define what you expect to be different once the therapy has ended. If you can state that goal and monitor your progress at every session, then there’s a good chance therapy will succeed.
We all want fewer migraines, right? So let’s make that our goal. But wait…how can therapy improve a physical condition?
- Reduces side effects by changing thought patterns that set up the expectation of side effects
- Reduces intensity of attacks by utilizing relaxation strategies that calm the nervous system and stimulate the release of pain-blocking hormones
- Facilitates the identification and avoidance triggers we might not have discovered on our own
- Improves treatment success by providing accountability and encouragement to follow a treatment regimen
- Facilitates the creation of healthy habits that minimize our risk of another attack
- Provides education on the biological link between emotion, thought, behavior, and pain sensations
- Facilitates our understanding of the body’s stress response and learning how to turn it off
- Facilitates the processing of old traumas that may have altered our brain function and coaches us on how retrain the brain
Yes, talk therapy can do all of that and more if you let it. Certain types of therapy can actually change the structure and function of the physical brain. No medical treatment can achieve the same results. There are five specific therapies that can help reduce the number and intensity of migraine attacks. Which one you choose is based on a variety of factors, including your emotional response to pain, your adherence to recommended treatments, any history of abuse or trauma, and co-morbid psychiatric disorders such as anxiety, depression, or PTSD.
- Cognitive Behavioral Therapy (CBT) is a nice starting place that has been proven effective in the widest variety of situations. Most licensed therapists are qualified to utilize CBT to treat clients. The focus of this therapy is to change the way you think about specific things and to help you see the connection between your habitual thoughts and your behaviors and emotions. The goal of CBT is to help you recognize and change habitual thinking patterns that contribute to your current problems.
- Behavioral Modification Therapy is great for migraineurs who are struggling to identify and avoid triggers, having difficulty maintaining good treatment compliance, and have a tendency to engage in behaviors that increase vulnerability to migraine attacks. The focus is solely on changing behavior, so the therapist serves as a coach, holding the client accountable for behavior change. Therapy consists of identifying dysfunctional behaviors, identifying and removing barriers to change, and creating reinforcement schedules to extinguish unwanted behaviors and condition new ones. This type of therapy is most successful for those who do not struggle emotionally and have reached the “Action” stage of change.
- Emotion-Focused Therapy (EFT) is a relative newcomer to the world of psychotherapy. Unlike the previous two therapies, EFT is all about emotions. An EFT therapist will focus in on your emotional responses to a migraine attack and challenge you to fully embrace and experience that emotion. In future steps, you will be asked to identify unmet emotional needs your earlier response represents. This therapy seeks to heal the emotional wounds that drive your reactions so that you are more easily able to change your emotional response to migraine.
- Dialectical Behavior Therapy (DBT) is great for clients with a history of trauma or frequent and unhealthy relationships. It’s a lot like CBT with a twist. The twist is that it incorporates mindfulness, relaxation strategies, meditation, and other self-soothing techniques. A DBT therapist helps you to identify those triggering situations in which your emotions are in control (like when you have a “10” migraine and can’t get any relief). DBT also includes a once-weekly skills development group where you meet with other clients and a facilitator to learn and practice new skills. One of the great things about DBT is that it has interpersonal skills training built right into the treatment plan. This can be very helpful if you find yourself having trouble getting doctors and loved ones to understand you.
- Eye Movement Desensitization and Restructuring (EMDR) is ideal for clients who have experienced severe enough trauma that they have difficulty verbalizing the details. At the other end of the spectrum, EMDR also works great for clients without any trauma history at all. The therapist will ask you to focus your attention on a distressing experience while following his or her hand with your eyes and repeating a series of taps on different areas of your body. This process gradually resets the brain’s response to stress so that you are able to respond with the appropriate intensity of emotion to a wide variety of stressors.
By retraining your brain’s response to stress, you also help to regulate the very hormones and chemicals involved in the migraine process. Improving your response to stress at a physical level makes you less vulnerable to triggers – your brain becomes less sensitive, which leads to fewer attacks.
Talk therapy is not a cure for migraine. It does not work the same for everyone. It is certainly not a fast-acting remedy. A typical course of therapy is 8-12 sessions and is often covered by your insurance provider. It is a drug-free treatment option with a proven track record of success. If you want to give talk therapy a try, ask your doctor for a referral to someone who specializes in behavioral pain management or visit the American Counseling Association to find a therapist near you.
Can you tell when a migraine attack is coming?