There are dozens of different treatments available to those who suffer from migraines, ranging from various drug medications to surgical interventions.
For many, conventional treatments work well, but they don’t work for everyone. And even when treatments are working well there can be side effects that the patient would rather not have. For sufferers who find drugs don’t work, or those with other medical complications, the emotional upset of frequent drug or dose changes can leave migraineurs feeling helpless and desperate.
There is an alternative though, and thanks to diligent and constantly evolving research into migraine causes and its treatment, cognitive behavioral therapy (CBT) is proving to work where other forms of treatment have failed or had limited success.
What is Cognitive Behavioral Therapy?
It’s not a new therapy generally, but is a relatively new approach to treating migraine.
Conventionally, CBT is used to train patients to alter the way they think about and approach, a problem. Examples of areas where CBT has a high success rate includes relationship difficulties, depression, or where there is drug or alcohol abuse. The therapy can also help people overcome anxiety, problems sleeping, or with weight management.
How CBT Works
Over a relatively short period, patients work one to one with trained a psychologist. Courses of treatment may last for ten or twelve weekly, hour-long sessions.
The aim is to help patients change their thinking and behavior patterns, empowering them to approach troublesome aspects of their lives with a more positive attitude.
But it’s not just ‘positive thinking’. It’s a practical, hands-on approach. Patients will often have homework in between sessions so they can practice what they learn and make notes about their progress.
The beliefs and attitudes we hold influence how we perceive everyday situations. Our negative thought patterns often lead us to the exact consequences we dread. We don’t realize how often we talk ourselves into negative situations until we stop to examine our thought patterns, then learn an alternative approach.
External stresses cause actual physical changes in the body: Muscles tense up, breathing becomes faster, pulses race. It’s the classic ‘flight of fight’ response to stress, and is intended to protect us. While it’s useful if we need a spurt of energy to run away from danger, it’s not so helpful when those physical responses have unwanted side effects, such as making blood vessels contract and triggering migraine.
Cognitive behavioral therapy retrains the mind so we can take control of physical responses and reduce unpleasant side effects. Relaxation techniques such as progressive muscle relaxation, mindful meditation, or visual imagery are skills that, with practice, patients can call upon to see them through stressful situations.
It’s not just about relaxation, however. CBT also helps us understand and recognize our thought patterns so we can avoid the negative self-talk that brings us down. How we handle situations often depends on the response we expect from others. So, if we expect a hostile response we might display hostility first, then when people respond in a hostile manner they fulfill our original expectations.
Migraine sufferers frequently experience intense guilt. CBT can help them find ways to overcome those negative feelings, giving them a new and more wholesome approach to self care.
Using Biofeedback to Reinforce Practice
Physically seeing the effects of their mental efforts helps patients identify beneficial thought patterns and actions, such as when making a conscious effort to relax muscles. Strategically placed electrodes provide physical evidence, which encourages patients to continue. Biofeedback can also be used to measure blood flow.
How CBT Can Help Migraine Patients
The emotional aspects of migraine can be as damaging as the physical pain. CBT can help migraine patients in three ways:
- Through training to cope with stress.
- With biofeedback.
- By teaching relaxation techniques.
Goals in CBT can be specific, tailored to individual needs. For instance, patients may learn new ways of thinking, new ways of acting or feeling, new coping strategies or ways of dealing with pain. It focuses on the present and what’s happening now rather than what happened before, and is more about individual beliefs and views than personality traits. It helps patients replace habits that don’t work with those that do, giving them more control over their lives.
More studies have been done on children with migraine than with adults, where it’s been shown once the skills are learned, kids with migraine have fewer migraine episodes and so don’t miss as much school. The coping skills, once learned, stay with them for life.
CBT is often covered by medical insurance, and your doctor may be able to refer you. It’s not currently a first line treatment for migraine, but if you’ve tried everything else and nothing is helping, it’s worth bringing up the subject with your care provider.