Psychological Treatment for Migraines

If severe, recurrent headaches are putting a strain on your ability to live life your own way, mind-body psychotherapy may help you regain your physical comfort and peace of mind. For over a decade, I’ve used the tools of psychotherapy and hypnosis to help people overcome debilitating medical symptoms. On this page, I’ll provide information about how that works. Feel free to call or email me if you’d like to discuss your situation and set up an appointment.

There is no single underlying cause of chronic headache pain, but rather a constellation of contributing factors. There is a genetic component, so a family history of migraine headaches does predispose you to also have migraine headaches. But even if your identical twin has migraines, there is still only about a 50% chance that you will have them as well. Hormones also play a role: women of child-bearing age are two to three times more likely than men to experience migraine headaches, and the headaches often ease up after menopause. Nerve tissue inflammation, skeletal problems, muscle tension, and dietary intolerances can all contribute.

There are also psychological factors. Chronic pain has a strong, cyclical relationship with anxiety and depression. The experience of chronic pain causes anxiety and depression, and these heightened emotional states exacerbate the pain symptoms. On top of that, most chronic pain patients are surprised to learn that certain personality types are more likely to experience chronic pain.

Headaches are complex, and require holistic treatment

Early in my career, I spent a year training at the Diamond Headache Clinic’s inpatient unit in Chicago, which provides treatment for severe, chronic, and intractable headache cases. While mild cases can often be managed reasonably well with medications, more severe cases require a variety of treatment modalities that work synergistically. These may include medication, dietary adjustments, physical therapy, massage therapy, chiropractics, acupuncture, biofeedback, hypnosis, and psychotherapy. The types of treatment used are often selected based on the specific types of headaches you are experiencing and the way that the symptoms present. Migraine headaches with aura, for example, call for a different treatment approach than tension headaches or cluster headaches.

Pain perception is psychological

Most chronic pain sufferers assume that since pain is a physical condition, there is nothing that a psychologist could do for them other than to help them process the feelings of frustration of being ill. But it turns out that pain is not as strictly physiological as you might think.

To begin with, no matter what part of the body feels hurt, the pain itself actually takes place within the brain. The nerve endings that register pain throughout your body simply send signals back to the brain, which processes the signals and decides how much pain sensation it should produce in response. The amount of pain that results is not necessarily related to the amount of nerve damage or activation, but is instead regulated by context, emotional state, beliefs and social expectations about pain experience, and the amount and type of attention the pain is given.

Additionally, there are no pain receptors in the brain itself — no tissue has been damaged in the moments leading up to a headache. Instead, the part of the brain which creates pain has been activated for some other reason. It is very significant that fMRI studies have shown that “painful” emotional experiences such rejection and loss share the same neurological circuitry as physical pain. That is why sufferers of chronic pain are more prone to psychological distress, and those experiencing psychological pain are more likely to develop chronic physical pain. So in many cases, part of the chronic headache pain is a physical manifestation of psychological turmoil.

Has your doctor recommended therapy?

There are many different types of psychological interventions that may be helpful, depending on the nature of your headaches. After a thorough assessment, I develop an individualized treatment plan that may include any combination of the following:

  • Cognitive Behavioral Therapy (CBT)
    • Behavior plays an important role in headache management. By optimizing diet, exercise, sleep, stress management and other behavioral aspects of headache management, we can help to create a relaxed physical state that encourages natural healing.
    • Identifying external triggers for headaches is another important part of psychological treatment. By managing these triggers more effectively, we can reduce headache frequency.
    • Cognitive restructuring provides tools to help you process pain differently, decreasing pain awareness and increasing your ability to tolerate discomfort.
  • Mindfulness – By cultivating your ability to recognize and manage thoughts and feelings, mindfulness-based treatment strategies can be especially helpful for people suffering from emotional disruptions related to chronic pain.
  • Hypnosis – This powerful psychological tool can make it much easier to introduce new behaviors, new ways of thinking and feeling, and to directly modify physical processes. I have seen many patients respond extremely well to treatment which incorporates hypnosis into the psychotherapy.
  • Visualization – By creating new internal representations of pain processes we can change their meaning, and this changes the way that pain is dealt with at the neurological level.
  • Depth-oriented Psychotherapy – Unconscious psychological processes contribute to chronic pain. For example, many people experience more intense and frequent migraines within the year or so following a traumatic experience or a major loss. Certain emotions can’t be expressed, so they get represented in the body. This cycle can be broken by examining and resolving psychological conflicts that stand in the way of dealing with those emotions directly.

Studies have shown that psychotherapy can be very effective for relieving chronic headache pain, with most patients being able to return to work and go back to living normal, happy lives after treatment. In my experience, the key to successful treatment of headache pain is developing a clear picture of what is happening for you as an individual, and addressing the root causes using a customized, targeted, and holistic treatment program.

Mind-body psychotherapy is simply one component of your care that can help to enhance your body’s resilience, response to treatment, and rate of healing… as well as your emotional well-being. When you schedule your first appointment, I’ll ask you to sign a release form that will allow me to communicate with your physician, so I can coordinate with them to provide you the best care.

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