Cognitive Behavioral Therapy for Migraines

Some migraineurs are fortunate enough to experience prodromal symptoms that let them know a migraine is coming.  It isn’t much, but it allows them to plan for the downtime they know they are about to enter into.  A migraineur who has learned cognitive behavioral therapy can utilize the same prodromal symptoms to short circuit their migraine headache.

Cognitive-behavioral therapy for migraineurs is aimed at recognizing at consciously manipulating the role that a patient’s behaviors play in the development of their headaches.  Together the patient and therapist will determine how the patient behaves when they feel a headache coming, or when the pain starts for those who do not experience prodromal symptoms.  They then develop alternative behaviors to try in the same situation in hopes that changing the behavior will change the migraine.

In cognitive-behavioral therapy, the doctor or therapist works with the migraineur to:

* Identify the problem behavior to be modified.  This is often done by having the patient maintain a headache diary.

* Establish a treatment goal.  This is usually not the total elimination of the migraine, but a step along the way, such as learning to relax around potential migraine triggers.

* Create a new behavioral pattern to try to affect change.

* Monitor the patient’s reaction to the new behavior and check for environmental factors that may be influencing the behavior.  

Common behavioral therapy techniques include:

* Desensitization

* Positive Thinking

* Reframing

* Role-Playing

* Self-Talk

Cognitive-behavioral therapy can be helpful by itself but is especially helpful to patients who are also on preventive drug therapies.  

A 1989 study found that clinic-based and minimal-therapist contact behavioral therapy had roughly equal success rates, both initially and upon follow-up six months later.  Minimal contact therapy is therefore an effective, affordable treatment alternative for migraineurs.