Behavioral Therapy for Migraines
Author: Claire Sandoe, MD, FRCPC, Headache Fellow
If you have previously seen a headache specialist, you may have been instructed to try relaxation techniques — but why? Some patients think that this means their doctor is blaming their headaches on stress.
Ongoing research indicates that relaxation training is important for improving skills for coping with pain, in addition to reducing the negative impact of stress.We also know that unpleasant or traumatic life events, both in childhood and in recent adult life, are a risk factor for an increase in the frequency of migraines. Learning how to deal with the stress related to these life events is a valuable tool for any patient with migraines.
Stress itself does not cause migraines directly, but it is a common trigger in patients who are genetically susceptible to migraine.We often think of the brain of a patient with migraines as being hypersensitive to small changes in its environment, whether these are weather changes, hormonal changes, illness, stress, or any of the other triggers patients sometimes identify for their headaches.
The goal of relaxation techniques is to reduce this hypersensitivity and make patients both less likely to have individual attacks, and more likely to be able to manage attacks as they occur
A number of different relaxation therapy techniques can be valuable. Some of these techniques can be tried at home, such as abdominal breathing, meditation, and mindfulness. Some techniques are done in conjunction with a healthcare provider, such as cognitive behavioural therapy (CBT) and biofeedback. One study showed that patients given a combination of a behavioral therapy with a preventative medication did better than patients given only the preventative medication. Multiple studies have shown that mindfulness meditation improves a number of chronic pain conditions, including migraine, and quality of life. Even 5 minutes of mindfulness per day can be beneficial! Guided imagery, visualization, and meditation may also be used to help with falling asleep, and improved sleep can in turn improve headaches.
Some patients with anxiety may find that mindfulness increases their anxiety symptoms. If you find home meditation/mindfulness too difficult, consider trying to find a CBT or biofeedback program in your area.
A few resources:
App and Website-based
Stop, Breathe, and Think
- Board of Directors
- Course and Workshop
- Migraine and Science
- Migraine and Society
- Migraine or Headache?
- Other headaches
- Preventing attacks
- Stop the attack
- Top Ten Topics of the EHMTIC congress in Glasgow
- What about Lifestyle?
- Women and Children