Discover how Cognitive Behavioural Therapy (CBT) can offer relief for people with migraine. CBT is a well-researched psychological treatment renowned for its effectiveness in addressing various health challenges, including migraine. By reshaping negative thought patterns and behaviors, CBT equips individuals with valuable skills to manage stress, enhance mood, and mitigate migraine triggers. Learn more about how CBT works, its different approaches, and what to expect if you’re considering this therapy to improve your quality of life
Understanding Cognitive Behavioural Therapy
What is Cognitive Behavioural Therapy (CBT)?
Cognitive Behavioural Therapy (CBT) is a psychological treatment that focuses on changing negative patterns of thinking and behaviour to reduce stress, improve mood, and better cope with problems. It emphasizes learning new skills to manage problems rather than fix them and is based on the idea that our emotions are largely dependent on how we think and behave.
Can CBT help people with migraine?
CBT is one of the most researched psychological treatments and has been found to be effective in helping people with various difficulties, including stress, mental health problems (such as depression and anxiety), and various health issues, such as migraine. CBT can help reduce the frequency and severity of migraine attacks, as well as help you learn coping strategies to better manage migraine.
If my healthcare provider recommends CBT, is it because I have mood problems that are causing my migraine?
CBT is recommended not because a psychological basis is seen as the cause of migraine, but because how people think and behave can trigger migraine attacks, worsen them, and reduce one’s quality of life. For some, mood disorders do contribute to migraine and should be managed proactively. Sometimes, learning how to deal with life stressors can also decrease migraine attacks. Using CBT for migraine does not mean that migraine is an imaginary condition.
How can CBT improve migraine specifically?
CBT helps people learn new ways of managing and coping with migraine. Changing negative thought patterns can decrease stress and improve emotions, which can then reduce the frequency and severity of migraine attacks. By monitoring thoughts and behaviours, people can gain insight into their specific migraine triggers and take steps to manage these triggers. Learning new behaviours, such as deep breathing exercises, meditation, activity pacing, and assertive communication, can also help control migraine and improve quality of life.
Is there more than one type of CBT?
Yes, CBT encompasses various approaches, including Acceptance and Commitment Therapy (ACT), Mindfulness-Based Stress Reduction (MBSR), relaxation training, and hypnosis. All focus on changing thoughts and behaviours and are generally more present- and future-focused (rather than exploring past experiences).
What about other psychological therapies (not CBT)?
Other psychological therapies exist, such as psychoanalysis, but they are less researched in relation to migraine and may not be as effective.
Do I have to see (and pay for) a therapist? What about self-help?
While seeing a therapist can be beneficial, self-help CBT through workbooks or online programs is a viable and cost-effective alternative, especially if finding a qualified therapist is challenging. However, self-help books and programs may not be helpful if problems are severe or motivation is low. Group CBT has also been studied and can be an interesting option if available in your area. Ask your physician and research resources in your community.
Trying Cognitive Behavioural Therapy: What to Expect
How does CBT work?
CBT works by helping you change how you think, feel, and act to prevent or cope better with migraine attacks. It teaches you new coping strategies, such as managing migraine triggers, deep breathing, relaxation, activity pacing, changing negative self-talk, and assertive communication.
What can I expect?
Your therapist will help you explore your thoughts, emotions, and behaviours within a trusting and collaborative relationship. Your therapist will provide a safe atmosphere of trust where you can feel free to be yourself and participate in therapy. You will be asked to attend sessions on a weekly or biweekly basis and may be asked to do take-home assignments to apply what you learn between sessions. You will be an active participant in your therapy. Even if you feel reluctant to try therapy, consider giving it a chance, as engaging in CBT can lead to significant positive changes in your life.
How long will I need to have CBT? Is it a lifelong commitment?
The number of CBT sessions varies for each person. Some people attend CBT for a short time until they start experiencing benefits (three to five sessions), while others attend longer (15-20 sessions or more). You can discuss the optimal number of sessions with your therapist. People usually start to experience benefits from CBT by the third session. If you do not feel that therapy is helping by then, consider trying CBT with a different therapist. Like medication, finding the right therapist may require trying two or three before you find the right fit.
Where do I get CBT?
Many CBT therapists work in private practice, and your sessions may be covered by your insurance benefits. CBT may also be offered by therapists in public healthcare, and you might need a referral from your family doctor.
Who is qualified to offer CBT?
CBT is a specialized form of psychological therapy usually performed by therapists with special training. Psychologists are typically trained in CBT, but other professionals such as counsellors, mental health therapists, psychiatrists, and nurses may also provide CBT. It is important to ask a potential therapist if they are certified and experienced in CBT.
When should I start seeing results?
Setting goals and a reasonable timeline to achieve them is important. Reducing the frequency of attacks is one goal, but improving your quality of life, mood, self-esteem, and interactions with others are also important. Therapy takes time, as changing thoughts and habits does not happen overnight. Patience is key! Progress may not be linear, but step by step, your new habits will solidify. Regular evaluations with your therapist can help track your progress.
What if CBT doesn’t work for me?
If you feel you are not making progress, discuss this with your therapist. Revisit the initial goals, assess any progress, and identify potential reasons for stagnation. Consider whether the relationship with your therapist is working well and whether other life factors are making change more difficult. If you decide to stop, ensure you have a proper wrap-up with your therapist. Remember, you can always give it another try in the future.
If I feel better, should I stop sessions?
This decision depends on many factors and should be discussed with your therapist. Sometimes, continuing for a while can help solidify new habits. Sessions can be spaced out, and you can reach out to the therapist as needed. Life is a path, and migraine fluctuates. Seeking support and guidance from a therapist is always an option.
References
- Christiansen S, Jurgens TP, Klinger R. Outpatient Combined Group and Individual Cognitive-Behavioral Treatment for Patients With Migraine and Tension-Type Headache in a Routine Clinical Setting. Headache. 2015;55(8):1072-91.
- Cousins S, Ridsdale L, Goldstein LH, Noble AJ, Moorey S, Seed P. A pilot study of cognitive behavioural therapy and relaxation for migraine headache: a randomised controlled trial. J Neurol. 2015;262(12):2764-72.
- Martin PR, Mackenzie S, Bandarian-Balooch S, Brunelli A, Broadley S, Reece J, et al. Enhancing cognitive-behavioural therapy for recurrent headache: design of a randomised controlled trial. BMC neurology. 2014;14:233.
- Ng QX, Venkatanarayanan N, Kumar L. A Systematic Review and Meta-Analysis of the Efficacy of Cognitive Behavioral Therapy for the Management of Pediatric Migraine. Headache. 2017;57(3):349-62.
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