Cognitive-behavioral therapy (CBT) is a psychological approach to managing headaches and migraine. The reason that people with headaches and migraine see a psychologist is not because those conditions are lacking a physical basis and it is all in their imaginations. Psychologists are involved in the treatment of pain for 2 reasons: 1) There are effective treatments for migraine and headache (e.g., relaxation strategies, stress management and coping strategies, assertive communication) that psychologists have been trained to administer, and 2) Patients suffering from chronic headaches and migraine may also be in a vicious cycle which is often helpful to discuss with someone familiar with them, i.e. pain causes stress, tension, anxiety, and/or depression which also causes more pain.
CBT assists in the reduction of the vicious cycle by facilitating the development of skills that increase your ability to cope with pain and reduce headache-related psychological distress. CBT is an intervention based on scientific evidence that uses various cognitive and behavioral strategies. A study of outpatient combined group and individual cognitive-behavioral treatment for adult patients with migraine and tension-type headache found a significant reduction in average headache intensity, headache frequency, and unhelpful thoughts about headache as well as an increase in the use of adaptive coping strategies. A review of the existing research showed that cognitive-behavioral therapy and relaxation techniques lead to a significant reduction in headache activity ranging from 30% to 60%.
Cognitive-based interventions are based on the assumption that much of what we feel is determined by what we think. Cognitive strategies focus on identifying and challenging unhelpful thoughts and responses to stressful events. They aim to enhance headache sufferers' ability to engage in behaviors that enhance their self-management of headaches. Reductions in negative thoughts about headache pain and the use of a greater number of positive coping strategies were associated with reductions in the disabling effects of headache in a research study comparing behavioral migraine management training, use of beta blocker medications, and a placebo.
Increasing and/or fine-tuning your coping skills can also positively impact your headache experiences. CBT also includes learning how to recognize and cope with headache triggers. Treatment also typically includes:
- Improving Wellness Activities
- These include strategies to improve: Sleep, Physical Activity, Hydration, and Eating Habits.
- Inconsistent and/or poor habits in these areas contribute to headaches and often involve small changes that reap large benefits.
- Relaxation Strategies
- These reduce the arousal of the central nervous system and reduce muscle tension which both are implicated in headaches. In addition, you are absorbed in a pleasant state which is incompatible with pain.
- Effective relaxation strategies include: Progressive Muscle Relaxation, Visual Imagery, Autogenic Relaxation, and Meditation.
- Stress Management Techniques
- Stress can precipitate individual headache episodes, exacerbate the progression of headaches, worsen the headache sufferer's quality of life, and be a result of frequent headaches.
- Stress management techniques include the altering or adapting to stress triggers, getting support for undertaking tasks, problem-solving skills, and assertive communication as well as the previously mentioned relaxation strategies.
- Managing Headache Triggers
- Light/glare, weather, smells/odors, dust, and alcohol can be headache triggers.
- While many individuals have developed some strategies to manage these triggers, often fine-tuning strategies can be valuable.
- Pacing of Activities
Headache sufferers get concerned about how headaches impede their productivity or functioning at work, home, or in social situations. In an effort to make up for lost time, when pain is tolerable they overexert themselves and usually increase their pain.
Pacing is based on observing what activities increase pain after what period of time and an awareness of one's limits. The objective is for the patient to be able to alternate active times with sedentary times and thereby get more accomplished without increasing pain and fatigue.
The chief goal of CBT is to exchange sick time for wellness time. You can spend the exchanged time enjoying yourself, staying healthy, managing triggers and stress thereby minimizing headaches.
Watch our videocast of Dr. Rathier's indepth discussion on CBT with Dr. Godley on YouTube.