Can CBT help reduce the frequency of migraine attacks?
  Cognitive Behavioral Therapy & Migraine  

Happy New Year! We continue to wait for the availability of CGRP related antibodies, which could possibly make 2018 a happier year for many. In the meantime, here is an evidence-based treatment tool that could have ramifications beyond migraine prevention and general stress reduction: Cognitive Behavioral Therapy (CBT).

With migraine being such an acutely painful condition it is natural to wonder how a non-pharmacological treatment could be effective. Cognitive behavioral therapy (CBT) teaches us to identify and modify our behaviors that contribute to one of the major migraine triggers - stress. CBT has been considered in a number of evidence-based, double-blind, placebo-controlled studies. It has often shown to be a successful approach to reduce the frequency of migraine headaches.

CBT is a type of psychological treatment used to address a large variety of mental health issues, not just migraine. The treatment focuses on helping patients identify and manage how they deal with problems by building effective coping strategies. The key is to reduce a problem into minor pieces to look at the stress-inducing event from a more practical viewpoint.  Patients can adjust faulty models of cognition (thinking) and break down patterns of negative, stress-inducing thoughts. In more simple terms, take a stressful experience, break it down into as many parts as you can, identify the negative reactions and change them, thus avoiding the stressful consequences.  Sounds easy, but it's not. Behavior change can be difficult, but it is definitely worth trying. It takes time and practice.

Although CBT in some circumstances may provide relief alone, it should be recognized as a component of a larger, multidisciplinary approach. Continue to work closely with your primary care doctor and if possible a migraine-literate specialist, whose efforts will augment the CBT. CBT is not a cure. Its goal is a decrease in the number and force of migraine episodes. It is possible, through reducing the number of migraines, that the amount of prescription drugs consumed is reduced. This has direct effect on the number of medication overuse rebound headaches.

Does it really work?  A recent study showed children and adolescents fared better with CBT plus amitriptyline, rather than just the medication alone. This is a useful beginning, especially for pediatric migraine. Unfortunately no publication of evidence based studies including CBT in adult patients for migraine exist. A report published in the British Journal of Pain (found at the end of this newsletter) showed mixed results using CBT. More research is certainly indicated.

What is the cost?  Different providers will charge different amounts, often depending on the credential or the insurance plan. Ordinarily you will receive about 20 sessions of 50 minutes per week. Insurance companies often pay a portion of the cost.  There is usually a significant amount of homework involved. Remember, you have to break down and record all of your behaviors, thoughts and feelings for later examination. Even if CBT has an impact on a fraction of your headaches it could prove worth the time and money.

Please keep in mind that migraine is a neurological disease in not a psychological one. CBT can work by eliminating or reducing stress that often awakens the underlying neurological condition. We would not wish to leave you thinking migraine is a psychological condition. It is most probably genetic in origin, like eye color. Until we have better treatments that focus on the neurological root cause, we must make our best efforts, like using CBT, to avoid rousing the sleeping beast.

If you would enjoy further readings on CBT and migraine please consider the following:

- Jim Carleton for AMD


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