Cognitive Behavioral Therapy

4 Out of 5 Migraine Sufferers Had Fewer Headaches After CBT

New research: Therapy had a bigger impact on migraine headaches than medicine.

Posted Jun 27, 2020

Migraine headaches are notoriously difficult to treat with pain medications, which perform no better than placebo in studies. Now, a new paper in the journal Headache finds that 83 percent of patients who completed a short course of cognitive behavioral therapy (CBT) had fewer headaches. The researchers believe that changes in a key brain area for pain management explains how CBT helps with migraines. But what’s most interesting about these findings is the way it challenges the way we classify these headaches in the first place.

Migraines hurt. Badly. Patients often describe the throbbing headaches as so painful, all they can do is lie down in a dark room. The mainstay of treatment for migraines has long been medication, but medications for acute migraines often don’t work. It gets even harder when people have frequent or chronic migraines, where preventative medicines are thought to work only about 20 percent of the time.

Photo by Aioni Haust on Unsplash
Migraine headaches are hard to treat, but CBT therapy helps.
Source: Photo by Aioni Haust on Unsplash

When medications don’t work, doctors prescribe other methods like biofeedback training, acupuncture, or stress reduction therapy. But because migraine is considered a medical problem, these treatments are second line.

Therapy for Migraine Headaches

That’s why this new study is so important. Most of the 18 adolescents in the study with frequent migraine headaches saw a reduction in their migraines. Unlike many studies, which run special protocols that no-one can access outside the lab, this one used an easily available remedy. Cognitive behavioral therapy is the one of most widely taught and available types of psychotherapy in the U.S. today.

To sort out how the therapy might have helped, researchers ran MRIs on the study participants both before and after their time in CBT. The adolescents had 15 + or - 7.4 headaches a month before enrolling in the study. They then participated in 8 weekly sessions of CBT. After the eight weeks, their headache frequency decreased to 10 + or - 7.4 a month.

The technical details: the MRIs were a particular type called structural and resting-state blood-oxygen-level-dependent contrast scans. They also used arterial spin labeling to look at brain activation during the resting state and compared the left and right amygdala to assess connectivity. They also looked at voxels, or 3D pixels, across the whole brain over time.

Therapy Activated the Brain’s Pain Control Areas

After CBT, the scans showed greater brain activations in the frontal regions associated with cognitive regulation of pain. So these were the areas in the frontal cortex where we can consciously think about our pain and cope with it. The MRIs also found increased connectivity between the amygdala and frontal regions after CBT. So the amygdala, which is the stress and raw emotion center of our brain, was talking more with the frontal area where we can think through our pain. In other words, cognitive behavioral therapy helped the part of our brains that freaks out about pain listen to calming thoughts from the brains’ higher levels.

That’s pretty cool. When medical problems are treated more effectively by talk therapy than by medication, it raises questions about the nature of the problem in the first place. It would be easy to wonder if migraine headaches are really an emotional or psychosomatic problem; an “all in our heads” sort of thing. It’s an old idea, passed down from ancient Greek ideas that formed a foundation in western culture: that the mind and body are separate. It leads us to ask questions like, “Is this a medical problem or this is a psychological problem?”

Mind and Body are a Single Biological System

Studies like this highlight the growing understanding that there is no separation between our minds and our bodies. Neither is there a meaningful separation between our thoughts, emotions, or our physical symptoms.

We exist as one biological system with different access points.

That idea can be challenging at first. But once we wrap our minds around it, humans make more sense. If we are a single interconnected and unified system with lots of inputs and outputs, recent findings in medical science stop seeming so weird.

Here’s one example: it’s a mind-bender to consider the role of the gut microbiome. The “guest” bacteria living in our gut impact a host of “separate” systems in our bodies. Evidence suggests that the population makeup of gut bacteria determines whether we have inflammation that leads to heart disease. AND those bacteria also impact our serotonin levels, making us happy or depressed.

How can the bacteria in our gut be the reason we are depressed? We have cherished the idea that depression is in the realm of mind and that it’s something we can control. Yet recent science suggests that organisms who live inside us are a big part of it. That only makes sense if we think of our bodies and minds as a single system.

Going to talk to a therapist because you have migraines may be giving you a lot more than just coping skills. It may be actually rewiring your brain.

This article was previously published on Forbes.com.