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Cognitive Behavioral Therapy for the Management of Episodic Migraine

  • Episodic Migraine (S Parikh, Section Editor)
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Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This article provides an overview of the application of CBT in the management of episodic migraine while also providing context and insight into the underlying neurophysiological mechanisms of therapeutic change. It discusses the theoretical foundations of CBT and highlights key components including education, cognitive restructuring, behavioral interventions, relaxation techniques, and lifestyle changes.

Recent Findings

Cognitive behavioral therapy (CBT) is an empirically based treatment that is well suited for the management of episodic migraine. Although first-line treatments of migraine are typically pharmacological, a review of empirical literature suggests growing evidence for the use of CBT as a standard non-pharmacological treatment of headache conditions.

Summary

In summary, this article explores evidence supporting the efficacy of CBT in reducing the frequency, intensity, and duration of migraine attacks as well as improving the quality of life and psychological well-being of those with episodic migraine.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. • Lipton RB, Silberstein SD. Episodic and chronic migraine headache: breaking down barriers to optimal treatment and prevention. Headache J Head Face Pain. 2015;55:103–22. This article highlights important barriers and factors that can significantly impact the course and outcome of headache treatment. This article also strives to emphasize the importance of chronic migraine prevention.

  2. Stovner LJ, Nichols E, Steiner TJ, Abd-Allah F, Abdelalim A, Al-Raddadi RM, et al. Global, regional, and national burden of migraine and tension-type headache, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology. 2018;17(11):954–76. https://doi.org/10.1016/s1474-4422(18)30322-3.

    Article  Google Scholar 

  3. Aurora SK, Kulthia A, Barrodale PM. Mechanism of chronic migraine. Curr Pain Headache Rep. 2011;15(1):57–63.

    Article  PubMed  Google Scholar 

  4. Bigal ME, Serrano D, Buse D, Scher A, Stewart WF, Lipton RB. Acute migraine medications and evolution from episodic to chronic migraine: a longitudinal population-based study. Headache J Head Face Pain. 2008;48(8):1157–68.

    Article  Google Scholar 

  5. Rains JC, Penzien DB, McCrory DC, Gray RN. Behavioral headache treatment: history, review of the empirical literature, and methodological critique. Headache J Head Face Pain. 2005;45:S92–109.

    Article  Google Scholar 

  6. Nahman-Averbuch H, Schneider VJ, Chamberlin LA, Kroon Van Diest AM, Peugh JL, Lee GR, Powers SW. Alterations in brain function after cognitive behavioral therapy for migraine in children and adolescents. Headache J Head Face Pain. 2020;60(6):1165–82.

    Article  Google Scholar 

  7. Shpaner M, Kelly C, Lieberman G, Perelman H, Davis M, Keefe FJ, Naylor MR. Unlearning chronic pain: a randomized controlled trial to investigate changes in intrinsic brain connectivity following cognitive behavioral therapy. NeuroImage Clin. 2014;5:365–76.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Singer AB, Buse DC, Seng EK. Behavioral treatments for migraine management: useful at each step of migraine care. Curr Neurol Neurosci Rep. 2015;15:1–8.

    Article  Google Scholar 

  9. Koechlin H, Coakley R, Schechter N, Werner C, Kossowsky J. The role of emotion regulation in chronic pain: a systematic literature review. J Psychosom Res. 2018;107:38–45.

    Article  PubMed  Google Scholar 

  10. Befus DR, Irby MB, Coeytaux RR, Penzien DB. A critical exploration of migraine as a health disparity: the imperative of an equity-oriented, intersectional approach. 2018.

  11. Wells RE, Burch R, Paulsen RH, Wayne PM, Houle TT, Loder E. Meditation for migraines: a pilot randomized controlled trial. Headache J Head Face Pain. 2014;54(9):1484–95.

    Article  Google Scholar 

  12. Jacobs GD. Clinical applications of the relaxation response and mind–body interventions. The Journal of Alternative & Complementary Medicine. 2001;7(1):93–101.

    Article  Google Scholar 

  13. • Thorn BE. Putting the brain to work in cognitive-behavioral therapy for chronic pain. Pain. 2020;161(Suppl 1):S27. This article highlights the fact that biopsychosocial treatments can lead to biological outcomes. This article provides an excellent template for treatment and discusses effective ways to work with patients who have chronic pain.

  14. World Health Organization. Regional Office for Europe. Therapeutic patient education: continuing education programmes for health care providers in the field of prevention of chronic diseases: report of a WHO working group. Copenhagen: WHO Regional Office for Europe. 1998.

  15. Buse DC, Greisman JD, Baigi K, Lipton RB. Migraine progression: a systematic review. Headache J Head Face Pain. 2019;59(3):306–38.

    Article  Google Scholar 

  16. Rosignoli C, Ornello R, Onofri A, Caponnetto V, Grazzi L, Raggi A, Sacco S. Applying a biopsychosocial model to migraine: rationale and clinical implications. J Headache Pain. 2022;23(1):100.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Pistoia F, Salfi F, Saporito G, Ornello R, Frattale I, D’Aurizio G, Sacco S. Behavioral and psychological factors in individuals with migraine without psychiatric comorbidities. J Headache Pain. 2022;23(1):1–9.

    Article  Google Scholar 

  18. Pavlovic JM, Buse DC, Sollars CM, Haut S, Lipton RB. Trigger factors and premonitory features of migraine attacks: summary of studies. Headache J Head Face Pain. 2014;54(10):1670–9.

    Article  Google Scholar 

  19. Packard RC. What does the headache patient want? Headache J Head Face Pain. 1979;19(7):370–4.

    Article  CAS  Google Scholar 

  20. Lipton RB, Stewart WF. Acute migraine therapy: do doctors understand what patients with migraine want from therapy? Headache J Head Face Pain. 1999;39:S20–6.

    Article  Google Scholar 

  21. Seng EK, Buse DC, Klepper JE, Mayson JS, Grinberg AS, Grosberg BM, Lipton RB. Psychological factors associated with chronic migraine and severe migraine-related disability: an observational study in a tertiary headache center. Headache J Head Face Pain. 2017;57(4):593–604.

    Article  Google Scholar 

  22. Butler DS, Moseley GL. Explain Pain 2nd Edn. Noigroup publications. 2013.

  23. Louw A, Diener I, Butler DS, Puentedura EJ. The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Arch Phys Med Rahabil. 2011;92:2041–56.

    Article  Google Scholar 

  24. Dantas MIO, Pereira TAB, DeSantana JM. Chronic migraine patients have low level of knowledge about pain neurophysiology. BrJP. 2021;4:339–43.

    Article  Google Scholar 

  25. Melzack R, Wall PD. Pain mechanisms: a new theory: a gate control system modulates sensory input from the skin before it evokes pain perception and response. Science. 1965;150(3699):971–9.

    Article  CAS  PubMed  Google Scholar 

  26. Moseley GL, Butler DS. Fifteen years of explaining pain: the past, present, and future. J Pain. 2015;16(9):807–13.

    Article  PubMed  Google Scholar 

  27. Fish RA, Hogan MJ, Morrison TG, Stewart I, McGuire BE. Willing and able: a closer look at pain willingness and activity engagement on the Chronic Pain Acceptance Questionnaire (CPAQ-8). J Pain. 2013;14(3):233–45.

    Article  PubMed  Google Scholar 

  28. • Kimpara K, Arizono S, Tanaka T, Kimpara T, Terada K, Ohgi S. Brain activation of unpleasant emotions increases catastrophizing in patients with chronic pain. Pain Manag Nurs. 2023. This article is important as it highlights the role that emotional states can have on brain function, thinking, and management of chronic pain. This article provides a unique perspective on the mind, body, and brain connection.

  29. Thorn BE, Pence LB, Ward LC, Kilgo G, Clements KL, Cross TH, Tsui PW. A randomized clinical trial of targeted cognitive behavioral treatment to reduce catastrophizing in chronic headache sufferers. J Pain. 2007;8(12):938–49.

    Article  PubMed  Google Scholar 

  30. Dolce JJ, Crocker MF, Moletteire C, Doleys DM. Exercise quotas, anticipatory concern and self-efficacy expectancies in chronic pain: a preliminary report. Pain. 1986;24(3):365–72.

    Article  PubMed  Google Scholar 

  31. French DJ, Holroyd KA, Pinell C, Malinoski PT, O’donnell F, Hill KR. Perceived self-efficacy and headache-related disability. Headache J Head Face Pain. 2000;40(8):647–56.

    Article  CAS  Google Scholar 

  32. Scharff L, Turk DC, Marcus DA. The relationship of locus of control and psychosociaI-behavioral response in chronic headache. Headache J Head Face Pain. 1995;35(9):527–33.

    Article  CAS  Google Scholar 

  33. Almarzooqi S, Chilcot J, McCracken LM. The role of psychological flexibility in migraine headache impact and depression. J Context Behav Sci. 2017;6:239–43.

    Article  Google Scholar 

  34. • Seminowicz DA, Shpaner M, Keaser ML, Krauthamer GM, Mantegna J, Dumas JA, Naylor MR. Cognitive-behavioral therapy increases prefrontal cortex gray matter in patients with chronic pain. J Pain. 2013;14(12):1573–84. This study is of great importance as it provides insight into the biological and physical changes that can occur in the brain through cognitive and behavioral therapy. This research has major implications as it pertains to understanding the human brain and the use of non-pharmacological approaches to improve biological outcomes.  

  35. McManus F, Van Doorn K, Yiend J. Examining the effects of thought records and behavioral experiments in instigating belief change. J Behav Ther Exp Psychiatry. 2012;43(1):540–7.

    Article  CAS  PubMed  Google Scholar 

  36. Martin PR, MacLeod C. Behavioral management of headache triggers: avoidance of triggers is an inadequate strategy. Clin Psychol Rev. 2009;29:483–95.

    Article  PubMed  Google Scholar 

  37. Adler AD, Strunk DR, Fazio RH. What changes in cognitive therapy for depression? An examination of cognitive therapy skills and maladaptive beliefs. Behav Ther. 2015;46(1):96–109. https://doi.org/10.1016/j.beth.2014.09.001.

    Article  PubMed  Google Scholar 

  38. Peroutka SJ. Migraine: a chronic sympathetic nervous system disorder. Headache. 2004. https://doi.org/10.1111/j.1526-4610.2004.04011.x.

    Article  PubMed  Google Scholar 

  39. Gazerani P. Migraine and diet. Nutrients. 2020;12(6):1658. https://doi.org/10.3390/nu12061658.PMID:32503158;PMCID:PMC7352457.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Gass JJ, Glaros AG. Autonomic dysregulation in headache patients. Appl Psychophysiol Biofeedback. 2013;38:257–63. https://doi.org/10.1007/s10484-013-9231-8.

    Article  PubMed  Google Scholar 

  41. Minen Mia T, Corner Sarah, Berk Thomas, Levitan Valeriya, Friedman Steven, Adhikari Samrachana, Seng Elizabeth B. Heartrate variability biofeedback for migraine using a smartphone application and sensor: a randomized controlled trial. Gen Hosp Psychiatry. 69.

  42. Koenig J, Williams DP, Kemp AH, Thayer JF. Vagally mediated heart rate variability in headache patients—a systematic review and meta-analysis. Cephalalgia. 2016;36(3):265–78. https://doi.org/10.1177/0333102415583989.

    Article  PubMed  Google Scholar 

  43. Aaron Shechter, Stewart Walter F, Silberstein Stephen D, Lipton Richard B. Migraine and autonomic nervous system function: a population-based, case-control study. Neurology. 2002;58(3):422–7. https://doi.org/10.1212/WNL.58.3.422.

    Article  Google Scholar 

  44. Lvming Zhang, Shi Qiu, Chunxia Zhao, Wang Peifu Yu, Shengyuan,. Heart rate variability analysis in episodic migraine: a cross-sectional study. Front Neurol. 2021;12. https://www.frontiersin.org/articles/10.3389/fneur.2021.647092.

  45. Nakao M, Yano E, Nomura S, Kuboki T. Blood pressure-lowering effects of biofeedback treatment in hypertension: a meta-analysis of randomized controlled trials. Hypertens Res. 2003;26(1):37–46.

    Article  PubMed  Google Scholar 

  46. Campbell J, Penzien, D. Evidenced-based guidelines for migraine headache: behavioral and physical treatments. 2000.

  47. Michael G. McKee. Biofeedback: an overview in the context of heart-brain medicine. Clevel Clin J Med. 2008;75(2). https://doi.org/10.3949/ccjm.75.suppl_2.s31.

  48. Seng Elizabeth K, Holroyd Kenneth A. Dynamics of changes in self-efficacy and locus of control expectancies in the behavioral and drug treatment of severe migraine. Ann Behav Med. 2010;40(3):235–47. https://doi.org/10.1007/s12160-010-9223-3.

    Article  PubMed  Google Scholar 

  49. Seng EK, Singer AB, Metts C, Grinberg AS, Patel ZS, Marzouk M, Rosenberg L, Day M, Minen MT, Lipton RB. Does mindfulness-based cognitive therapy for migraine reduce migraine-related disability in people with episodic and chronic migraine? A phase 2b pilot randomized clinical trial. Headache J Head Face Pain. 2019;59:1448–67.

    Article  Google Scholar 

  50. Kisan R, Sujan MU, Adoor M, Rao R, Nalini A, Kutty BM, et al. Effect of Yoga on migraine: a comprehensive study using clinical profile and cardiac autonomic functions. Int J Yoga. 2014. https://doi.org/10.4103/0973-6131.133891.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Hasenbring MI, Hallner D, Rusu AC. Fear-avoidance-and endurance-related responses to pain: development and validation of the Avoidance-Endurance Questionnaire (AEQ). Eur J Pain. 2009;13(6):620–8.

    Article  PubMed  Google Scholar 

  52. Vlaeyen JWS, Crombez G, Linton SJ. The fear-avoidance model of pain. Pain. 2016;157(8):1588–9. https://doi.org/10.1097/j.pain.0000000000000574. (PMID: 27428892).

    Article  PubMed  Google Scholar 

  53. McLean A, Coutts K, Becker WJ. Pacing as a treatment modality in migraine and tension-type headache. Disabil Rehabil. 2012;34(7):611–8. https://doi.org/10.3109/09638288.2011.610496. Epub 2011 Oct 8 PMID: 21980991.

    Article  PubMed  Google Scholar 

  54. Roditi D, Robinson ME. The role of psychological interventions in the management of patients with chronic pain. Psychol Res Behav Manag. 2011;4:41–9. https://doi.org/10.2147/PRBM.S15375. Epub 2011 May 11. PMID: 22114534; PMCID: PMC3218789.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Kim J, Cho SJ, Kim WJ, Yang KI, Yun CH, Chu MK. Insufficient sleep is prevalent among migraineurs: a population-based study. J Headache Pain. 2017;18:50.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Lin YK, Lin GY, Lee JT, et al. Associations between sleep quality and migraine frequency: a cross-sectional case-control study. Medicine (Baltimore). 2016;95: e3554.

    Article  PubMed  Google Scholar 

  57. Ong JC, Taylor HL, Park M, Burgess HJ, Fox RS, Snyder S, Wyatt JK. Can circadian dysregulation exacerbate migraines? Headache J Head Face Pain. 2018;58(7):1040–51.

    Article  Google Scholar 

  58. Amin FM, Aristeidou S, Baraldi C, Czapinska-Ciepiela EK, Ariadni DD, Di Lenola D, European Headache Federation School of Advanced Studies (EHF-SAS). The association between migraine and physical exercise. The journal of headache and pain. 2018;19:1–9.

    Article  CAS  Google Scholar 

  59. Lemmens J, De Pauw J, Van Soom T, et al. The effect of aerobic exercise on the number of migraine days, duration and pain intensity in migraine: a systematic literature review and meta-analysis. J Headache Pain. 2019;20:16.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Song TJ, Chu MK. Exercise in treatment of migraine including chronic migraine. Curr Pain Headache Rep. 2021;25:14.

    Article  PubMed  Google Scholar 

  61. Altamura C, et al. The healthy eating plate advice for migraine prevention: an interventional study. Nutrients. 2020;12(6):1579.

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Megan Amatrudo.

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Amatrudo, G., Kengetter, J., McCrea, S. et al. Cognitive Behavioral Therapy for the Management of Episodic Migraine. Curr Pain Headache Rep 27, 471–477 (2023). https://doi.org/10.1007/s11916-023-01129-y

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