Every time I go to the neurologist for my migraines, it's a little bit like a game of Clue: We talk about all the migraines I've gotten since the last appointment, and then trace the steps backwards to figure out what the trigger was. Was it the glass of rosé I stupidly drank at dinner? The uncharacteristically warm weather? My period? Stress? All of the above?
Last fall, I was perched on my neurologist's examination table, going through our routine questioning, when we determined, once again, that it was likely stress that triggered my last migraine. Frustrated, I told her, "I just can't turn off stress. I'm just always so stressed." And then I started crying. With the clinical grace that only a board-certified neurologist with emotional intelligence could muster, she handed me a tissue and said, "You should see a therapist."
I left the office with a referral to a therapist and a glimmer of hope. For the past five years, I'd gotten about one migraine a month (sometimes more) that left me incapacitated. I'd tried everything I could to treat them: three different triptan drugs, all the Excedrin, over-priced acupuncture, cannabinoid oil, and, after I had a grand mal seizure, an anticonvulsant that also happens to work quite nicely as a preventative drug for migraines.
I am lucky that I have options to try in the first place, but the tricky thing about migraines is that, even with medication, there are certain factors — like weather or stress — that can't be controlled. So, I'm often left stressing about the prospect of getting a migraine, which sometimes triggers a migraine in itself.
I started weekly cognitive behavioral therapy a couple of weeks after the teary appointment, and was migraine-free for six whole months, which is pretty incredible for me. My migraines haven't disappeared altogether, but they have decreased significantly in frequency. And more importantly, I feel more adept at handling life's stressors that are otherwise out of my control. It feels really good to go somewhere once a week, lay all my stress and anxiety on the table, and then work through it with someone who knows how to, not just listen, but truly help. I've also learned how to acknowledge and challenge my anxious thoughts when they arise — and trust me, they arise quite frequently. There could be another reason why I was migraine-free for all those months (some women grow out of them), but I felt like I found the miracle treatment for migraines — at least for me. As it turns out, researchers have studied this exact topic.
Typical migraine management therapy starts and ends with stress management.
Elizabeth Seng, PhD
In a 2014 study in the journal Headache, 232 migraine sufferers who didn't have success with acute migraine treatments were either prescribed a preventative migraine drug, placed in behavioral therapy for migraines, or given a combination of both. The researchers found that cognitive behavioral therapy was as effective as preventative medication at reducing migraine frequency. And when the treatments were put together, they were even more effective.
To be incredibly clear: Migraines are not a psychological disorder, although historically the condition has been mischaracterized as one. But, "managing your stress is an important part of managing migraine," says Elizabeth Seng, PhD, study author and assistant professor at Yeshiva University, research assistant professor, at Albert Einstein College of Medicine, and psychologist at Montefiore Medical Center. While there are migraine-specific therapy programs (like the one used in the study), there's reason to believe that regular cognitive behavioral therapy could help you respond to and cope with stress. And if you're someone whose migraines are stress triggered, then therapy could help reduce migraine frequency in the long run. "Typical migraine management therapy starts and ends with stress management," Dr. Seng says.
So, if therapy works so well for migraines, then why don't all neurologists recommend it? "We have evidence that behavioral treatments work for migraines, and there's certainly knowledge that they work," Dr. Seng says. But treatment varies a lot from neurologist to neurologist, and some physicians may not know treatment providers in their area to recommend. "Or, there's so much other stuff they're working on with this in the moment, and they're just trying to get your medication right," she says.
My unqualified suggestion to anyone grappling with migraine treatments would be to talk to your neurologist or primary care physician about behavioral treatment strategies (like breathing techniques, relaxation visualizations, or talk therapy) to supplement whatever you're already trying. Dr. Seng agrees with this advice: "And if they feel like that conversation with their provider doesn’t give them enough support in changing those lifestyle strategies, they should ask the neurologist or seek out a mental health provider who is trained in CBT, or who has a specialty in health psychology," she says. And look, even if therapy doesn't "cure" your migraines (there is no cure for migraines), there are plenty of other very good reasons why you should go.
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