Cognitive Behavior Modification for Migraines (CBT)

Written by Holly Hazen

Cognitive behavior modification is widely used to generate positive thinking and optimism. It is used to encourage better health by reducing stress. And we know that reducing stress is good for us migraine sufferers.

According to the New York Times Health Guide, the behavioral treatments that are proven to reduce stress are:

biofeedback therapy, relaxation techniques and cognitive behavioral therapy.

Behavioral methods like these help counteract muscle tension from contraction and the uneven blood flow associated with some migraines and headaches.

They are particularly useful for children and teens, pregnant or nursing moms that cannot take appropriate migraine medications. Biofeedback has been shown as effective treatment for reducing migraine frequency.

Relaxation therapy like: progressive muscle relaxation technique adapted for migraine relaxation, meditation, deep breathing and visualization have also been shown to be effective for pain relief. Although it is more effective to combine this with medications and a cold ice pack or compress to the forehead and neck. Relaxation therapy alone will not provide enough relief from migraine pain.

Cognitive Behavioral Therapy (CBT) teaches us how to better understand our thought process and how it might affect our symptoms. Which also effects how the body responds to pain. Research shows that CBT is most effective when combined with other therapies.

Have you considered using any of these? If not, keep reading ...

Optimism Creates Optimal Health

During World War II a rather large group of Harvard undergraduate students completed questionnaires for a research project around cognitive behavior modification that followed the group for 35 years.

The questionnaire measured their optimism and found several decades later that the students scoring higher in optimism maintained better health in their middle age than compared to the pessimistic students.

The newest form of this is now called Positive Psychology. 

Cognitive Behavior Modification on Dogs (poor dogs)

Behavioural Modification Has Been Done on Dogs

There is a famous study done by Martin Seligman, said to be the father of positive psychology, in 1967 at University of Pennsylvania where groups of dogs were placed in cages and given mild electric shocks. One group of dogs could stop the shock by learning to push a lever and the other group could not stop the shock.

The dogs in the second group were not able to avoid the shocks administered at certain times and were forced to submissively suffer the pain rather than instinctively escape. When the psychologists finally opened the doors of the cages to let the dogs out when the shock was being delivered, the dogs remained lying down in their cages – deflated – unable to rise.

This sounds very much like depression to me. This proved Seligman's theory around learned helplessness. It refers to the long-term effects of experiencing a situation that is out of our control. Sound like migraine? Migraines are out of our control. So the questions is - can we use cognitive behavior modification with migraine somehow?

Now I know we are not dogs and perhaps have more resilience than animals. But further studies done later by Seligman showed that one third of the 150 dogs they experimented with (poor dogs) eventually managed to find a way out of the situation despite their past experience with it all.

Having a chronic illness, like migraines, where there is no escape from the pain cycle, can cause the feeling of helplessness just like in the dogs. Deflated. Depressed. But just as this is a learned response, feelings of optimism can also be learned. 

Martin Seligman, the founder of positive psychology, has written a number of books, and this one Learned Optimism  highlights the many benefits of cognitive behavior modification and being optimistic. It also comes in an audio book.

My Adaptation of CBT for Migraines

Cognitive Behavior Modification

When I was studying CBT it inspired this cognitive behavior modification for migraines article and worksheet.

I adapted the CBT process to use with my Migraines. I hope you find it useful too.

Please print out this form Migraine Prevention CBT and Anxiety to use at your leisure.

The process is divided into three steps:

Step One

Identify your negative, habitual thought processes you have around your migraines like:

“This pain will never go away. My life is ruined. This is hopeless, futile.”

Step Two

Once you have acknowledged your negative and probably recurring thoughts, you can validate them.

Ask yourself "is this still true? Is this thought that this will NEVER end, that the excruciating pain will NEVER go away, still hold true?"

Or does that fact that the pain does subside, and the pain does eventually go away, and you do return to your life … does that hold true? 

Step Three

Devise a more realistic thought. This is where you train your mind to use only realistic and positive words and replace the negative ones with the new thoughts like:

"This migraine will pass. I have survived them for years. Everything will get back on track tomorrow. I just need to care of myself right now. My life is, in fact, simple and peaceful." 

It is not just to substitute your words; it is more so your mind integrates the new evidence of the more realistic conclusion in a more balanced way. This will reduce stress in the moment, and long term. And that will simultaneously help stop attacks from escalating by calming the nervous system. Win Win!

I hope this sounds like easy cognitive behavior modification that you can do.

Write A Letter to Your Migraines

cognitive behavior modification journal

Another method I can suggest around cognitive behavior modification is to try writing a letter to yourself and more specifically to your migraines.

Please read our migraines and depression article if you would like another method to use to process your emotions and help cope with your migraines.

If you don't want to do anything quite so structured, it is very beneficial to just keep a migraine journal so that you have some way to express your thoughts and emotions. Migraines and all the life changes and impacts that come with this condition are very difficult to manage.

I highly recommend getting some extra migraine support. Taking care of yourself is essential.

More Help for Migraines

I recommend counselling to help with this process and re-training the brain. You can also read these:

Cognitive Behavior Modification Reference: New York Times (2011) Behavioral Treatments [Online], Available at:  Accessed Jan. 14, 2013.

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