While migraines are a medical and not a psychological condition, it is well known that psychological factors can impact a patient’s experience with migraines. It is widely known that migraines can be triggered by psychological stressors. Factors such as work stress, home stress, relationship difficulties, anxiety, depression and other issues can trigger headaches, maintain them, exacerbate their presentation or add to the disruption of overall functioning above and beyond that experienced from headaches alone. Additionally, severe migraines can cause psychological stress, which can worsen the problem.
Behavioral management is an important treatment for pain conditions in general, alongside medical treatments. The basis of this is in brain imaging and functional studies. Functional imaging has shown that a person’s thoughts, emotions and pain experiences affect how he processes pain input.
Research has also shown a complex bidirectional association between migraines and mood disorders. Patients with major depressive disorder are at greater risk for developing migraines and patients with migraines are at greater risk for developing major depressive disorder. For patients with co-morbid mood disorders and migraines, effective treatment of the mood disorder with medication and therapy reduces the frequency and intensity of the migraines.
Behavioral management techniques has been underutilized for a variety of reasons: lack of understanding of effect, stigma, and desire for a “quick fix”, to name a few. Some people recommend that behavioral management be a part of treatment for any child presenting with chronic headaches.
Behavioral management can fall into different categories. Behavioral techniques include relaxation, biofeedback, and implementing changes in lifestyle and routines to reduce the frequency of migraines; Cognitive techniques include developing an awareness of patterns, observing thinking styles, shifting the locus of control from “chance” to internal control to reduce feelings of helplessness and catastrophizing, and working on motivation for change; Psychoeducation includes understanding the etiology of headaches and triggers; Mindfulness is a way to build body awareness and regulation of attention. The effects of these techniques have shown to be longer lasting than medication treatment alone and have also shown to reduce the use of medication in patients with migraines.
It is important to consider behavioral management as part of the treatment plan for a patient with migraines. It can be effective when medication treatment alone is not effective. Behavioral management is a way to take advantage of the interplay between psychological factors and physical factors in the presentation of migraines. The following online article is a nice way to explain to patients how behavioral interventions can be helpful in the treatment of migraines: