Migraine & Chronic Pain

Migraine is a neurological disease and it can begin at any age. Headache specialists will often probe you with questions about your family history because an estimated 80-90 percent of those who are afflicted with migraine have a family history of migraine and there are a number of genes that have been associated with a higher risk of developing migraine. However, twin studies and other studies have shown that genes may only account for fifty percent or less of the cause of migraine ^{[5] [6]}. Other factors such as hormonal changes, co-morbid neurological disorders, unconscious conflicts, overexertion, and environmental stimuli may be equally responsible.

I believe that’s why headache specialists should be incorporating psychotherapy into treatment for migraine from the beginning. They briefly talk about SEEDS for Success, which are all lifestyle changes that are behavioral in nature. Headache specialists briefly promote SEEDS for Success for their patients to do while under their care, but then they focus on the rescue medications such as triptans and DHE combined with preventative treatments such as Botox, Nerve blocks, and other medications such as blood pressure, anti-seizure, anti-depressants, and CGRP monoclonal antibodies. When the medical model doesn’t work, the doctors become frustrated with their patients and start treating them like they are “faking”, “attention-seeking”, or “drug-seeking”, even though everything that they told their patients in the first few meetings mentioned that they may have to try multiple different approaches.

Anything less, is considered episodic migraine. Migraine attack features vary from person to person, but include one or more of the following:

• • With or without aura
  • Blurred vision
  • Pulsating or throbbing pain, starting gradually and building up in intensity
  • Sensitivity to light, sound, smell, or touch
  • Nausea and vomiting
  • Fatigue
  • Mood changes
  • Lightheadedness, sometimes followed by fainting
  • Weakness

Note: Untreated migraine can last for hours, days, or months. For some people, migraine progresses through four stages: prodrome, aura, headache (migraine attack), and postdrome. It’s important to note that not everyone who has migraine will experience all four stages (e.g. aura). Some people who experience migraine may not actually even feel the pain commonly associated with a “migraine headache”, but they do experience other symptoms consistent with migraine, which this phenomenon is known as a “silent headache”.

1 in 4 Americans currently live with chronic pain. The four most common causes of chronic pain include back pain, headaches (tension headaches, migraine, eye strain headaches, and cluster headaches), joint pain (arthritis, repetitive motion injury, bursitis, and tendinitis), and nerve pain (sciatica, diabetic neuropathy, carpal tunnel syndrome, post-therapeutic neuralgia, and trigeminal neuralgia). Chronic pain can affect your mood (e.g., severe depression) ^[7], ability to function in normal activities of daily living including work and self-care, and your relationships with others if it is not properly treated and if you do not get the help and support that you need from a psychological perspective as part of your other treatments.

While poor body mechanics, injury and genetics are common medical explanations, which may be correct, the treatment options do not work for everyone. Pain medications, physical and occupational therapy are often used, and while some people report that they get results, many others suffer from chronic pain and either need more medication because they build up a tolerance or some choose not to use pain medications because of a fear that medication overuse can cause an addiction.

Some people do become addicted to these pain medications and as their doctors try to reduce the dosage after surgery because physical therapy has been completed and the wound is “healed”, now they have a new problem with no way to control their pain experience and the other effects that the pain medications provided them. People, who never used illegal drugs, may seek out synthetic opioids such as fentanyl, which are 50-100 times more potent than morphine and approximately 43% of the pills sold on the street have a lethal amount in a single pill.

While I do believe that medical and even some alternative medicines such as chiropractic medicines work and should be used in combination with psychotherapy, research shows that psychotherapy techniques can help reduce migraine and chronic pain even when nothing else seems to work. If you are committed to the therapeutic process and willing to acknowledge the psychological impact that migraine or other chronic pain has on your life, there’s a lot of hope that your life can get better.

In session, we will first work towards understanding how your pain is impacting your life and how you would like your life to be different. Next, we will work towards identifying and understanding any unconscious psychological conflicts that may need attention. Psychotherapy techniques can help you to put new language and meaning to things that you were not able to do on your own, but we will work together to help you to do so and to find new, healthier ways of seeing your situation and living so that your pain is no longer having so much control over you.

My approach is carefully designed to promote healing and wellness. I have been able to help a lot of clients overcome unconscious conflicts, some of which result in physical manifestations of their distress. Some clients who have had migraine or chronic pain that started in childhood or after a trauma, stop having pain after their first session with me simply because I have been able to identify the cause of their unconscious anger, but they have continued treatment to experience psychological healing and ultimately stopped receiving medical treatments for migraine or chronic pain. In some cases, I may include treatment methods which include making changes in your lifestyle and integrating practices that promote physical and mental exercise that are different than how you are living now.

I believe that psychotherapy should be highly personalized based upon your unique and specific needs. I will work in collaboration with your medical professional, if you choose. However, we will need to discuss the limits of confidentiality, if you choose that approach. At this time, all of my clients who have migraine and who have not already been provided access to an online educational course created by specialists and advocates for migraine from around the world, which has a value of $99, are provided this at no additional charge as part of their first one hour, initial consultation, with me.