Learn what Dr. Elizabeth Seng, a clinical psychologist specializing in chronic pain management, says about managing migraine and other chronic pain conditions—and how methods like cognitive behavioral therapy and mindfulness can help.
If you’re living with migraine, you know how much care goes into avoiding anything that can trigger an attack. For people managing other chronic pain disorders alongside migraine, the stress of everyday pain management can make it even harder to keep your migraine symptoms at bay. In fact, people living with chronic pain—like back pain, arthritis and fibromyalgia—are more likely to experience migraine.
To learn more about how managing chronic pain fits into a larger migraine treatment plan, we spoke with Dr. Elizabeth Seng, a clinical psychologist and an Associate Professor of Psychology in the Ferkauf Graduate School of Psychology and Research Assistant Professor of Neurology in the Saul R. Korey Department of Neurology at Yeshiva University.
Below we recap our discussion with Dr. Seng and review how approaches like cognitive behavioral therapy, mindfulness and neuromodulation devices can help people who are managing migraine along with other chronic pain conditions.
Differences in Treating Migraine and Other Chronic Pain Conditions
Dr. Seng works with patients to develop behavioral strategies for dealing with chronic pain. This often involves things like lifestyle changes, increased body awareness and helping people make better decisions around pain management. However, these strategies are not always the same for migraine and other chronic pain conditions.
Chronic conditions like lower back pain or arthritis often have pain patterns that are relatively consistent. “We’re talking about [conditions] that are producing pain in a pretty expected way every day,” says Dr. Seng. Pain management in these cases usually takes a fixed, scheduled approach to minimize pain and manage its affect on daily life.
Managing migraine is different, because you never know exactly when a migraine attack is going to strike. Dr. Seng says that “for most people, migraine attacks are [unexpected] significant disruptions to daily life associated with a significant amount of pain and other neurologic symptoms.” While a migraine treatment plan will often include preventive treatments and ways to avoid triggers, there will always be a need for acute treatments to manage symptoms during an attack.
This is the key difference in how migraine and other chronic pain conditions are managed. “You treat migraine attacks in the moment with an as-needed medication that reduces your symptoms,” says Dr. Seng. “For many conditions like chronic lower back pain and arthritis, we’re actually trying to avoid treating in the moment… So that basic medication management is very different.”
How to Manage Chronic Pain With Migraine
Managing migraine alongside other chronic pain conditions is about balancing the needs of your daily life with the pain and challenges presented by each condition. Dr. Seng says the key is to decide what strategies will have the biggest impact on your daily life while also understanding that you can only take on so much.
“The way to make those decisions is to really sit down and say, ‘What is it that I want to be doing in my life and which of these symptoms are really interfering with my ability to do the things that I care about?’” says Dr. Seng. “That’s a good place to start with your doctor: ‘If I was going to change one thing about how I’m managing my pain right now, this is the symptom that I care most about.’”
Here are some pain management strategies and treatments Dr. Seng often discusses with patients.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is a type of psychotherapy designed to help people change negative or harmful thought patterns and behaviors. CBT may focus on reducing behaviors that trigger pain and/or encouraging behaviors that help people keep migraine attacks to a minimum. This can be helpful in creating the conditions for medications and other treatments to work more effectively.
“With cognitive behavioral therapy, we’re trying to change evidence-based behaviors that we know can change the way you’re thinking about [pain] so that you can engage in the behaviors that you need to,” says Dr. Seng.
Mindfulness is a practice for focusing one’s attention on the present moment without judgment. It can be a helpful stress-reduction strategy for people living with migraine. Studies have shown that incorporating mindfulness and meditation into a person’s daily routine may result in fewer headache days per month and decreased headache severity. Mindfulness can help people accept that some degree of chronic pain is unavoidable and learn how to minimize disruptions to their daily lives.
“Mindfulness is a wonderful tool to help get people moving towards valued life activities when those have kind of gone by the wayside,” says Dr. Seng. “It gives you some attention strategies to experience pain but not have it be such a barrier to engaging in daily life.” For this reason, she notes that it often comes after CBT in a long-term pain management strategy.
Neuromodulators and Stimulators for Migraine
Dr. Seng also points to the growing range of assistive devices like neuromodulators and stimulators as an option for people who are managing migraine and other chronic pain conditions at the same time. While these types of devices have multiple applications, Dr. Seng says they can be especially useful for acute pain management during a migraine attack for people who are already taking pain medication for another condition.
“We worry about medication overuse in people who have chronic pain and are taking medications for that chronic pain frequently. So in that context, you don’t want to then also take more medications for migraine attacks when they happen,” says Dr. Seng. “Devices offer a really attractive alternative in this situation—they provide similar benefits to acute medications with none of this overuse potential.”
Challenges of Managing Both Migraine and Other Types of Chronic Pain
Chronic pain conditions can actually trigger migraine attacks by increasing stress, disrupting sleep, or making it difficult to consistently follow lifestyle-based management strategies like getting regular exercise. Additionally, for people living with migraine and another chronic pain condition, what works to treat one condition won’t necessarily work to treat the other.
“There are many lifestyle migraine management [strategies] that may not make any sense for other diseases at all,” says Dr. Seng. “Everyone should eat consistent, healthy, high quality meals, but for people with migraine, that’s a really important piece of advice—for somebody with chronic lower back pain, it may be less crucial.”
In some cases, certain types of treatments for chronic pain conditions can create additional challenges for people with migraine. One example is the use of long-term opioid therapy for people managing chronic injuries and muscle pain. “Opioids are not recommended for migraine,” says Dr. Seng. “They don’t really seem to help all that much, and they can contribute to medication overuse… People with migraine just need to be more careful with certain classes of pain medications.”
Fighting the Stigma Around Chronic Pain and Migraine
One of the main challenges facing people living with migraine and other chronic pain conditions is stigma. “Patients are receiving a lot of messages from their friends and family and coworkers that their symptoms are not believable, that they’re not real,” says Dr. Seng. “Sometimes they receive that message from their physicians. Many patients will say that at least one physician at some point has told them ‘the brain doesn’t work that way’ or ‘the body doesn’t work that way.’”
Dr. Seng suggests that people who are struggling with chronic pain look for a pain therapist who can help them with the psychological, emotional and behavioral elements of pain management. Remember, everyone experiences migraine differently, and you deserve to have all the resources you need to create a treatment plan that works for you.
She adds that one thing every person living with chronic pain should hear is that “the pain [you’re] experiencing is happening, it’s biologically plausible because it’s happening to [you]. That doesn’t necessarily mean any individual provider will have it all figured out—but it’s certainly not your fault “
The American Migraine Foundation is committed to improving the lives of those living with this debilitating disease. For more of the latest news and information on migraine, visit the AMF Resource Library. For help finding a healthcare provider, check out our Find a Doctor tool. Together, we are as relentless as migraine.