How to Talk to A Therapist About Migraine

Therapy can help you manage migraine-related stress. Here are some expert tips for finding the right therapist for you and how to talk to your therapist about migraine.

In addition to following the treatment plan you’ve set up with your medical doctor, managing migraine also often involves focusing on healthy lifestyle choices, such as getting enough sleep, exercising and reducing stress. With 50-70% of people reporting a significant link between their daily stress levels and migraine symptoms, stress management is particularly important. Migraine attacks themselves are disruptive and stressful to manage, and that increased stress can impact your physical and mental health in other ways.

Dealing with stress is one of several reasons people with migraine may consider therapy. Other reasons include learning effective ways to communicate your migraine-related health needs to your loved ones or employer. Some people may also consider therapy to help manage anxiety or depression and want to make sure they find a therapist who understands what it’s like living with migraine.  

We spoke with Dr. Steven Baskin, AMF Editorial Board Member, and Clinical Psychologist and Co-director of Behavioral Medicine Services at the New England Institute for Neurology and Headache about how to find a migraine-friendly therapist, how to talk to your therapist about migraine and the connections between migraine and mental health.

Finding a Therapist Who Understands Migraine

When searching for a therapist, Dr. Baskin recommends that you find someone who has experience seeing people with migraine. “It doesn’t mean that they actually have to treat [migraine],” he says, “but they should have some experience or a willingness to learn about it.”

Dr. Baskin notes that even if a therapist isn’t already familiar with migraine symptoms and management, it’s not necessarily a dealbreaker. “I think you want a therapist who’s curious,” he says. 

Look for a therapist who will ask you questions about your symptoms and who is willing to learn more about the aspects of living with migraine they may not currently understand. This may include learning more about what triggers migraine attacks and how to help people with migraine emotionally cope with their symptoms. 

What do you need to tell your therapist about your migraine?

Each person will have different reasons for going to therapy and unique goals for what they hope to get out of it. It can be helpful to share and define these goals with your therapist from the start.

Many people go to therapy for emotional support and help dealing with the stress that migraine attacks often cause. Others seek help self-advocating and communicating about how migraine affects them day-to-day—including tools for talking to significant others, employers or colleagues about their specific needs and symptoms. For example, someone may want their therapist to help them prepare for a conversation with their employer about accommodations, such as working from home when a migraine hits or having the lights in the office adjusted to prevent attacks.

If you are someone who lives with anxiety and depression, you’ll also want to make sure your therapist has a basic understanding of the connection between mental health and migraine.

“I think it’s important for the patient to communicate to the mental health professional that these psychiatric issues and emotional stressors [frequently occur together] with migraine, but they’re not the same disorder,” Dr. Baskin says. “It’s important that the mental health professional does not think their job is to cure migraine by focusing on psychological issues.”

Connections Between Mental Health and Migraine

The connection between mental health and migraine is complex. Migraine is often linked to mental health conditions like anxiety and depression, and research has shown that people with migraine are more than five times as likely to develop depression. Additionally, about 30-50% of people with chronic migraine have anxiety. 

Dr. Baskin stresses that people with both migraine and mental health conditions often face more disability and reduced ability to go about their daily lives. “Migraine is a very disabling condition,” he says. “If you add mental health conditions like anxiety and depression, you get a much lower quality of life.” 

While managing your mental health conditions won’t necessarily eliminate your migraine attacks entirely, it can help you reduce certain triggers and better manage symptoms when they occur. Even for people with an established migraine management plan, seeking help for any mental health issues that may arise is essential to maintaining that treatment plan’s ongoing effectiveness.

Migraine and Mental Health Strategies to Discuss With Your Therapist

While therapy is not a “cure” for migraine, there’s evidence that it can help significantly. Behavioral treatment for migraine—which includes “talk therapy” and other types of treatments focused on changing key behaviors—can reduce migraine symptoms and help people better manage stress. Research has found that 30-60% of people who use biofeedback, relaxation or cognitive behavioral therapy experience fewer headaches after treatment.

“It is helpful to have a therapist who has some knowledge and fluidity with cognitive behavioral therapy or other forms of behavioral therapy and who knows something about mindfulness training and relaxation approaches,” Dr. Baskin says. “They can then learn how to adapt those approaches to a person managing migraine.”

Cognitive behavioral therapy (CBT) in particular can be a powerful tool when dealing with migraine attacks. CBT involves becoming more aware of your thoughts and feelings and how these affect your actions and overall mental health. These types of therapy can also help people maintain a greater sense of non-judgmental awareness moment-to-moment, as is taught in mindfulness practices.

“When you have migraine and an anxiety disorder or a mood disorder, it has an effect on your sense of safety,,” says Dr. Baskin. “You have a disorder where you’re disabled for periods of time and fearful of getting another [attack], and you also have low mood or high anxiety, which can be debilitating… What most therapy tries to do is increase a sense of safety, reduce danger signals and facilitate more adaptive coping mechanisms with changes in thoughts and behaviors.”

Therapy can help you reframe your thoughts and reactions to these migraine symptoms and triggers, which in turn can decrease stress and anxiety that may contribute to a future attack. “It’s a very subtle distinction between noticing something in your body and saying, ‘Oh my God, this is going to lead to something terrible,’ or just saying, ‘I have a plan. I can tolerate this and manage it one step at a time. I know what it is.’” says Dr. Baskin. 

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.