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Migraine Therapy — More Effective Than Medication?


Can a specialized form of psychotherapy, geared towards relief in chronic migraine headaches, possibly be just as effective, if not more effective, than medication?

It’s long been assumed that when a person has a history of migraines, they have a purely medical (physiological) issue. This isn’t necessarily incorrect, by any means. It certainly seems purely medical when a person has a debilitating headache, nausea, and visual and/or aural disturbances (along with many other types of migraine auras that exist). When there is a medical issue, usually medical treatments are utilized to resolve the issue (conventional and/or alternative treatments).

But what happens when you exhaust the various medical approaches, and you still find yourself struggling with chronic migraines?

One thing I have observed with the people who I’ve treated with therapy for migraines, is that people come in saying that they “have migraines,” as if it’s something they own that it is in them and must be exorcised out (some have chronic daily migraines).

It is the case that some people are more physiologically and genetically susceptible to migraines than others. And, there are many possible triggers that can result in a migraine — foods, weather, hormonal shifts, over-exertion, flashing lights, scents, loud noise, muscle tension, etc. But it’s important to know that the migraine isn’t there until it is triggered. Meaning – it is actually possible to decrease the frequency of occurrences (as well as the severity) if a person can understand and eliminate, or at least manage their triggers as well as possible. It isn’t just that “the time” for a migraine is here — they occur when something (often a combination of things) has triggered it.

But, the issue with triggers is that they are not as cut and dry as people always believe. For some, triggers can be concrete, and that makes it much easier for them to overcome. However, for most, triggers often work in combination, and they may not be as easy to identify as one would like. Basically, not all headaches are the same, and they don’t all come from the same thing. Migraine triggers and experiences are different for each individual, even if some triggers may generally overlap.

Can Emotions Be Triggers?

On a simple level, think of how a state of panic rapidly increases heart rate. This is one example of the correlation between emotional shifts and/or states, and the physiological impact of this. In terms of the head and brain, medical studies have shown more recently that significant triggers for migraines and headaches can be sudden or strong changes and shifts in brain activity.

What causes these shifts?

First, it is always a good idea to rule out any organic medical issues when experiencing chronic headaches and other symptoms related to migraine aura. When the issue is non-organic chronic migraines (meaning there isn’t an identifiable medical cause for the migraines), medical tests generally reveal nothing.

Once this has been determined, when people start to learn about triggers, people often don’t consider the emotional elements that underly the internal environment for migraines. The one emotional issue that gets the most attention is “stress.” Though when people refer to stress, they generally tend to refer to the present (for example, “I’ve had a stressful few weeks at work.”), rather than considering a longer-term history of chronic underlying stressors.

Migraine Therapy

People often come to me for help when they’ve exhausted many conventional and alternative approaches to migraines. Their “last stop” is to try therapy for migraines. Most come in saying that they expect nothing from this, but feel they’re out of options and need to ensure they’ve left no stone unturned.

Most wonder basically the same thing: How can simply sitting and talking with me bring relief to something they have actively searched to the end of the earth for something concrete to resolve the issue? The reality is, what’s underlying the chronic migraines may not always be so concrete. But it doesn’t mean there isn’t something going on that can’t be remedied.

Emotions Impact the Brain; The Brain Impacts the Body

Emotions are incredibly powerful. And what’s more important — it’s not just the emotions that we consciously experience that can trigger migraines, it’s often the unconscious, cut off (dissociated, repressed) emotions and experiences that can wreak the most physiological havoc (it’s not always migraines. IBS is another).

We carry our emotional experiences from our life histories with us, whether or not we are always conscious of them. And wether or not we are aware, the residue of these emotional experiences can manifest themselves in physiological ways. For many, this can turn into migraines.

As an example, dissociation and inhibition are two areas that can heavily contribute to the internal migraine environment — such as dissociated sadness, anger, sexual repression, suppression of parts of ourselves, etc. (more on these in a later article). What’s important to understand for now is how our brains, and therefore our bodies, react to significant histories of dissociation, repression, and inhibition.

In addition to this, there is also the circular effect of emotionally managing recurring migraines. Merely having to deal with chronic migraines and the accompanying emotions — the loneliness, frustration, feeling misunderstood, etc. — can in itself trigger more migraines. So it’s not only what’s already there from our histories, but it’s how the present situation adds to this.

When we manage the clear cut triggers, what we’re basically doing is taking away the known concrete factors that cross the threshold as a trigger. With therapy, part of what we do is work to decrease the migraine environment in the brain so it becomes more difficult to cross the threshold (inflammation, neurotransmission imbalance, etc).

What about those shifts in brainwaves?

Strong emotional shifts trigger brainwave shifts. And when people are physiologically more susceptible to migraines, an earthquake in the brain can be a trigger. When we become stressed, angry, sad, hyper, excited, etc., these cause shifts in our brains. It would be nice if we could just say, “Okay, I’m going to take my time and slowly get frustrated now.” Even jumping up out of bed too quickly in the morning from a sleep state to an active state can cause enough of a shift to be a trigger.

From Stuck, to Forward Movement

Whether it’s repression, patterns of strong emotional shifts, avoidance through emotional overdrive, trauma, or other issues, what’s key is moving these mechanisms forward — out of a place of emotional patterning where migraines continue to circulate. For example, someone who has difficulty with confrontation due to underlying fears of retaliation (inhibition) will learn about its personal significance, and eventually start to learn to face to confrontation in a safer, more healthy manner. Or, someone who has difficulty connecting to anger (repression) will learn to feel safer facing anger as an acceptable emotion that has its appropriate time to be experienced. (More on the “emotionally stuck” position in a later article). This isn’t an overnight process, by any means.

My job is to partner with each person to help figure out what’s going on underneath the migraines, manage the present state of the migraines, and to support you in creating a new, less susceptible migraine environment, both internally and externally. This is what Migraine Therapy is about. We also work on migraine discovery, trigger identification and management, and emotional management.

Does Migraine Therapy Work?

Many of the people on their “last treatment stop” report to me during the course of the treatment (sometimes even as early as the second month) that they have mysteriously been experiencing a reduction in migraines. I had a woman recently tell me just after two months that she’s been feeling better than usual, though isn’t quite sure why since nothing has really changed in her life except for our therapy. Though she still is experiencing migraines at this early point, when they are triggered, they also haven’t been as bad and hasn’t needed her abortive medication. This was a change she hadn’t experienced at any point during her long struggle to find a treatment.

Many of the people I have worked with experience this type of mysterious reduction. As we work, the migraines become less frequent and less severe. As they continue with the treatment, this trend of reduction tends to continue for most (I have also seem similar results for Crohn’s Disease and IBS).

We don’t only look at emotions, but we also try to understand the whole migraine picture, with emotions as a significant contributing piece of the overall pie. But this doesn’t mean the medical is less relevant, by any means. All the components of migraines needs to be addressed.

Though there are many possible triggers to migraines, it appears that underlying emotions may be much more relevant in the whole picture than is commonly considered. If you are someone who’s had difficulty finding a migraine treatment that has been markedly effective, this may be a step to consider.

Migraine Therapy — More Effective Than Medication?

Nathan Feiles, MSW, LCSW-R

Nathan Feiles is a psychotherapist in private practice in New York City. He also provides online coaching nationally and internationally. In his practice, Nathan specializes in anxiety issues, relationship struggles, commitment issues, fear of flying (specialized method), decision-making, creative blocks, depression, and migraines. For more information about Nathan Feiles’s work, including a complete list of services, please visit his website at

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APA Reference
Feiles, N. (2016). Migraine Therapy — More Effective Than Medication?. Psych Central. Retrieved on June 2, 2020, from


Last updated: 22 Oct 2016
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