Control Your Migraines With CBT

Migraines are often described as storms—unpredictable, overpowering, and disruptive to daily life. For the millions who experience them, these episodes can feel like they dominate not just the body but the mind as well. But cognitive behavioral therapy (CBT) offers a different way to engage with this experience, focusing on how we think about pain and, ultimately, how we can change our relationship with it.

As a clinical psychologist specializing in pain management, I’ve seen firsthand how CBT can empower individuals to manage their migraines. While it isn’t a cure, CBT can reduce the frequency and intensity of migraines, help people to reclaim a sense of control, and improve quality of life.

What are cognitive distortions and how do they affect pain?

When we experience pain, particularly migraines, it’s easy to fall into patterns of thinking that amplify our distress. These patterns are called cognitive distortions. Common examples include:

• Catastrophizing: Thinking in terms of the worst case scenario, such as This pain will never stop.
• Labeling: Reducing oneself to a singular and often negative descriptor, like I’m so boring and lame because of these migraines.

Cognitive distortions often make pain feel more overwhelming. Pain is both a physical and psychological experience, and the way we interpret it can intensify or mitigate its effects.

This is where CBT comes in. By identifying and challenging these distortions, CBT helps reshape unhelpful thoughts into more balanced and constructive ones.

For instance, a thought like I can’t handle this migraine can be reframed as I’ve managed migraines before and I can manage this one, too. This shift doesn’t minimize the pain but reduces the sense of helplessness that often accompanies it.

CBT techniques to help manage migraines

CBT provides structured tools to address the emotional and cognitive aspects of migraines. Here are two techniques I often suggest to my patients:

Thought monitoring

When a migraine begins, jot down the automatic thoughts that arise. These might include assumptions about how long it will last or how it will disrupt your life. Then, systematically evaluate these thoughts. Ask yourself:

• Is this thought a fact?
• Is there evidence that contradicts it?
• Can I generate a more accurate statement?

For example, if you think, I’ll never feel better, recall times when the pain subsided, and life returned to normal. You can then create an alternate, more realistic thought such as this migraine is awful, but my past experiences suggest that the pain will eventually subside.

Mindfulness awareness

Pain often triggers resistance—an urge to fight against it or escape it. Instead, mindfulness encourages acknowledging the pain.

When the pain arises, shift from that natural instinct to say I need to get rid of this immediately to asking yourself a series of open-ended questions that allow you to focus on the present. For example, you might ask:

• Where do I feel the pain most intensely?
• How far does the pain spread?
• What is the quality of the pain?
• Is there a pattern in the way I experience this?

In making this shift, you can reduce the emotional intensity of the experience.

How effective is CBT for migraine management?

CBT is supported by extensive research as an effective tool for managing migraines. Studies indicate that CBT can lower both the frequency and severity of migraine episodes by addressing the psychological factors that exacerbate pain.

The process doesn’t mean the pain disappears, but it helps individuals respond differently to it. This distinction is key: While migraines may remain a part of life, they no longer have to dominate it.

How to get started

For those interested in exploring CBT for migraine management, there are several paths to consider:

• Work with a licensed therapist: Seek a professional trained in CBT for chronic pain. Telehealth options have made therapy more accessible than ever.
• Use digital resources: Apps and online programs offer CBT-based techniques that you can practice independently.
• Read educational materials: Books and guided journals focusing on pain management through CBT can provide useful tools and frameworks.

Migraines are a deeply personal experience, but they don’t have to feel all-encompassing. As I often tell my patients, “If a person feels like the pain is in the driver's seat, CBT helps give them back control of the wheel.” This shift—from feeling controlled by pain to actively managing it—can make a profound difference.

• Learn more about migraine management from our webinar series.
• What’s triggering your migraines?
• The difference between a migraine and a headache.