The basics of CBT By Tammy Rome

There is a growing body of research to support the use of Cognitive Behavioral Therapy as part of an integrative approach to migrainetreatment. CBT won’t replace headache specialistspreventive therapies, or acute medical interventions. It can help with one of our biggest triggers though.


Many migraineurs cite stress as their #1 trigger. The theory is that CBT can help patients increase their tolerance level and reduce the number of attacks triggered by stress. One of the strategies used in CBT is to challenge and change the way a patient thinks aboutmigraine as it relates to their lives.

Negative feedback loop

It starts with the idea that negative thinking patterns about yourself, others, and your future create a self-sustaining feedback loop that can affect your whole outlook on life. Breaking the cycle of negative thinking requires us to change the way we think about ourselves, our relationship to others, and our outlook on the future. The way with think about migraine can become an ever-increasingly negative pattern. We can break that cycle by catching our thinking mistakesand correcting those errors.



It works for me

I am just as guilty as everyone else of getting caught in this negative thought/belief pattern many times. Because I have comorbid depression, I am more susceptible to giving in to this kind of thinking. I have to work harder to make sure my thoughts are consistent with reality. The use of CBT strategies has helped to keep my depressive symptoms in remission. It also helps me to manage stress better so I am less vulnerable to those nasty let-down migraine attacks.

Thinking errors

#1 – Drawing a broad conclusion based on irrelevant or insufficient evidence.

Example: “This is my last option.”

I made this mistake when I pursued a “cure” by trying to qualify fortrigger site release surgery. I believed it was the only availabletreatment in my city. That wasn’t true. I just wasn’t willing to look hard enough. I was in a hurry to find a solution, so I didn’t do all of my homework. If you’d asked me back then, I would have denied it. However, the fact that I found several other options after I’d been turned down for surgery proves that my thinking was faulty.

#2 – Focusing on a single aspect of a situation and ignoring others

Example: “There’s nothing left to try.”

I made this mistake when I found out I didn’t qualify for trigger site release surgery. Because I focused on surgery as my only option, I was devastated when it didn’t work out. It took me weeks to finally recognize the truth. There were other treatments to try and otherdoctors to see. I just had to look harder. I tried two more doctors and 6 more treatments before finally finding my current doctors and effective treatments.

#3 – Exaggerating the importance of undesirable events

Example: “I can’t take one more day.”

This was my thinking after getting turned down for surgery. That thought nearly drove me to take my own life. It seems silly now, but in the middle of those thoughts I couldn’t break free. I was so tired of hurting all the time. At least for me, surgery was a passive way to have somebody else fix my problem. In truth, I could tolerate many more days. I know this now because I have done it. If someone had told me in the middle of that darkness that I would face at least 2 more years before getting results, I probably would have given up. Thankfully I was able to focus on getting through one day at a time. Gradually I was able to cope for several days, looking forward to that next appointment. Before long, I had abandoned my lethal plans. My outlook changed because I was able to change how I saw myself and my doctors.

#4 – Underplaying the significance of an event

Example: “I’m fine.”

Don’t we all say this? We minimized our own pain because we rationalize that 1) no one cares to know the truth, 2) we’ve been worse off, or 3) we really don’t want the negative attention. By doing this, we downplay the severity of our symptoms. What’s worse, we do it with our doctors! I’m not suggesting we exaggerate our experiences. Let’s just be honest – any single migraine attack sucks. We’re not fine. We may be fine in a few hours or days, but in the middle of an attack, we are anything but fine.

#5 – Drawing a broad negative conclusion based on a single insignificant event

Example: “Doctors are no help.”

We make a sweeping generalization about all doctors without having tried to work with more than a handful. To be honest, there are some doctors who aren’t any help to us. But that doesn’t mean none of them can help. I know this because I work with two amazing doctors who have helped me a great deal. Neither one of them are UCNS certified and you won’t find them listed on any registry. I’ve also met some very caring, helpful headache doctors. They’re not my doctors, but I know they are helpful because my friends are helped by them. Many of us make this mistake when our doctor tells us there are no more options to try. Just because one, or two, or ten doctors run out of options doesn’t mean there aren’t doctors with new ideas who can help us.

#6 – Attributing the negative feelings of others to yourself

Example: “My husband blames me for always being in pain.”

I made this thinking error many times. When I finally started inviting my husband to talk about the effects of migraine on his life, I learned something very different. Sure, he was frustrated, angry, resentful, and exhausted. He didn’t blame me. He blamed migraine. There’s a big distinction. I get frustrated, angry, resentful, and exhausted because of migraine, too. Once we both realized we were angry about the same thing, we were able to view each other as partners again. The antidote to this mistake is to talk with the person. Ask questions. Listen carefully. Keep an open mind. It may feel as though you are the target of someone’s negative emotions, but that doesn’t make it true. Even if someone does blame you for your migraine, that isn’t necessarily true. They may be guilty of thinking mistakes too.

Interested in learning more about Cognitive Behavioral Therapy and how it can help you with migraine? More articles are in the works that will address different CBT strategies you can use at home.

If you are not familiar with CBT, it might also be a good idea to find a therapist who specializes in CBT for chronic pain. A good starting place is the “Find a Healthcare Provider” tool  at When you search, make sure to select the Psychiatry/Psychology/Behavioral Medicine option under Specialty. The providers listed are those who have a good understanding of the impact that migraine has on a patient’s life. They will likely be more sympathetic to your challenges than the average CBT therapist.

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Tammy’s first experience with Migraine started in 1975. Currently disabled by multiple pain conditions, Tammy still uses her expertise to help others. She holds a Master’s degree in Professional Counseling and is a skilled Herbalist and Reiki Master. She shares her extensive experience in both conventional and complementary medicine here at and on her own blog, Brain Storm.Subscribe

Have Fibromyalgia and Migraines?

wpid-img_20150323_064829.jpgStudy Shows an Increased Risk of Suicide

A new study published in the journal Neurology says that people who suffer from fibromyalgia and migraines are at increased risk of suicide.

Researchers from the University of Taipei surveyed 1,318 people with migraine headaches, and 10.1% of them also had fibromyalgia. Four out of five of the survey respondents were women.

The results didn’t surprise Dr. Ginevra Liptan, who founded the first practicedevoted to fibromyalgia in Lake Oswego, Oregon.

“Several different studies have demonstrated that that the risk of suicide is higher in fibromyalgia,” she said. ” I think a huge contributor is that people suffering from this ” invisible” illness often feel misunderstood by the medical community- and even sometimes by their family. ”

Of 1,318 patients with migraine included in the analysis 10,1% were found to have co morbid Fibromyalgia. Patients with migraine and co morbid FM had higher headache frequency and headache-related disability, poor sleep quality, and were more depressed/anxious in comparison to those patients who only had migraine.

Of the patients with migraine 27.3% reported suicidal ideation and 6.9% reported suicide attempts. These results were even higher in patients with co morbid FM (58.3% thought about it and 17.6% attempted.).

The researchers also found an association between FM co morbidity and a higher suicide risk in three different migraine subgroups, i.e., migraine without aura, migraine with aura, and chronic migraine. Importantly, FM co morbidity was found to be a predictor of suicidal ideation and attempts in patients with migraine.

Based on these results the authors believe that co morbid FM is associated with a high risk of suicide in migraine patients and awareness of suicide risk should be increased in this specific group of people.

Chronic pain sufferers of all indications are at increased risk of suicide. National Pain Report reported on how NASCAR legend, Dick Trickle, ended his life because of chronic back pain.

If you do not already have a mental health professional as part of your pain management team, you should consider it.

If you or a loved one are in emotional distress or have suicidal thoughts, the National Suicide Prevention Lifeline has counselors available 24 hours day, seven days a week, at 800-273-TALK (8255).

Medication Overuse Headache by Migraine Pal

One of the biggest stumbling blocks for migraineurs, particularly those who have had migraines for years, is medication overuse headaches (MOH).

MOH is the official classification for the common term “rebound headaches”. These are headaches (and even migraines) which occur because of the medication and drugs we’re taking. Typically it occurs when taking medication too often which causes a physical dependence on the drug. When the medication is stopped withdrawal symptoms are experienced and result in a headache or migraine.

MOH often goes unnoticed. Many doctors fail to ask about the frequency and type of medication you’re taking and if there not looking for it, it’s easily missed.

If you experience daily migraine attacks or headaches, there is a 30% to 50% chance you overuse acute medications.

Up to 80% of those who visit migraine headache specialty clinics either overuse acute medication or already have MOH.

MOH is a complication of migraine. It is a secondary condition as a result of the overuse of treatment for the primary migraine or headache. Even if an individual has migraines, MOH becomes the prioritised condition to treat before any progress can be made on the underlying migraine condition. This is the case even if migraines caused MOH in the first place.

MOH is extremely important to address first and foremost. MOH can block or reduce the effectiveness of other treatments. It can be extremely difficult to reduce your migraine frequency whilst you have MOH.

For most migraineurs, they don’t even realise they have MOH. For others, they might feel trapped and concerned about withdrawal symptoms. As you’ll discover from this guide, MOH is very treatable with strong success rates. By addressing MOH, you can get back to improving your migraine condition.

Read the complete MOH guidewpid-wp-1432820161178.jpeg at MigrainePal

Kind regards,

Carl from MigrainePal

A note from LollipopsAndCandyCanes : If you don’t already follow @migrainepal, you should start. Great articles, advice, recommendations, and empathy.

Headache Help: Q&A with Hossein Ansari, MD

Headaches are the most common pain issue brought to physicians and a major reason cited for missed work and school days. Although most headaches are benign, some headaches are disabling enough to compromise a person’s ability to work, socialize and exercise. The financial burden of headaches on the afflicted is currently believed to be greater than that of diabetes, asthma or high blood pressure.

Migraines are also now viewed as a progressive disease which, like heart disease or high blood pressure, may worsen and become more difficult to treat over time. Hossein Ansari, MD, a board-certified neurologist who specializes in diagnosing and treating headaches and facial pain, talks about how to differentiate a migraine from an ordinary headache and potential treatments.

Question: What is a migraine?

Answer: A migraine is a complex neurologic disease with a genetic basis and is not synonymous with a severe headache. Migraine suffers may experience symptoms we call aura without ever having headaches. Aura symptoms can be visual (e.g., seeing dots and lines) or sensory (e.g., numbness on the cheeks, arms or legs) or speech-related.

Q: What are some symptoms suggesting that I should seek medical help for my headaches?

A: Individuals should seek immediate referral to a neurologist, preferably a headache specialist, if they experience any of the following: a stiff neck or fever with a headache or a headache that gets worse when lying down; constant numbness, dizziness, weakness or difficulty with speech; confusion, drowsiness or loss of consciousness with headaches; headaches for the first time after age 50 or “the worst headache of your life.” Those who develop headaches while on an immunosuppressant, such as chemotherapy or steroids, should also seek immediate help from a neurologist.

Q: What is known about the relationship between foods and fasting in triggering migraines? What about alcoholic beverages?

A: Artificial sweeteners, nitrates (often found in processed meats) and MSG can induce migraines. Most migraine triggers assumed to be food-related, though, are actually part of the migraine itself. By this I mean that before a headache begins, a person may experience food cravings or aversions. Fasting and alcohol, particularly red wine, can also trigger migraines.

Q: What can I do to prevent migraines?

A: We recommend regular, light exercise at least three days a week. Yoga, tai-chi and other mind-body practices are particularly beneficial. Multiple studies show that migraines often become chronic among overweight individuals. For this reason, attaining or maintaining a healthy, normal weight is critical. Drinking plenty of fluids, avoiding stress and getting adequate sleep are also important.

Q: How do you differentiate a sinus headache from a migraine?

A: Headache specialists consider the term sinus headache a misnomer. Most persons who think they have sinus headaches actually suffer from migraines.

Q: What about hormone fluctuations and migraines?

A: Hormonal fluctuations associated with the menstrual cycle can bring on migraines. Hormone therapies that regulate estrogen levels can avert attacks. Women who have migraines with aura should avoid certain birth control pills to prevent an increased risk of stroke.

Q: What are the most promising investigational treatments in the pipeline?

A: The most promising interventional treatment is a surgical procedure known as a migraine trigger point deactivation surgery. There is also a new drug on the horizon – a calcitonin gene-related peptide (CGRP), long postulated to play a key role in the pathophysiology of migraines – that has shown promise in preclinical and clinical trials.

Source: UC San Deigo Health Headache Help: Q&A with Hossein Ansari, MD

Another Dawn, Another Day

Here I am again. 3:30 am. Typing about my feelings. Wanting so badly to be asleep. Deep, restorative sleep. No dreams sleep. Reassuring sleep. Rejuvenating sleep. But sleep is becoming a dream in itself. Short, light sleep is what I get. If I go too deep into REM, the nightmares come. I don’t remember them as a whole. Just bits and pieces. They’re dark, scary, fraught with anxiety and panic. Clawing at the light. Begging to wake up. And I do. And it all starts again. A cycle of pain, fear, sleep, wake, dream, flashes of memory, dark, light. Too afraid to fall asleep, too exhausted not to. Endless circles of day and night blending together. Dawn is my time to think, type, try to put down into words what is happening to me. Not to scare others, not to scare myself. But to seek out those who feel as I do. For reassurance. For comfort. For ideas. Suggestions. To know I’m not alone. Because at 3:00 am, I  feel alone. #AlwaysKeepFighting wpid-wp-1422496248237.jpeg