The role of a psychologist in migraine

by Dr Sophie Mitchell, Clinical Psychologist, Headache Group, National Hospital for Neurology & Neurosurgery, University College London Hospitals NHS Foundation Trust

A psychologist, really?!

As a psychologist in a headache service, I know that I can be met with some confusion or apprehension when I tell people my job title. People might worry that I’m there to tell them that they are mad or that they are making up their symptoms. In fact, my job in a headache service is very different and I try to be helpful in various ways to people living with migraine and other headache conditions.

We understand that the experience of migraines is not just a physical one that happens in the body. It has a range of consequences to other areas of your life, including your thoughts, feelings, relationships with other people, what you choose to do every day and perhaps even your longer-term goals. It is normal for us to have changes in our mood at times, but we understand the potential emotional impact of living with a headache condition. Whilst the statistics can vary, it is estimated that people with headache conditions are 2 to 5 times more likely to experience depression or anxiety than the average population (Minen et al., 2016). This can create a cycle between how we feel emotionally and physically: the symptoms make us feel stressed; this stress can make our existing symptoms worse or act as a trigger for the next attack.

How can a psychologist help?

How psychologists work with people can differ depending on what they need. We use a range of therapy approaches, including Cognitive Behavioural Therapy (CBT) or Acceptance and Commitment Therapy (ACT). These are approaches that have been successfully used to help people to adjust to a range of chronic conditions, including migraine (Grazzi et al., 2019; McCracken & Vowles, 2014).

One way in which I work is to help people to break the cycles between stress and their symptoms. This might include helping them to manage stress in other parts of their life, or by helping them to cope with the emotional impact of living with their headache condition. A psychologist can also help you to find ways to cope with the pain itself, such as mindfulness strategies. The aim here is to give you skills as part of a “toolkit” of ways to cope, in order to make the attacks less frightening in themselves. Research has even shown us that learning these strategies alongside taking your medication is the most effective way to manage headache conditions in both adults and young people (Holroyd et al., 2010; Powers et al., 2013).

Sometimes I may work more broadly with people to help them to think about the journey they have been on so far with their symptoms or how to improve their overall quality of life. Sometimes people who live with chronic conditions can feel disconnected from the things that matter the most in life. Psychologists can be helpful in finding a way to connect to these things again, despite and with their symptoms. It is true that as a psychologist I cannot take away all your pain and symptoms. But what if it was possible for you to have these symptoms, without all the extra frustration, worry and sadness? What if you could find a way to move forward with your life, to be the person you want to be, even with the symptoms in tow?

How can I get help?

If you would like to get some support regarding these issues, then there are a number of ways you can find this. If you are receiving help from a neurologist, you can ask them whether there are any psychologists or counsellors available in their team. If not, then you can seek help through your local Improving Access to Psychological Therapies (IAPT) service (only available in the UK). It is worth asking your GP or looking online for these services in your area.

If you would like to learn ways to cope but do not feel ready to speak to a therapist, then you may find the following resources useful:

  • “Mindfulness for Health: A practical guide to relieving pain, reducing stress and restoring wellbeing” by Vidyamala Burch and Danny Penman
  • “The Reality Slap” by Russ Harris
  • “Overcoming Chronic Pain: A Self-Help Guide Using Cognitive Behavioral Techniques” by Frances Cole, Helen Macdonald, Catherine Carus & Hazel Howden-Leach.

If you are experiencing thoughts of suicide or self-harm, then it is important to know that there is help available to you. You may find it helpful to alternatively call the Samaritans on 116 123 or email jo@samaritans.org (the helpline is open 24 hours a day, 365 days a year). If you can, speak to your GP about what you are going through as they may be able to help. If you feel in immediate danger then you should attend A&E. 

References

Grazzi, L., Bernstein, C., Raggi, A., Sansone, E., Grignani, E., Searl, M., & Rizzoli, P. (2019). ACT for migraine: Effect of acceptance and commitment therapy (ACT) for high-frequency episodic migraine without aura: Preliminary data of a phase-II, multicentric, randomized, open-label study. Neurological Sciences, 40(1), 191-192.

Holroyd, K. A., Cottrell, C. K., O’Donnell, F. J., Cordingley, G. E., Drew, J. B., Carlson, B. W., & Himawan, L. (2010). Effect of preventive (β blocker) treatment, behavioural migraine management, or their combination on outcomes of optimised acute treatment in frequent migraine: randomised controlled trial. British Medical Journal, 341, 4871-4883.

McCracken, L. M., & Vowles, K. E. (2014). Acceptance and commitment therapy and mindfulness for chronic pain: Model, process, and progress. American Psychologist, 69(2), 178-187.

Minen, M. T., De Dhaem, O. B., Van Diest, A. K., Powers, S., Schwedt, T. J., Lipton, R., & Silbersweig, D. (2016). Migraine and its psychiatric comorbidities. Journal of Neurology, Neurosurgery & Psychiatry, 87(7), 741-749.

Powers, S. W., Kashikar-Zuck, S. M., Allen, J. R., LeCates, S. L., Slater, S. K., Zafar, M., Kabbouche, M.A., O’Brien, H.L., Shenk, C.E., Raush, J.R., & Hershey, A. D. (2013). Cognitive behavioral therapy plus amitriptyline for chronic migraine in children and adolescents: a randomized clinical trial. Journal of the American Medical Association, 310(24), 2622-2630.