Many doctors often look at their patients with suspiciousness, at first, and may even run tests to try to diagnose the “cause” before they will prescribe any sort of treatment .
Even though some doctors, including headache and pain specialists, will look at their patients like they are “crazy” after they have tried a combination of preventative and rescue medications, very few will ever recommend, from the beginning, to include psychotherapy as part of their treatment regimen. So, when they do, the patient then becomes angry and confused as to why their doctor thinks they need to go see a “shrink”. The message that the patient would like to scream out to the doctor is, “No, doc. My pain is not all in my head. It’s real!”
It can be a devastating and degrading experience to be treated like that by a doctor who you placed your trust in and had hoped that your migraine or other chronic pain would be reduced or eliminated. Many in the medical and mental health professions lack so much understanding about migraine and chronic pain that they can actually do more harm to their clients who are already suffering. Many of the so-called expert neurologists who are referred to as headache specialists and other pain management specialists, including chiropractors and alternative medicine doctors, who cannot find a way to treat your pain according to everything they know, may refer you to an insurance-based mental health provider. These mental health clinicians will most likely suggest a few visits of cognitive-behavioral therapy (CBT) or eye-movement desensitization and reprocessing (EMDR) therapy.
While some people report that they experience some benefit from CBT and EMDR for their chronic pain and I even use cognitive-behavioral therapy, when appropriate, there are limitations to these methods. The one-size fits all approach, including timelines for treatment, is a major concern in regard to providers who accept insurance. Additionally, there are significant risks to EMDR as it relates to migraine and chronic pain, as well as commonly co-morbid disorders.
If you have experienced migraine, you are not alone. When people hear the word “migraine”, they often think of a really bad “headache”, but it is much more than that. 
Migraine is a neurological disease and it can begin at any age. Headache specialists will often probe you with questions about your family history because an estimated 80-90 percent of those who are afflicted with migraine have a family history of migraine and there are a number of genes that have been associated with a higher risk of developing migraine. However, twin studies and other studies have shown that genes may only account for fifty percent or less of the cause of migraine  . Other factors such as hormonal changes, co-morbid neurological disorders, unconscious conflicts, overexertion, and environmental stimuli may be equally responsible.
I believe that’s why headache specialists should be incorporating psychotherapy into treatment for migraine from the beginning. They briefly talk about SEEDS for Success, which are all lifestyle changes that are behavioral in nature. Headache specialists briefly promote SEEDS for Success for their patients to do while under their care, but then they focus on the rescue medications such as triptans and DHE combined with preventative treatments such as Botox, Nerve blocks, and other medications such as blood pressure, anti-seizure, anti-depressants, and CGRP monoclonal antibodies. When the medical model doesn’t work, the doctors become frustrated with their patients and start treating them like they are “faking”, “attention-seeking”, or “drug-seeking”, even though everything that they told their patients in the first few meetings mentioned that they may have to try multiple different approaches.
Anything less, is considered episodic migraine. Migraine attack features vary from person to person, but include one or more of the following:
Note: Untreated migraine can last for hours, days, or months. For some people, migraine progresses through four stages: prodrome, aura, headache (migraine attack), and postdrome. It’s important to note that not everyone who has migraine will experience all four stages (e.g. aura). Some people who experience migraine may not actually even feel the pain commonly associated with a “migraine headache”, but they do experience other symptoms consistent with migraine, which this phenomenon is known as a “silent headache”.
1 in 4 Americans currently live with chronic pain. The four most common causes of chronic pain include back pain, headaches (tension headaches, migraine, eye strain headaches, and cluster headaches), joint pain (arthritis, repetitive motion injury, bursitis, and tendinitis), and nerve pain (sciatica, diabetic neuropathy, carpal tunnel syndrome, post-therapeutic neuralgia, and trigeminal neuralgia). Chronic pain can affect your mood (e.g., severe depression) , ability to function in normal activities of daily living including work and self-care, and your relationships with others if it is not properly treated and if you do not get the help and support that you need from a psychological perspective as part of your other treatments.
While poor body mechanics, injury and genetics are common medical explanations, which may be correct, the treatment options do not work for everyone. Pain medications, physical and occupational therapy are often used, and while some people report that they get results, many others suffer from chronic pain and either need more medication because they build up a tolerance or some choose not to use pain medications because of a fear that medication overuse can cause an addiction.
Some people do become addicted to these pain medications and as their doctors try to reduce the dosage after surgery because physical therapy has been completed and the wound is “healed”, now they have a new problem with no way to control their pain experience and the other effects that the pain medications provided them. People, who never used illegal drugs, may seek out synthetic opioids such as fentanyl, which are 50-100 times more potent than morphine and approximately 43% of the pills sold on the street have a lethal amount in a single pill.
While I do believe that medical and even some alternative medicines such as chiropractic medicines work and should be used in combination with psychotherapy, research shows that psychotherapy techniques can help reduce migraine and chronic pain even when nothing else seems to work. If you are committed to the therapeutic process and willing to acknowledge the psychological impact that migraine or other chronic pain has on your life, there’s a lot of hope that your life can get better.
In session, we will first work towards understanding how your pain is impacting your life and how you would like your life to be different. Next, we will work towards identifying and understanding any unconscious psychological conflicts that may need attention. Psychotherapy techniques can help you to put new language and meaning to things that you were not able to do on your own, but we will work together to help you to do so and to find new, healthier ways of seeing your situation and living so that your pain is no longer having so much control over you.
My approach is carefully designed to promote healing and wellness. I have been able to help a lot of clients overcome unconscious conflicts, some of which result in physical manifestations of their distress. Some clients who have had migraine or chronic pain that started in childhood or after a trauma, stop having pain after their first session with me simply because I have been able to identify the cause of their unconscious anger, but they have continued treatment to experience psychological healing and ultimately stopped receiving medical treatments for migraine or chronic pain. In some cases, I may include treatment methods which include making changes in your lifestyle and integrating practices that promote physical, mental, and spiritual exercises that are different than how you are living now.
I believe that psychotherapy should be highly personalized based upon your unique and specific needs. I will work in collaboration with your medical professional, if you choose. However, we will need to discuss the limits of confidentiality, if you choose that approach. At this time, all of my clients who have migraine and who have not already been provided access to an online educational course created by specialists and advocates for migraine from around the world, which has a value of $99, are provided this at no additional charge as part of their first one hour, initial consultation, with me.
“SEEDS for Success” is a plan for self-care, which headache specialists often advise their patients on at the beginning of treatment, as a form of patient education or counseling. SEEDS is a mnemonic used to describe the behavioral or lifestyle modifications that a patient may want or need to make in areas of Sleep, Exercise, Eating, Diary (formerly Drinking), and Stress, in order to better manage their migraine or headaches, particularly if the patient has chronic pain.
While there are a small percentage of people who “fake” or “exaggerate” their pain, the mere suggestion that psychotherapy can help you heal or be more responsive to your medical treatments does not imply that I believe you are one of them. My belief in psychotherapy being beneficial in treating migraine and chronic pain is based on research and experience in treating clients who have experienced both.
I understand that it adds an additional layer of pain, not just psychologically and emotionally, but also physically when a person, especially someone who you have put your trust in, doesn’t believe you. Even our understanding of pain and the current definition of pain that the medical field is using demonstrates the real lack of empathy, compassion, and understanding that a person who experiences migraine and chronic pain feels when they hear it. I can make no guarantees that the work that we do together will work. But I can tell you that I have helped many people experience less pain and feel more at peace, even when they are in pain, as a result of our work together.
Pain is unique and specific based upon each person, so the correlation between trauma and pain is not universal. For example, physical trauma can cause headaches and other chronic pain to start. A person may also experience unconscious conflicts related to the original physical trauma that, if left unresolved, can exacerbate the pain and leave the person unable to respond to the medical treatments provided. A clinician may have no history of migraine or chronic pain until after a few years of working with victims of trauma. Yet, the clinician may ultimately end up with debilitating chronic migraine because he or she was reminded of his or her own trauma (e.g. childhood sexual abuse) that was left untreated.
None of these scenarios are situations that would lead me to believe that a person’s pain is not real. Rather it would help to show how trauma may be related to that person’s level or frequency of pain and how psychotherapy may be able to help a person who is experiencing migraine or chronic pain. Medical treatments may need to be used in combination with psychotherapy during treatment and thereafter. But, the person’s ability to respond to medical treatment is typically enhanced by his or her participation in psychotherapy.
If you do not already have access to this course through your doctor, you will need to schedule an initial one-hour consultation with me through BOOK A CALL. If I determine during the initial consult, that the course is necessary or will add value to your treatment, I will provide you with a code for you to access the course.
 There aren’t very many tests that can diagnose most of the causes of migraine and many causes of chronic pain. Doctors may do this as a way to try to protect their license out of concern that the patient may be “drug-seeking” or because they lack the qualifications and understanding necessary to diagnose and treat migraine and chronic pain.
 Clients who participate in EMDR are often required to sign an extensive, separate “EMDR Informed Consent” document, which vaguely informs the client of a number of potential risks, risk factors, and instructs the client as to what to do in a given circumstance, which requires the client to initial next to each paragraph. Most of the ownership is placed on the client with very little explicit warning of the potential risks in the agency/clinician’s disclaimer about “Risks & Benefits of EMDR”.
 Burch, R. C., Buse, D. C., & Lipton, R. B. (2019). Migraine: Epidemiology, Burden, and Comorbidity. Neurologic clinics, 37(4), 631–649. https://doi.org/10.1016/j.ncl.2019.06.001
 Serendipitously, I made a fascinating discovery during the height of COVID-19, which may be a new area of research for migraine and headaches. What I found goes beyond the idea that, migraine is not just a headache. It suggests that migraine isn’t even a headache, yet the pain is often felt in and on the person’s head, although it’s not always localized because the gut, neck, shoulders, and back are often impacted as well.
 Fitzgerald, M. C., Saelzler, U. G., & Panizzon, M. S. (2021). Sex Differences in Migraine: A Twin Study. Frontiers in pain research (Lausanne, Switzerland), 2, 766718. https://doi.org/10.3389/fpain.2021.766718
 Mulder, E. J., Van Baal, C., Gaist, D., Kallela, M., Kaprio, J., Svensson, D. A., Nyholt, D. R., Martin, N. G., MacGregor, A. J., Cherkas, L. F., Boomsma, D. I., & Palotie, A. (2003). Genetic and environmental influences on migraine: a twin study across six countries. Twin research: the official journal of the International Society for Twin Studies, 6(5), 422–431. https://doi.org/10.1375/136905203770326420
 85% of people who suffer from chronic pain, also experience severe depression. The Good Body. (2023). 31 Chronic Pain Statistics: US & Global Prevalence. Retrieved on January 17, 2023, from https://www.thegoodbody.com/chronic-pain-statistics/