Cognitive Behavioral Therapy (CBT)

Summary:
CBT targets maladaptive thought patterns and behaviors related to stress, pain, and coping. It has robust support for improving migraine frequency, severity, and disability.

Biological Plausibility

Migraine is modulated by stress and cortical excitability. CBT improves self-efficacy, reduces sympathetic activation, and enhances pain coping strategies.

Evidence

Meta-analyses and RCTs show CBT significantly reduces attack frequency and improves quality of life. Recommended by guidelines for chronic migraine and comorbid anxiety/depression.

Effect Size

Moderate to high; benefits increase over time and are often sustained.

⚠️ Risk

Minimal; barriers are mostly logistical (time, cost, therapist availability).

Cost

$$$

Scores

  • Benefit: 4
  • Burden: 3
  • Ratio: 1.33

Clinical Takeaways

  • Strong option for chronic migraine or stress-sensitive patients.
  • Requires access to trained therapists.
  • Digital CBT platforms are emerging as more scalable alternatives.

Key References

  • Houle TT, et al. *Cognitive-behavioral therapy for migraine: a meta-analysis.* Cephalalgia. 2021.
  • Buse DC, et al. *Psychological and behavioral treatment of migraine and tension-type headache.* Headache. 2012.
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