Migraine headaches are notoriously difficult to treat with pain medications, which perform no better than placebo in studies. Now, a new paper in the journal Headache finds that 83% of patients who completed a short course of cognitive behavioral therapy (CBT) had fewer headaches. The researchers believe that changes in a key brain area for pain management explains how CBT helps with migraines. But what’s most interesting about these findings is the way it challenges the way we classify these headaches in the first place.

Migraines hurt. Badly. Patients often describe the throbbing headaches as so painful, all they can do is lie down in a dark room. The mainstay of treatment for migraines has long been medication, but medications for acute migraines often don’t work. It gets even harder when people have frequent or chronic migraines, where preventative medicines are thought to work only about 20% of the time.

When medications don’t work, doctors prescribe other methods like biofeedback training, acupuncture or stress reduction therapy. But because migraine is considered a medical problem, these treatments are second line.

That’s why this new study is so important. Most of the 18 adolescents in the study with frequent migraine headaches saw a reduction in their migraines. Unlike many studies which run special protocols that no-one can access outside the lab, this one used an easily available remedy. Cognitive behavioral therapy is the one of most widely taught and available types of psychotherapy in the U.S. today.

To sort out how the therapy might have helped, researchers ran MRIs on the study participants both before and after their time in CBT. The adolescents had 15 + or – 7.4 headaches a month before enrolling in the study. They then participated in 8 weekly sessions of CBT. After the eight weeks, their headache frequency decreased to 10 + or – 7.4 a month.

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The technical details: the MRIs were a particular type called structural and resting-state blood-oxygen-level dependent contrast scans. They also used arterial spin labeling to look at brain activation during the resting state and compared the left and right amygdala to assess connectivity.

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