Exploring Ways to Increase Pain Resilience

by Dawn C. Buse, PhD

Behavioral Treatments for Migraine Management

Has your health care professional recommended adding biofeedback or cognitive behavioral therapy to your treatment regimen? Maybe you are thinking of getting pregnant and want to learn about non-medication treatments for migraine. Or perhaps you just like to know all of your treatment options. Here’s a brief guide to behavioral treatments for migraine management.

Behavioral treatments including relaxation training, biofeedback, and cognitive-behavioral therapy are backed by hundreds of studies, have been used for decades, and are recommended by medical headache societies. While behavioral treatments are often administered by a psychologist, it does not mean that you have a psychological disorder or coping deficiency.  These health care professionals have special expertise helping people balance their nervous system and increase resilience, which may raise the threshold for migraine attacks. Behavioral treatments may be used alone or in conjunction with medications. They are often covered by health insurance, but could require specific diagnostic codes from your doctor.

Relaxation therapies

While we all probably think we already know how to relax, relaxation exercises are specifically designed to balance and calm the nervous system. Our autonomic nervous system regulates important bodily functions. It has two opposing branches:

  • The sympathetic nervous system, which activates the “fight or flight” response when we are in physical danger, pain, or emotional distress.
  • The parasympathetic nervous system, which controls the “rest and digest” response and returns the body to balance.

While both of these systems have important functions for survival, longterm activation of the sympathetic nervous system is unhealthy and may lower the threshold for migraine attacks. Relaxation exercises activate the parasympathetic (calming) branch of the nervous system with techniques including diaphragmatic breathing, progressive muscle relaxation, and guided visual imagery. Goals include increasing oxygen and blood flow throughout the body, slowing the heart rate, and relaxing muscles. You can learn and practice these techniques on your own with apps, books, or recorded exercises, or by working with a psychologist or other health professional.


Biofeedback for migraine measures physiological functions related to the “fight or flight” response. During this treatment, you are connected to sensors that convey information (“feedback”) about your body (“bio”). Finger temperature (circulation), breathing, and muscle tension are commonly measured. Other measures may include heart rate, brainwave activity, and “skin conductance” (or goosebumps and sweaty palms).

You will see graphs showing your data on a computer screen and then learn ways to relax your nervous system. Some systems even look like video games. You’ll witness the benefits of practicing these techniques immediately during the session and be instructed to practice afterwards. The benefits will extend for as long as you practice throughout your life.

Cognitive-behavioral therapy (CBT)

CBT helps people adopt more functional and healthy ways of thinking (cognitive) and acting (behavioral). In CBT for migraine management, a psychologist or other mental health professional will work with you to understand your unique situation, skills, thinking styles, and behaviors to improve coping skills, teach stress management, reduce migraine-related disability, and enhance your strengths.

Mindfulness based therapies and acceptance and commitment therapy

There is strong evidence that these therapies are effective for chronic pain management, and they have recently been studied for migraine. Results indicate that they help with wellbeing, quality of life, and reduction of the disability associated with migraine.

Mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR) focus on being fully present and attending to what is happening in the moment without judgment. Mindfulness meditation is practiced, and in MBCT, CBT skills are also taught.

Acceptance and commitment therapy (ACT) combines acceptance, mindfulness, commitment, and behavior change therapies to increase psychological flexibility and move towards valued behaviors and goals.

Lifestyle management

Everyone with migraine can benefit from maintaining a regular daily routine and engaging in healthy lifestyle habits. The following actions can balance the nervous system and raise the threshold for attacks:

  • Practicing good sleep hygiene and maintaining the same wake and bedtime every day of the week
  • Eating healthy, regularly scheduled meals
  • Staying hydrated
  • Moderating caffeine intake
  • Getting regular exercise or activity and maintaining a healthy body weight
  • Managing stress 
  • Not smoking

If stress, depression or anxiety feel unmanageable or if you have thoughts about hurting yourself, talk to your doctor or a mental health professional, or call the National Suicide Prevention Lifeline (800) 273-8255.


Dawn Buse’s website with free relaxation exercises and her latest research: dawnbuse.com

Dawn Buse’s YouTube video on biofeedback for migraine: bit.ly/2UvT4vg

Resources to find a health care professional for various behavioral treatments:

Cognitive behavioral therapy:

Association for Behavioral and Cognitive Therapies: abctcentral.org/xFAT/

American Psychological Association: locator.apa.org/

Psychology Today: psychologytoday.com/us/therapists (choose “chronic pain” specialty)


Association for Applied Psychophysiology and Biofeedback (AAPB): bit.ly/2t1XoGI

Biofeedback Certification International Alliance: bit.ly/2HNIVZm

Acceptance and commitment therapy:

Association for Contextual Science Behavior: bit.ly/2aM3NQT

About Dawn C. Buse, PhD

Dr. Buse is a Clinical Professor of Neurology at Albert Einstein College of Medicine, a licensed psychologist and on the Board of Directors of the American Headache Society.  She conducts research on migraine and chronic pain and treats patients using cognitive behavioral therapy, biofeedback, relaxation, and mindfulness training. Twitter: @dawnbuse.