Dear Therapist:

I have suffered from migraine headaches for a few years. I have tried a bunch of different types of treatments and have seen all sorts of doctors. Somethings have helped a little, some not at all, and some for a short time but it didn't last. I am wondering if there is some possible help to be had from psychology in this area? I have definitely heard of psychology for back pain, can it work for headaches also? 



When a client complains to me about physical symptoms, my initial response is to ask them if they have ruled out medical causes. Headaches in particular can be caused by a multitude of physical factors. These range from lifestyle choices like exercise, stress, sleep patterns and diet to medical issues, including those that can be diagnosed by general practitioners, ophthalmologists, ENTs, neurologists, and psychiatrists, among others.

I don’t know how many doctors you have seen from how many specialties. It does sound like you have seen numerous specialists without a clear diagnosis.

You wonder about psychological treatment for physical symptoms. It seems like your assumption is that the source of your headaches is physical, and that since they cannot pin down the cause or effect change through medical means you are wondering about psychological treatment.

The simple answer is that there certainly are therapists who help clients to reduce or eliminate pain. I have helped clients to reduce pain both when it was their primary concern and in instances where pain was secondar to their primary, psychological complaint.

If I can help people to reduce pain, why then do I advise them to first utilize the medical community? The reason is twofold. Although psychological treatment can help to reduce pain, the pain that it is most capable of relieving is that which has a psychological cause. I would hate to assume that someone’s pain is psychological in nature and work with them for months, only to discover that there is a simple medical cause and treatment. Worse than this would be never discovering the true cause, allowing the client to live with unnecessary pain.

Often, a key component of psychological treatment of pain is understanding the underlying cause for the pain. This is important for two reasons. When pain is caused by something psychological, it is the unconscious mind that is controlling the reaction. If, for instance, I am repressing strong emotions, my unconscious mind may signal my body that something is wrong. Since the conscious mind is not dealing with the actual issue (my strong emotions) my brain interprets the problem as physical in nature, thus causing me to sustain a headache.

This brings us to the second reason that understanding underlying causes is important. If I were never to recognize that my headaches are actually being caused by suppression of emotions, I will likely never acknowledge these suppressed feelings. Even if I am able to temporarily reduce my pain, it will likely recur. If I actually succeed in eliminating my headaches entirely, my brain will need to find another outlet for the underlying emotional pain. This could result in other (perhaps worse) pain or debilitation. Or it could lead to other afflictions, like ulcers, trouble sleeping, anxiety, and depression, just to name a few.

It is quite possible that your headaches are psychological in nature. If you decide to see a therapist, remember that you will likely work on understanding unconscious causes, which may lead to further work on those emotional issues that are seemingly lying dormant. Of course, your goals are the only ones that are important in the therapy process. You should always be the one to make determinations as to type and extent of the therapeutic work.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro College

  Graduate School of Social Work

  author of Self-Esteem: A Primer / 516-218-4200


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