Chronic Migraines: The Significance of Emotional History
By Nathan Feiles, LCSW, World of Psychology, PsychCentral.com
20 Apr 2015

I received some pretty harsh criticism recently from a group of headache doctors because I suggested psychological and emotional history could have a place in chronic migraines. Some even went so far as to call me sexist for suggesting sexual repression could be a component in some cases, even though I referred to this being an issue for both genders. Many medical professionals recognize and value the effect of psychoemotional history on some forms of chronic pain. The accusations were still alarming. Are there still medical professionals who reject psychoemotional history as a plausible underlying cause for some types of physical pain? (Itís worth noting that the migraine-sufferers appreciated the article, and the medical doctors were the ones bashing it.)

Currently there is no cure for migraines. They are treated by ďwhat seems to work.Ē And that goes for all approaches to migraine. It isnít just medical and it isnít just psychoemotional. But treating both seems to do more than focusing on just one or the other.

Think of a moment of significant stress, nervousness, or anxiety. Do you feel your heart rate increase, your stomach start to hurt, get diarrhea, or feel nausea? How about a stress-induced headache? Simply stated, emotions cause changes in the working order of our bodies. Suffice to say that when we live in long-term states of stress, or close off parts of ourselves to cope, it can manifest itself physiologically.

Here are some points of clarification to combat the faulty accusations:

  • Both men and women suffer migraines. Even if the majority of migraine sufferers are women, when I write about migraine issues, Iím speaking to all migraine sufferers.
  • Both men and women suffer all types of repression.
  • Migraines are not caused only by repression.
  • There are many possible types of repression. People can repress all different types of emotions and self-states. Significant repression of any kind can play a role in physiological manifestations.
  • Just because someone may hold areas of repression doesnít automatically mean they experience migraines. Just because someone experiences migraines doesnít automatically mean theyíre caused by repression.
  • For optimal results, migraines usually take a team of health care professionals to treat. Underlying psychoemotional history often is relevant, but medical care also is necessary. It isnít an either/or issue. I wonít see migraine sufferers in my practice until theyíve had a medical evaluation first.
  • Migraine therapy isnít meant to cure migraines. At this point, there is no absolute cure. Migraine therapy is meant to help people understand their migraine picture as a whole ó triggers, daily life environment (including food, sleep, and stressors) ó while simultaneously focusing on the areas of psychoemotional history that may be relevant to each personís individual case. It also helps cope with the emotions of dealing with migraines. The overall aim is to reduce frequency and severity. There are no illusions of offering a cure.
  • The underlying cause of migraines is different from one person to the next. If the medical approach isnít working, psychoemotional history should be next in line. The more that can be understood about each personís migraine picture, the better.


I have spent more than 20 years working to resolve my own vicious, chronic migraines. Though nothing has been perfect, with a combination of various approaches, I have been able to go from three or four episodes per week (at its worst), to one or two episodes every six months. The more I was able to learn about myself, both inside and out, past and present, the more I was able to respond to both internal and external triggers. Some triggers were more concrete, and some were more psychoemotional. The more I learned, the more I could respond, and the more the episodes decreased in frequency and severity.

So with migraine therapy, I bring not only my education and experience as a psychotherapist, but my own experience. I wish I had a therapist who could have offered this combination treatment to me at the time. But Iím glad I can offer this to others who struggle now.

If the goal is to help migraine sufferers feel better, health care professionals should be working together. Competition only perpetuates the struggle.