Psychological therapy for migraine and chronic headache, online in Washington

How migraine relates to stress, sleep and the nervous system

Stress and sleep are the triggers that people with headache name most often. A 2018 meta-analysis in Cephalalgia by Pellegrino and colleagues pooled 85 survey studies of people with migraine or tension-type headache, covering 27,122 people, and on average 58% named stress as a trigger and 41% named sleep.

Stress and migraine also move together over time. In a 2015 population study in Cephalalgia by Schramm and colleagues, 5,159 adults aged 21 to 71 reported their stress and headaches every three months from 2010 to 2012. Among those with migraine, each 10-point rise on a 100-point stress scale went with 4.3% more headache days a month.

Sleep is part of the picture too: a 2021 meta-analysis in Neurology by Stanyer and colleagues found worse self-reported sleep quality in adults with migraine than in people without it. A 2021 review in The Journal of Headache and Pain by Stubberud and colleagues noted that stress may make the nervous system more sensitive over time, and it concluded that stress-focused behavioral therapies should be offered alongside conventional treatment. Stress and sleep are things you can work on, and that is where psychological treatment comes in.

What psychological treatment for headache involves

Psychological treatment for headache works on what you can influence between attacks: stress, sleep, the feelings and pressures that build up around headaches, and how much they get in the way of daily life. Your physician or neurologist diagnoses the type of headache, rules out other causes and manages any medicines, and our work adds to that care. With a release of information signed by you and your providers, I keep your physician, neurologist and other providers updated on our work.

Working closely with physicians is familiar ground for me. I was formerly an Acting Assistant Professor in Family Medicine at the University of Washington, working in primary care behavioral health.

What the research says about therapy for migraine

Psychological treatment has a recognized place in migraine care. The American Headache Society's 2021 consensus statement in Headache, by Ailani and colleagues, describes cognitive behavioral therapy (CBT), biofeedback and relaxation therapies as effective preventive treatments for migraine. It lists their goals as fewer and milder headaches, less disability, more personal control and less distress, and it notes that they can be used alone or alongside medication, with the combination possibly working better than either one. The 2026 guideline from the American Academy of Neurology and the American Headache Society also calls lifestyle and trigger management essential alongside medication.

How I work with migraine and chronic headache

I lead with Emotional Awareness and Expression Therapy (EAET), which I trained in with its co-developers, Mark Lumley and Howard Schubiner. I also draw on attachment-oriented psychodynamic therapy as each person's pattern calls for, and I use Pain Reprocessing Therapy for other forms of chronic pain.

EAET helps people work through unresolved conflict by recognizing and expressing emotions they have learned to avoid, such as anger, guilt and grief. In a 2026 article in Psychotherapy Bulletin, I described how persistent physical symptoms can be read as the nervous system signaling danger, and how avoided feelings tied to relationships, conflict, loss or anger may surface in the body.

Migraine and headache pain is real, and it can be debilitating and deeply frustrating, especially when medication and other treatments have not brought the relief you hoped for. In my clinical work I have seen how, for some people, a headache comes on just as a strong feeling is rising, such as frustration or disappointment when someone has let them down, and the pain then crowds out the feeling. Emotions are not the only thing behind headaches, but when they play a part, this work can help. Together we look at when your headaches began, what tends to happen before an attack and what was going on in your life and relationships at those times, and we notice what happens when feelings such as anger, guilt and grief come up. When a connection shows itself, we practice noticing those feelings, feeling them fully and putting them into words, so that they no longer have to stay held back. Alongside this work, we also look at sleep, diet, exercise and everyday stress.

EAET's roots in headache research go back to a 2013 randomized trial by Slavin-Spenny and colleagues, in which a short precursor of EAET, anger awareness and expression training, reduced headache days in college students with frequent headaches. In 2026, Kaufmann and colleagues, a team that includes EAET's co-developer Mark Lumley, published the first randomized trial of EAET specifically for migraine, in Pain Medicine. In other chronic pain, EAET reduced pain more than CBT in a 2024 randomized trial.

Attachment-oriented psychodynamic therapy informed by ISTDP (intensive short-term dynamic psychotherapy) looks at the longer patterns behind the pressure, such as self-criticism, perfectionism and the habit of overriding the body's signals to keep performing. I use it to understand the person behind the headaches. I trained in ISTDP with Allan Abbass and Joel Town, and Abbass and colleagues described this way of identifying and working with the emotional factors in chronic headache in a 2008 review in Cephalalgia.

Headache signs that need emergency care

A few headache signs need emergency care before anything else. Call 911 or go to the nearest emergency department if you have a headache and any of the following applies, as listed on the UK National Health Service's headaches page:

• You have had a seizure (fit).
• You have numbness or weakness in the body or face.
• The headache started suddenly and is extremely painful.
• You have had a head injury within the last 3 months.
• You are finding it difficult to speak, balance, walk or remember things.
• You are drowsy or confused.
• You have loss of vision.
• You have a rash that does not fade when a glass is rolled over it.
• You have a very high temperature, a stiff neck, or bright lights are bothering you.

The same NHS page lists other headache signs that call for a prompt visit to your physician.

Fees and format

Sessions are by secure video anywhere in Washington or in person on Fridays at my Lynnwood office. The practice is private pay and does not bill insurance; an initial consultation is $325 for 60 minutes, ongoing sessions are $265 for 60 minutes, and full details are on Services and fees.

Questions about therapy for migraine and headache

Which therapy is best for migraines?

Several psychological therapies help prevent migraine. The American Headache Society describes relaxation training, biofeedback and cognitive behavioral therapy (CBT) as effective preventive treatments. Emotion-focused methods such as EAET are now being studied in migraine as well, beginning with the first randomized trial of EAET for migraine in 2026. The right fit depends on your pattern of attacks, what you have already tried and the kind of work that suits you, and a discovery call is a good place to talk it through.

What should chronic migraine sufferers do?

There is a lot that can help with chronic migraine. A physician or neurologist can confirm the diagnosis and offer preventive treatment. The 2026 guideline from the American Academy of Neurology and the American Headache Society says physicians should offer it when migraine occurs on 4 or more days a month, and it calls lifestyle and trigger management essential alongside medication. Psychological treatment can be one part of that plan.

How can I get rid of chronic migraines?

Begin with a treatment plan built with your physician, who can confirm the diagnosis and offer preventive treatment. Psychological treatment can be added to that plan, and the American Headache Society describes the goals of behavioral treatments such as CBT, biofeedback and relaxation as fewer and milder headaches, more personal control and less distress.

How to stop getting migraines every day?

Daily headaches deserve a careful medical look, and your physician can identify the type of headache and what is driving it. Chronic migraine and chronic tension-type headache both involve headache on 15 or more days a month for more than 3 months, according to the International Classification of Headache Disorders. With a diagnosis in hand, psychological treatment can work alongside your physician's plan.

How do I know if my pain is psychological?

Migraine is a neurological condition, and its pain is real. Your physician's evaluation tells you what kind of headache you have, and stress and sleep are linked with how often attacks come. Those links are what psychological treatment works on.

Book a free discovery call

Book a free discovery call to talk about whether therapy could fit alongside your headache care. It is a short conversation, with no obligation, about what is going on and how I work.

References

Abbass, A., Lovas, D., & Purdy, A. (2008). Direct diagnosis and management of emotional factors in chronic headache patients. Cephalalgia, 28(12), 1305–1314. https://doi.org/10.1111/j.1468-2982.2008.01680.x

Ailani, J., Burch, R. C., Robbins, M. S., & Board of Directors of the American Headache Society. (2021). The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice. Headache, 61(7), 1021–1039. https://doi.org/10.1111/head.14153

Headache Classification Committee of the International Headache Society. (2018). The International Classification of Headache Disorders, 3rd edition. Cephalalgia, 38(1), 1–211. https://doi.org/10.1177/0333102417738202

Jin, J. (2026, July). Danger, not damage: Attachment, emotion, and the somatic language of relational threat. Psychotherapy Bulletin, 61(4). https://societyforpsychotherapy.org/danger-not-damage-attachment-emotion-and-the-somatic-language-of-relational-threat/

Kaufmann, D., Sturgeon, J. A., Mirow, S., Zinkhan, G., Schlesinger, N., Yarns, B. C., Kommit, K., Miller, A., & Lumley, M. A. (2026). Emotional awareness and expression therapy for migraine: A preliminary randomized controlled trial. Pain Medicine, 27(8), 948–951. https://doi.org/10.1093/pm/pnag034

National Health Service. (2024, April 17). Headaches. NHS. https://www.nhs.uk/conditions/headaches/

Pellegrino, A. B. W., Davis-Martin, R. E., Houle, T. T., Turner, D. P., & Smitherman, T. A. (2018). Perceived triggers of primary headache disorders: A meta-analysis. Cephalalgia, 38(6), 1188–1198. https://doi.org/10.1177/0333102417727535

Potrebic, S., Tanveer, S., Becker, W. J., Burch, R., Cooke, L. J., Fenton, T., Fletcher, J. J., Gordon Perue, G. L., Hershey, A. D., Jackson, J. L., Kessel, S., Loder, E. W., Minen, M. T., Oskoui, M., Ramanan, V. K., Murren, M., Schwedt, T. J., Silberstein, S. D., Smith, D. B., . . . Pringsheim, T. (2026). Pharmacologic treatment for migraine prevention in adults practice guideline recommendations: Report of the AAN Guidelines Subcommittee and the American Headache Society. Neurology, 107(7), e214881. https://doi.org/10.1212/WNL.0000000000214881

Schramm, S. H., Moebus, S., Lehmann, N., Galli, U., Obermann, M., Bock, E., Yoon, M. S., Diener, H. C., & Katsarava, Z. (2015). The association between stress and headache: A longitudinal population-based study. Cephalalgia, 35(10), 853–863. https://doi.org/10.1177/0333102414563087

Slavin-Spenny, O., Lumley, M. A., Thakur, E. R., Nevedal, D. C., & Hijazi, A. M. (2013). Effects of anger awareness and expression training versus relaxation training on headaches: A randomized trial. Annals of Behavioral Medicine, 46(2), 181–192. https://doi.org/10.1007/s12160-013-9500-z

Stanyer, E. C., Creeney, H., Nesbitt, A. D., Holland, P. R., & Hoffmann, J. (2021). Subjective sleep quality and sleep architecture in patients with migraine: A meta-analysis. Neurology, 97(16), e1620–e1631. https://doi.org/10.1212/WNL.0000000000012701

Stubberud, A., Buse, D. C., Kristoffersen, E. S., Linde, M., & Tronvik, E. (2021). Is there a causal relationship between stress and migraine? Current evidence and implications for management. The Journal of Headache and Pain, 22(1), 155. https://doi.org/10.1186/s10194-021-01369-6

Yarns, B. C., Jackson, N. J., Alas, A., Melrose, R. J., Lumley, M. A., & Sultzer, D. L. (2024). Emotional awareness and expression therapy vs cognitive behavioral therapy for chronic pain in older veterans: A randomized clinical trial. JAMA Network Open, 7(6), e2415842. https://doi.org/10.1001/jamanetworkopen.2024.15842