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(PSYCHIATRIC TIMES) - The dialogue:

Primary care doctor: How can I best determine—and address—the cause of this patient's worsening headaches?

Headache specialist: The importance of a thorough headache history cannot be overestimated. In particular, I would ask about the circumstances that surround the onset of a headache.

Primary care doctor: My patient believes that her headaches worsened after a prolonged argument with her husband...

The development of migraine appears to be based on a cascade of events in susceptible persons that probably occurs as a result of many irritating processes that affect the brain and the peripheral nervous system.1-6 Many potential precipitants are easy to recognize. Known triggers include bright sunlight, persistent loud noise, missed meals, alcohol use, food sensitivities, and stress.







The stress that arises from a given situation may involve elements from several categories. Often, stressful situations involve relationships that have become unsatisfactory and that make the persons involved feel unsafe or overwhelmed. In general, stress triggers are more difficult to isolate and manage than other types of migraine triggers. They are often unique to a particular patient; that is, a situation that triggers a migraine attack in one patient would not necessarily precipitate a migraine attack in another patient.

Therapy may not change specific behaviors in a stressful life situation, but it can sometimes alter a patient's internal response to a triggering event. By learning to control her reaction to her husband's comments, your patient may be able to prevent her headaches.

Is there any particular type of psychotherapy that is more effective in helping patients manage migraine triggers?

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