How Pain Reprocessing Therapy Can Help With Migraine

Our understanding of pain continues to evolve. We now recognize that there are different types of pain. For one, there is structural pain, which is what we typically think of when we injure ourselves and cause tissue damage in the body. However, there is also non-structural pain, which occurs when the brain mistakenly interprets normal, safe signals as threatening, even when there is no ongoing tissue damage causing the pain. This is often referred to as neuroplastic pain. Many chronic pain conditions appear to involve significant neuroplastic components.

One fascinating aspect of pain is that the brain can learn to anticipate it. Generally, the brain is constantly making predictions and filtering our experiences through a “top-down” lens. As a result, situations that have frequently been associated with pain in the past can begin to trigger pain responses in the present. Pain functions as the body's alarm system, signaling us to stop, avoid, or pay attention to potential threats.

Migraine is a neurological condition that often leads to head pain and can be either episodic or chronic (occurring 15 or more days per month). As anyone with migraine can tell you, a migraine attack involves far more than head pain. People may also experience sensory sensitivities, gastrointestinal symptoms, cognitive difficulties, emotional symptoms, and muscle stiffness. Although migraine remains an active area of research, evidence suggests that the nervous system of someone with migraine can become hypersensitive, lowering the threshold at which certain internal cues (such as hunger or fatigue) and external cues (such as weather changes) may contribute to an attack. Over time, some of these cues can become strongly associated with migraine, leading people to become increasingly vigilant about them. This can create a cycle in which fear, anticipation, and stress amplify the body's alarm response and contribute to ongoing suffering.

Recently, researchers have identified an important protein involved in migraine called Calcitonin Gene-Related Peptide (CGRP). CGRP naturally occurs in the body and acts as a chemical messenger. It helps regulate blood flow, protects cardiovascular tissue, and transmits sensory and pain-related signals. Research suggests that CGRP plays an important role in migraine pathophysiology. During a migraine attack, elevated CGRP levels are observed, and CGRP signaling is thought to contribute to pain transmission within the trigeminovascular system. Specifically, nerve endings around the brain release high levels of CGRP, which leads to inflammation, widening of blood vessels in the meninges (the membranes surrounding the brain), and intense pain signaling via the trigeminal nerve. This discovery has recently led to the development of several effective migraine medications that target CGRP directly.

The way someone responds to their symptoms can influence their experience of them. When a person with migraine begins to catastrophize symptoms, stress and anxiety often increase. This heightened stress response can amplify pain perception, increase distress, and make symptoms feel more overwhelming. The physical discomfort then feeds back into the brain, reinforcing fear and catastrophic interpretations, which can further perpetuate the cycle.

Taken together, these findings suggest that people with migraine may develop powerful threat associations around certain bodily sensations, environmental triggers, and symptoms. Current behavioral therapies aim to help individuals "turn down the volume" on these alarm responses and reduce the fear associated with them. One such treatment that has gained increasing attention is Pain Reprocessing Therapy (PRT), a behavioral intervention designed to address neuroplastic pain. A core technique in PRT is Somatic Tracking: mindfully observing sensations while reminding oneself that these sensations are not necessarily indicators of danger and can often be experienced safely.

To date, PRT has the strongest clinical evidence for chronic low back pain. More recently, a small case series investigated the use of PRT in three individuals with chronic migraine (Fishbein et al., 2025). The results were encouraging, with migraine frequency decreasing from 18–30 headache days per month to approximately 3–5 days per month. Participants also reported reductions in pain, decreased reliance on medication, and improvements in other chronic pain symptoms. While these findings are preliminary and larger controlled studies are needed, they suggest that PRT may hold promise as an additional treatment option for some people with chronic migraine. As someone who has experienced migraine since early childhood and has tried many abortive and preventive medications, I have personally found these approaches helpful in managing my symptoms more effectively.

Fortunately, I was able to become certified in PRT. If you are seeking help with chronic pain and would like to learn more about this approach, please feel free to contact me to discuss whether it may be a good fit for you.