Inadequate medical care and lack of Migraine information can set us up for a thinking pattern called catastrophizing. An estimated 25% of people with chronic Migraine struggle with catastrophizing. When Migraine attacks are out of control, it’s understandable how this pattern of thinking can take hold of our lives.
The term “catastrophizing” comes from the cognitive model of psychotherapy. In this theory, catastrophizing is one of several cognitive distortions that can negatively impact emotion and behavior. In simple terms, it’s a pattern of thinking that promotes negative feelings and self-sabotaging behaviors. It’s the habitual imagining the worst possible outcome from any unpleasant experience that can feel uncontrollable. In fact, the longer it goes on, the harder it is to break out of this thinking pattern.
Some examples of catastrophizing include:
- Thinking we’ve been misdiagnosed and really have life-threatening brain disease the doctors have missed
- Thinking we’re going to die from a Migraine attack even if it’s a typical one
- Fearing the ER is going to treat us like drug seekers when we’ve never been or had only a few bad experiences
- Believing all medications cause dangerous, intolerable side effects
- Believing nothing can help Migraine
- Convinced that everyone thinks we’re faking without evidence
- Convinced that everyone thinks we’re crazy without evidence
- Believing that no doctor can or wants to help us
Sometimes our worst fears really happen, so not every negative prediction that pops into our heads is a problem. The trouble comes when we get stuck in the habit of thinking the worst every time we are faced with an unpleasant experience. Let’s face it, Migraine attacks are seriously unpleasant, downright painful, and sometimes excruciating. There’s a big difference between a realistic assessment of potential outcomes and obsessive worry that everything will fall apart all the time
Why it matters
This mental anguish is linked to many negative outcomes for Migraine patients. A 2007 study published in Cephalagia2 concluded that catastrophizing is associated with poorer quality of life and impaired functioning of people living with migraine when compared with migraine patients who do not catastrophize.
A more recent study published in the July, 2015 issue of Headache1 supported the earlier conclusions after exploring the occurrence of catastrophizing among women with migraine who were seeking weight loss treatment at an outpatient headache clinic.
Both studies concluded that a long-term pattern of catastrophizing is associated with:
- Higher attack frequency
- Longer attack duration
- Higher prevalence of allodynia
- Poor treatment response
- Increased rates of depression
- Increased rates of anxiety
- Decreased self-efficacy
- Greater levels of disability
- Poorer doctor-patient relationships
- Higher body mass index (BMI)
- Lower quality of life
- Four times greater risk of developing Chronic Migraine
What we can do about it
Catastrophizing isn’t a character flaw or moral weakness. It’s simply a pattern of thinking that can create misery our lives. The thoughts come racing in, no matter how hard we try to suppress them. We may have tried to stop on our own and failed.
The good news is that there are effective treatments to break the cycle of catastrophizing and give us a greater sense of control over Migraine. By seeking treatment, we lower our risk of worsening Migraine and improve our quality of life. The best treatment for catastrophizing is cognitive behavioral therapy (CBT). Almost any licensed mental health provider can offer CBT. However, the best results are achieved by working with one who specializes in behavioral pain management and understands Migraine. Ideally, our therapists should work closely with our Migraine specialists to coordinate our care.
Where to find a therapist
1Bond, D, Buse, D, et al. (May 2, 2015). Clinical Pain Catastrophizing in Women with Migraine and Obesity, Headache. July 2015; 55(7): 923-933. doi: 10.1111/head.12597
2Holroyd, K, Drew, J, et al (May 26, 2007). Impaired functioning and quality of life in severe Migraine: the role of catastrophizing and associated symptoms, Cephalalgia, 2007(27): 1156-1165, doi:10.111/j.1468-2982-2007-01420.x.