What to Expect in Therapy for Migraines: A Lee’s Summit Therapist’s Perspective
You've decided to try therapy for your migraines. That's a big step, especially if you're skeptical that talking to someone could possibly help with physical pain.
So what actually happens in migraine therapy? How is it different from regular counseling? And what should you expect in those first few sessions?
At Aspire Counseling, we specialize in Counseling for Chronic Pain including chronic migraines. Our approach to migraine therapy is different from traditional talk therapy. It's focused, skill-based, and addresses the nervous system patterns that keep migraines stuck.
Here's what to expect.
What Happens in My First Migraine Therapy Session?
Your first session is a consultation to make sure your therapist is a good fit. The next couple of sessions are what we call assessment sessions. First, your therapist will ask a lot of general questions about your life. This helps set the scene and gives us the main “characters” of your life. By knowing the basics of your story, we won’t have to stop you to ask a lot of questions when we get to work treating your migraines.
Then, your therapist will start asking questions about migraines specifically. Here, they’re trying to develop a treatment plan and decide which interventions will be most helpful to you.
We start by asking about your specific experience with migraines:
When did they start?
How often do they happen?
What does a typical migraine look like for you?
How long do they last?
What makes them better or worse?
We also want to know what you've already tried. Medications, trigger elimination, lifestyle changes, supplements—all of it. This isn't about proving you've done "enough." We just need to understand what's worked, what hasn't, and what patterns you've already noticed.
Then we explore the mind-body connection in your situation.
This is where things get interesting.
Does stress affect your migraines? Do they get worse when you're anxious or after emotional experiences? Are there times when migraines seem to come out of nowhere, or times when you expected one and didn't get it?
These questions help us understand how much of your migraine pattern has a nervous system component. And that tells us how to focus our work together.
We'll also talk about your goals. Some people want their migraines to disappear completely. Others would be happy to reduce frequency from three times a week to once a month. Some just want to stop being terrified of the next one. All of these are valid goals.
Your first 4-8 sessions should leave you feeling heard and hopeful. You should understand why we think therapy can help your specific situation. And you should have a sense of what we'll be working on together.
How Do You Track Migraine Patterns Without Making Them Worse?
You've probably tried tracking your migraines before. And it might have made you more anxious, not less. You become hypervigilant, constantly scanning your body for warning signs.
We approach tracking differently.
Instead of tracking with fear—trying to control everything, afraid you'll miss something—we track with curiosity. We're gathering information, not trying to prevent every possible migraine.
Here's what that looks like:
We pay attention to what happens before migraines. Not just the obvious triggers like wine or bright lights. We're looking at stress levels, sleep quality, emotional experiences, even good things that might activate your nervous system.
We notice patterns without judgment. If you get a migraine after visiting family, we're not saying "family is bad for you." We're noticing that maybe there's something about those interactions—holding tension, not speaking up, trying to keep everyone happy—that affects your nervous system.
We look at the bigger picture. One bad night of sleep might not trigger a migraine. But poor sleep plus a stressful week plus skipping meals plus bright office lights? Now we're seeing how things add up.
We welcome what we find. Sometimes people discover that migraines happen after particularly good days, because they've been holding tension to keep everything perfect. Or after they finally relax, because their nervous system doesn't know how to shift gears. These discoveries are valuable, not shameful.
The goal isn't to create a long list of things you can't do. It's to understand your nervous system well enough to work with it instead of against it.
What Techniques Do Therapists Use for Migraines?
Migraine therapy is much more active and skill-based than traditional talk therapy.
You'll learn specific techniques including:
Somatic tracking - This means paying close attention to sensations in your body without immediately interpreting them as dangerous. When you feel pressure behind your eyes, instead of thinking "oh no, here it comes," you practice noticing: "There's pressure. It's moving. Now it's shifting." This interrupts the fear response that often escalates a sensation into a full migraine.
Nervous system regulation - We teach you specific ways to help your nervous system shift out of high alert. Deep breathing techniques, gentle movement, even how you talk to yourself in moments of stress. These aren't just nice ideas—they directly affect your physiology.
Working with parts - You probably have a part that's terrified of migraines, a part that's angry they keep happening, a part that tries to push through anyway. We help these parts work together instead of against each other. When your internal system stops fighting, your physical system often calms down too.
Reframing sensations - Your brain has learned that certain sensations mean "migraine coming." We help you teach it something different. This doesn't mean ignoring warning signs. It means not letting every tension headache turn into a migraine because you panicked.
Between sessions, you'll practice. This isn't homework in the traditional sense. It's more like experiments. "What happens if I notice tension without immediately fearing a migraine?" "Can I help my nervous system settle when I feel stressed?"
The learning happens in the practicing, not just in our sessions together.
How Long Does Migraine Therapy Take to Work?
This is always the first question people want answered. And it's the hardest to answer precisely.
Some people notice changes quickly. Within the first few weeks, you might feel less afraid of migraines. You might catch yourself in the fear spiral and interrupt it. You might have a migraine that's less intense than usual. These early changes are real and meaningful.
But sustained improvement usually takes time. Most people work with us for 2-4 months before they see significant reductions in migraine frequency. If you've had chronic migraines for years, it might take 6 months or more for your nervous system to fully shift into new patterns.
Progress is rarely linear. You might have three great weeks, then two migraines in one week. That doesn't mean therapy isn't working. It means your nervous system is in a process of change. Each time you respond differently to a migraine—with less fear, with more tools—you're reinforcing new patterns.
The goal isn't always zero migraines. Sometimes the most meaningful change is that migraines stop controlling your life. You still get them occasionally, but you're not constantly afraid. You make plans without the "what if I get a migraine" anxiety. That shift in your relationship to migraines is itself a major win.
We'll check in regularly about what you're noticing. If you're not seeing any benefit after 8-10 sessions, we'll talk honestly about that and adjust our approach.
Can I Do Migraine Therapy Online in Missouri?
Yes. And for many people, online therapy for migraines works even better than in-person.
Here's why online migraine therapy is effective:
The work we do is about learning new skills and changing patterns. You don't need a therapist to physically touch you or be in the same room. You need to learn how to work with your nervous system, and that translates perfectly to video sessions.
Online therapy removes barriers. When you're dealing with migraines, getting dressed, driving to an office, and sitting in a waiting room can feel overwhelming. Online sessions mean you can connect from your own comfortable space. If you're having a tough pain day, you can still keep your appointment.
You can practice in real-time. If you're experiencing early migraine symptoms during a session, we can work with that directly. I can guide you through techniques while you're actually experiencing the sensations. This is often more effective than describing it later.
We serve clients throughout Missouri via secure, HIPAA-compliant video. You'll need a private space, reliable internet, and a device with a camera and microphone. That's it.
Many of our clients actually prefer online therapy for migraine treatment because it's more accessible and practical when you're in pain.
Ready to Start Migraine Therapy?
You don't have to keep living in fear of the next migraine. Therapy can help you understand and change the patterns keeping them stuck.
Migraine counseling in Lee's Summit and online throughout Missouri - We offer in-person sessions at our Lee's Summit office and virtual appointments for clients anywhere in Missouri.
Schedule your free consultation by contacting us online or calling us at 573-328-2288.
This article was written by the clinical team at Aspire Counseling, a therapy practice in Lee's Summit and Columbia, Missouri, specializing in chronic pain, anxiety, and trauma. Our therapists use evidence-based approaches including Internal Family Systems (IFS), Pain Reprocessing Therapy (PRT), and mindfulness-based interventions to help clients with chronic migraines. Available in person in Lee's Summit and online throughout Missouri.
