CBT Provides Relief for Injury-related Migraines

A small but extremely impairing condition we see among injured workers is migraine headaches. As anyone who has had a migraine knows, these can be debilitating.

• Are migraines a common complaint you hear from injured workers?
• Are they associated with any particular injuries?
• What treatments do you see approved for them?

As is the case with other chronic pain conditions, these migraines are often exacerbated by psychosocial issues that are present along with the original injury. Cognitive behavioral therapy (CBT) can provide tremendous relief for injured workers suffering with them.

Psychosocial Factors and Migraines
Two of the most prominent psychosocial risk factors — catastrophizing and kinesiophobia, (fear of moving) are associated with both migraine headaches and temporomandibular disorders (TMD), or pain related to the jaw area. Similar to fear-avoidant behavior, kinesiophobia is a condition in which the person believes movement will cause additional injury and pain.

While chronic migraines and TMD are different in many ways, research shows an interesting connection in terms of the two particular psychosocial risk factors. In a study comparing 20 women with chronic migraines (CM), 19 with chronic TMD, and 20 healthy volunteers “no differences were observed in pain catastrophizing and kinesiophobia between women with CM and with chronic TMD,” it said. However, “women with CM or chronic TMD showed higher levels of pain catastrophizing than asymptomatic subjects.”

This study is yet another example of the potential impact of psychosocial risk factors on injuries. Catastrophizing and fear-avoidant behavior are often responsible for delayed recoveries among injured workers. These creeping catastrophic claims, as they are often called, start with seemingly minor injuries that are expected to heal and be off the books in a relatively short period of time. As we see all too often in workers’ compensation, these claims can take on a life of their own and include multiple medical treatments and medications, all of which are unsuccessful.

Treating injured workers with migraine headaches can be challenging for a number of reasons. First, medical science is not clear on exactly what causes migraines. Also, as with most chronic conditions, there are no cures; just treatments for the symptoms. Finally, it is difficult to assess whether a headache is actually work related.

An estimated 28 million Americans may have migraines that affect their ability to work. Fortunately, there are just a handful of work-related injuries that are typically associated with migraines, and we have treatment protocols for them.

Injured Workers and Migraines
The most common migraines associated with work injuries are cervicogenic — related to a neck injury; and concussion — related to head trauma. Several particular diagnoses may involve migraines. They are treatable with CBT.

Concussion/mild traumatic brain injury. This type of injury occurs from a blow or jolt to the head and can change the way the brain works. The types of issues that cause these among injured workers include motor vehicle accidents and falls.

These injuries are classified as ‘mild’ if a loss of consciousness or confusion/disorientation lasts less than 30 minutes. Often these are not even apparent on MRIs or CAT scans, even though they can cause severe problems for the injured worker and those around him. Along with migraines, typical symptoms include difficulty thinking and remembering, attention deficits, sleep disturbances, dizziness, mood swings and frustration. The symptoms may not appear for days or even weeks after the incident.

Most people who sustain a concussion or mild TBI recover within three months. Some injured workers, especially those with psychosocial risk factors such as catastrophizing and fear-avoidant behavior, suffer for longer periods. Some have the symptoms for a year or more.

Failed back surgery syndrome. Despite its name, this is actually a generalized term that describes patients who continue to have pain following back surgery. Spine surgery is typically successful only to decompress a nerve root that is pinches or to stabilize a painful joint. In many cases, back surgery does not relieve pain and may even increase it.

Along with migraine headaches, symptoms often include dull and aching pain in the back, neck or legs. Injured workers may also feel a sharp, burning or stabbing pain in the extremities.

Complex regional pain syndrome. This chronic condition typically affects one limb following an injury. Injured workers who experience it say it feels like a burning or ‘pins and needles’ sensation, or as if someone were squeezing the affected area. Some injured workers also experience changes in skin color, temperature, or swelling in the affected area. Migraines are also common side effects.

Because of the way the brain and nervous system function, the pain often extends out beyond the original site. It can also travel to the limb on the opposite side of the body.

Researchers have speculated the syndrome is caused by problems of the peripheral and central nervous systems. The central nervous system includes the brain and spinal cord, while the peripheral nervous system involves nerve signals from the brain and spinal cord sent to the body.

Phantom limb pain. This refers to pain in a limb that has been surgically removed, such as a leg, arm or breast. The pain typically occurs shortly after surgery.

The pain experience from this varies from person to person, and has been described as:
• Burning.
• Shooting.
• Like “pins and needles.”
• Twisting.
• Crushing.
• Like an electric shock.

Injured workers also say they experience sensations such as temperature, pressure, vibration, itchiness and movement from the missing body part.

While medical researchers are not sure of the cause, one strong theory is that it is part of the brain’s rewiring after it loses signals from the missing limb. Just as a pain signal is sent to the brain when part of the body experiences a perceived threat, the affected area around the missing limb senses that something is wrong and sends a signal to the brain.

Conclusion
Migraine headaches are somewhat common among injured workers with specific diagnoses. They are chronic and must be treated as such. Several aspects of CBT, such as biofeedback, are especially helpful for these injured workers.

We’d like to hear from you:

• Are migraines a common complaint you hear from injured workers?
• Are they associated with any particular injuries?
• What treatments do you see approved for them?

Please share your thoughts with us.

Integrated Medical Case Solutions (Ascellus) is a national network of Health Providers in Psychology that delivers cognitive behavioral therapy (CBT) for chronic pain, trauma and insomnia across the country for the workers’ compensation industry.

For additional information, contact us at https://theimcsgroup.com, or http://www.cope-with-pain.com. Please join our LinkedIn group, COPE with Pain at https://www.linkedin.com/groups/8540640