Changes in Brain Function, Amygdalar Connectivity Drive Preventative Effect of CBT on Migraine

Brain outlined in girls head
The investigators observed greater brain activations in the frontal regions associated with cognitive regulation of pain after CBT.

The preventative effect of cognitive behavioral therapy (CBT) on migraine headaches in adolescents may be driven by changes in brain function and amygdalar connectivity with areas associated with nociceptive processing, cognitive function, and emotion regulation, according to the findings of a basic mechanistic study published in Headache.

The researchers noted that migraine treatments often focus on pharmacological approaches, although “placebo is as effective as commonly used drugs for migraine prevention.” While CBT has been shown to relieve pain in migraine, little is known about the potential mechanisms.

A total of 18 adolescents (mean age, 15.1±2.1 years; 15 women) with neurologist-diagnosed migraine were enrolled in this study. The study intervention consisted of 8 weekly sessions of CBT. To examine brain activation and resting-state connectivity in response to CBT, the investigators performed structural and resting-state blood-oxygen-level dependent contrast MRI scans in each patient prior to the first and after the last CBT session. Brain activation during the resting state was also assessed with arterial spin labeling. The left and right amygdala were chosen as seed regions for connectivity analyses. The researchers examined the associations between the time courses within the seed regions with voxels across the whole brain.

Approximately 83% of patients experienced a reduction in migraine frequency after CBT. The frequency of headaches from before CBT to after the last CBT session significantly decreased from 15±7.4 headaches per month to 10±7.4 per month, respectively (P <.001).

The investigators observed greater brain activations in the frontal regions associated with cognitive regulation of pain after CBT. Increased connectivity was also observed between the amygdala and front regions after CBT. There were noticeable associations between brain activation and amygdalar connectivity that corresponded with a headache frequency reduction.

Limitations of the study included the lack of a control intervention, as well as the small sample size of the migraine cohort. The researchers of this study suggested that future studies should “examine the effects of specific CBT components (eg, relaxation, cognitive restructuring/reappraisal, education) on neural function” in patients with migraine.

To conclude, the study authors stated, “The alterations in amygdalar connectivity with areas involved in cognitive control may be the mechanism underlying the preventive effect of CBT in migraine.”


Nahman-Averbuch H, Schneider VJ, Chamberlin LA, et al. Alterations in brain function after cognitive behavioral therapy for migraine in children and adolescents [published online April 23, 2020]. Headache. doi:10.1111/head.13814.