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Published on: June 2, 2014
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Pain Reprocessing Therapy for migraine: A case series
Joel N Fishbein1,2,3, Nathaniel M Schuster4, Alpha Anders4
1VA San Diego Healthcare System, San Diego, California, USA.
Headache
|August 27, 2025
Summary
Pain Reprocessing Therapy (PRT) shows promise for chronic migraine. This behavioral intervention reduced headache frequency and improved outcomes in three patients refractory to standard treatments.
Area of Science:
- Neurology
- Behavioral Medicine
- Pain Management
Background:
- Migraine is a leading cause of disability with limited treatment options for refractory patients.
- Emerging models suggest learned threat associations contribute to migraine pathophysiology.
- Pain Reprocessing Therapy (PRT) targets these learned associations in chronic pain.
Purpose of the Study:
- To investigate the efficacy of PRT for chronic migraine.
- To present the first case series of PRT in patients with chronic migraine.
- To explore PRT as a potential treatment for migraine refractory to standard care.
Main Methods:
- Three individuals with chronic migraine and inadequate response to standard treatments underwent PRT.
- PRT involved education on neuroplastic pain and guided somatic tracking.
- Treatment was delivered by a physician over multiple sessions.
Main Results:
- All three patients experienced significant reductions in headache frequency.
- Patients reported clinically meaningful improvements in pain intensity and function.
- Case examples show dramatic decreases in headache days and medication use.
Conclusions:
- PRT may be a relevant, mechanistically informed behavioral intervention for migraine.
- This case series is the first to document PRT for migraine.
- Further controlled studies are needed to validate PRT's effectiveness in migraine.
