A Therapist’s Take on Pain Reprocessing Therapy for Migraine

OK, before we get into this, I need you to know a couple of things. One is that I’ve lived with migraine for more than a decade, and have tried many diets/supplements/treatments that were “guaranteed” to “fix” my migraine. So I understand any hesitation you may have in reading this article. Second, despite being a therapist myself, I absolutely hated Pain Reprocessing Therapy (PRT) when I first learned about it. I felt invalidated and minimized. I tried reading The Way Out by Alan Gordon (the creator of PRT), but I didn’t get very far. How could someone say that the way to get out of the debilitating, life-shrinking, earth-shattering pain I was in was to RELAX and NOT TAKE IT TOO SERIOUSLY?! Get real. (Now I know there’s more to PRT than this, but this is what this book seemed to be saying to me back then.)

I came back to PRT solely to make sure I was offering my psychotherapy clients comprehensive care. If this could benefit any of my clients with migraine or other chronic pain, that was reason enough to learn more, regardless of my own feelings. So, I signed up for Alan Gordon’s training on PRT for clinicians. 

Surprisingly, one week into the training, I was on board. I understood the hype and was even excited to learn more about it. 

And even MORE shockingly, PRT ultimately changed my relationship to pain — and has done the same for many of my clients. I was hesitant to admit it, but the difference in my life speaks for itself. Now I can go to the beach for weeks at a time and spend hours in the sunlight, things I NEVER thought possible a couple of years ago. I have clients who used to travel, drive, see friends, and now are finally back to doing that after PRT. They are now living in ways that THEY never thought would be possible. 

As a psychotherapist and licensed clinical social worker specializing in migraine, I want to give you my clinical thoughts on this modality and why it can be beneficial for those of us with migraine. It may not be a good fit for everyone, and I recommend consulting with your medical team before trying something like PRT.

What Exactly is Pain Reprocessing Therapy?

So, the basics: Pain Reprocessing Therapy is a mind-body treatment based in neuroscience. It’s an evidence-based, therapeutic system of psychological techniques that helps retrain the brain to break the cycle of chronic pain.¹ PRT has two main goals: accurately identifying and responding to what’s happening in the body, and building more safety and regulation in the body.¹

To determine whether Pain Reprocessing Therapy could be helpful for you, it’s important to understand the difference between structural pain and non-structural pain, also known as neuroplastic pain.^2,3 Structural pain includes things like tissue damage or a fracture. While PRT does not eliminate structural pain, it can help with the emotional aspects (i.e., anxiety and fear) of dealing with pain. On the other hand, neuroplastic pain occurs when the brain mistakenly interprets normal, safe signals as threatening, producing pain even in the absence of actual damage. Imagine a smoke detector that detected a big fire a month ago and is now really sensitive. Now, if someone lights a match two houses away, the smoke detector goes off, alarm blaring and lights blinking. The smoke detector is trying to keep you safe, but there’s no actual danger — the neighbors are just trying to light a candle! This is what happens in our nervous systems with neuroplastic pain. When we spend a lot of time experiencing pain, the brain gets really good at anticipating that something COULD cause pain. Even moments that are not actually dangerous, like walking into a brightly lit room when lights have often triggered migraine attacks in the past, can still trigger the release of pain signals.

Neuroplastic pain comes from the concept of neuroplasticity — the idea that our brains can adapt and learn new skills throughout our entire lives. This is great when we want to learn to speak French at age 18, but not so great when our brain starts learning to be in pain when it doesn’t need to be. Neuroplastic pain occurs for various reasons, and understanding why it happens allows us to unlearn those patterns. 

Here’s what’s different about PRT: It’s not just about coping with symptoms. PRT asks, ‘Where is this pain coming from?’ and helps you understand how the brain creates and sustains pain through misinterpreted signals.⁴ Research shows that learning about pain can reduce pain, improve function and reduce disability.⁵

PRT also helps you identify your personal triggers, factors that may exacerbate pain, and factors that may reduce pain. The PRT model then teaches you skills to feel safer in your body, even when unpleasant sensations occur. It includes self-regulation, mindfulness, and other techniques to support both body and mind.

PRT can help you uncover cognitive patterns that may be keeping your brain stuck in “danger mode” (keeping the smoke detector alarm turned on in your brain, sending out pain signals to the body that might not be necessary). Fear, urgency, perfectionism, self-criticism, and any other factors that keep your system on high alert can all serve as fuel to keep that alarm system on. 

How Does Pain Reprocessing Therapy Help Migraine?

When we apply this theory to migraine, we think about sensitization. We know that even a few bad migraine attacks can cause sensitization, which can lead to more attacks and increased sensitivity to triggers.⁶ This is the same concept that PRT employs. Learned sensitization means that there is a capacity for learned desensitization. 

When PRT works, that doesn’t mean the pain wasn’t real — it means it was a different kind of pain than you and your medical team were treating before. Our healthcare system primarily still treats pain from a biomedical standpoint (focusing on the biological and physical, aka medications and surgeries — very important, but not always the full picture!) Even though we have incredibly compelling research around neuroplastic pain treatment, we are deeply behind on the neuroplastic pain front.

While research on Pain Reprocessing Therapy (PRT) for migraine is still very limited, it has been used successfully for other pain conditions such as back pain, neck pain, and fibromyalgia. One small study looked at PRT for migraine in three people with chronic migraine who had not improved with standard preventive or acute treatments and also had other pain conditions.⁷ After completing PRT sessions, all three experienced significant improvements, reducing their migraine days from 18–30 per month down to just 3–5.⁷ They also reported less pain, used fewer medications, and noticed improvements in their other pain conditions.⁷ I hope that future studies will be conducted, as these results are very promising. 

So if you’ve tried multiple medications and treatments and have not found relief, Pain Reprocessing Therapy might be a missing piece for you. 

References

1. “Pain Reprocessing Therapy (PRT): Break Free from Chronic Pain.” Pain Reprocessing Therapy Center, 27 Feb. 2025, www.painreprocessingtherapy.com/.
2. Song, Qingbiao, et al. “Neuroplasticity in the transition from acute to chronic pain.” Neurotherapeutics, vol. 21, no. 6, Oct. 2024, https://doi.org/10.1016/j.neurot.2024.e00464.
3. https://www.painreprocessingtherapy.com/pain-reprocessing-therapy-faqs/
4. https://www.painreprocessingtherapy.com/reprocessing-project/what-is-pain-reprocessing-therapy/
5. Louw A, Zimney K, Puentedura EJ, Diener I. The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Physiother Theory Pract. 2016 Jul;32(5):332-55. doi: 10.1080/09593985.2016.1194646. Epub 2016 Jun 28. PMID: 27351541.
6. Suzuki K, Suzuki S, Shiina T, Kobayashi S, Hirata K. Central Sensitization in Migraine: A Narrative Review. J Pain Res. 2022 Sep 7;15:2673-2682. doi: 10.2147/JPR.S329280. PMID: 36101891; PMCID: PMC9464439.
7. Fishbein JN, Schuster NM, Anders A, Portera AM, Herbert MS. Pain Reprocessing Therapy for migraine: A case series. Headache. 2025 Aug 27. doi: 10.1111/head.15043. Epub ahead of print. PMID: 40859715.

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