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MAM22 Interview - Psychology, Migraine & Mental Health with Allie Mackay

Psychology, Migraine & Mental Health
- with Allie Mackay

Allie Mackay (BA Psychology, Child and Family, BSocSci Psychology Hons, Assoc MAPS), from Allie Mackay Psychology in Sydney, discusses psychology, migraine and mental health with Sarah, our Director of Engagement, Communications and Campaigns. 

What is a psychologist?

A psychologist is a registered term, so in Australia it means that a person has completed an undergraduate degree in Psychology studies (usually considered a science degree), then an Honours degree (4th year) with a focus on conducting a unique piece of psychological research, then after completion of two more years of supervised practice with 6 monthly assessments, or a masters degree, passing a national examination covering the laws relating to practice. Passing requires a good understanding of the application of the ethical decision making required in the profession. Psychologists may go on to academic study, research, work in human resources, marketing, business, forensics, assessment of childhood disorders, or treatment of a wide range of human conditions such as pain management, rehabilitation after illness, or mental health disorders such as depression, anxiety and post traumatic stress.

How do we access a psychologist, do we need a GP referral?

A GP referral is not necessary, but it will allow for a rebate of the fee from Medicare if the GP decides you are eligible. Usually, this decision is based on your description of your symptoms and the distress or functional difficulty your symptoms are causing you.

What made you choose psychology as a career?

To be a psychologist requires a good mix of scientific logic, critical thinking and ability to understand research and also the capacity for creative, imaginative, and flexible thinking. I was that high school kid who couldn’t decide between reading, creative writing and science studies. In fact, until I discovered Psychology as a subject offered in my first year of a Science degree at Sydney university I was convinced I was going to have to give up one for the other, and I have been a duck to water ever since.

Why is migraine an area of focus for you?

My interest in migraine developed while I was working for a Neurologist. I used biofeedback to demonstrate to patients that pain from muscle tension (behind their eyes and on their shoulders) and breathing rate were connected to stressful or anxious thoughts in the moment and that they could reduce both with mindful awareness. The neurologist presented the findings at an international conference and we published them. 

Why should someone with migraine see a psychologist?

Managing pain usually requires a bit more than taking an analgesic. As the readers will know all too well, the anticipation of pain can be crippling, causing pre-emptive cancelling of events, and anxious contingency planning about what to do if the next day is a migraine day.  In other words, our minds are very interested in helping out our bodies but they can get in the way with prediction and worry, sometimes even creating the conditions for a migraine attack by creating a stress response. At worse, the fear of pain causes avoidance, leading to social isolation, self-blame or asking “why me” and depression. Psychologists are trained to help you identify and then re-wire the worrying thoughts so that you can enjoy quality of life and manage pain with less anxiety and depression.

What does a typical treatment plan look like?

There are five stages typically -

  1. History taking and assessment of the impact of the migraine on your quality of life (including triggers, pain levels, patterns and using interview as well as standardised pain scales).
  2. Identifying body responses, thoughts and feelings associated with those triggers and situations that feed into the patterns.
  3. Learning skills to un-hook from unhelpful thinking and emotional triggers that maintain or perpetuate patterns.
  4. Practicing, fine tuning and becoming independent from pain.
  5. Defining the type of therapies that can help with chronic pain.

Techniques from cognitive behavioural therapy (CBT) and Acceptance and Commitment Therapy (ACT), which incorporate Mindfulness (the ability to notice your thoughts as ‘just thoughts’) all help with chronic pain. Sometimes underlying memories of traumatic events are maintaining pain (such as a hospital experience) and targeted trauma focussed therapy can assist in that instance.

What are your suggestions for someone who is struggling with grief from losing their life prior to chronic illness or migraine?

I would suggest that a few sessions with a psychologist could be transformative!  Grief work is about letting go of what was, and embracing what is. There is a lot more to that story of course, and it may be that grief work is not necessary if the other interventions mentioned already have not yet been tried.

Is having the right fit with your psychologist an important part of treatment?

Yes! In fact, research shows that therapist-client alliance accounts for more than 30% of the success of treatment, irrespective of the technique used or the client issue.

Not all psychologists are the same, so how do we find the RIGHT psychologist for migraine?

Ask your GP for a Mental Health Care Plan and a referral to a Psychologist who has experience with pain, chronic health conditions, or migraine. The APS has a directory “find a psychologist” where registered psychologists in Australia list their areas of interest.

If we cannot access a psychologist, what are some things we can do ourselves for migraine, chronic pain and mental health?

My top five favourites are:

  1. Practice relaxation every day. This is not specific. What makes YOU feel calm, relaxed, safe, and peaceful? Do that!
  2. Focus on what is already alright. It might be that you are in pain and even so, there are some things that are ok. Pain causes the stress response to activate, making us focus too much on all the things that aren’t ok. We can deliberately change that balance.
  3. Move your body. Regular shifts in the posture of the spine, neck, head, eye gaze, arm height, and legs all help your brain to update, move fresh oxygenated blood around and promote healing and allow muscles to contract and release.
  4. Have a routine. It doesn’t matter what it is, just have one. Stick to a regular wake time and a regular bedtime. Make sure that some of the things you do are what you CHOOSE to do, rather than what you HAVE to do.
  5. Find pleasure in something. It might be helpful to write a list of enjoyed experiences to recall, or to look forward to, or of people who make you feel good, who are glad to see you. Just looking at the list is as good for your brain as having those experiences, although, you will want to add to the list by having more pleasant experiences! Pleasure increases naturally occurring opioid uptake in the brain and body and reduces our perception of pain.

Do you recommend any apps for mental health or chronic pain?

There are too many apps to list and I don’t want to endorse a commercial product, however, Insight Timer is a free app that has thousands of meditations from simple rain sounds to assist with sleep, to guided body relaxation exercises. Any app that offers a body scan is worth trying.

From a psychologist's perspective, what is the one thing you would tell someone with migraine?

I would say "We can deal with this and I am here to help you find the best ways to do so".


Migraine Australia would like to take this opportunity to thank Allie Mackay for her time and for helping us bring migraine #OutOfTheDark

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