Happy November, all! It is my pleasure to bring all of you a “preview” of our CHaSCI-hosted Social Work Grand Rounds for November 2025, Pain Reprocessing Therapy Use in a Chronic Migraine Support Group Program.
My name is Eve Escalante and I am a clinical social worker at Rush University Medical Center and part of the CHaSCI team. I have been a consumer of a pain reprocessing therapy support group and will be sharing about my personal experience with migraine and this treatment modality below.
I have lived with migraine since age 18 (I am 43). From age 18-35, I experienced episodic migraine, and from age 35 until present I have had chronic migraine, which means experiencing migraine pain and/or other symptoms associated with migraine for 15 or more days per month. My treatment journey began with a very standard, Western medical approach and slowly moved to integrating more alternative options as I became more desperate to find relief.
Chronic migraine has had a sweeping impact on my life. It has affected other areas of my health, shifted my role as a mother and wife, and forced me to not only take leave away from my professional role as a social worker but also reconsider how to make my vocation sustainable once I returned. Chronic migraine has also forced me to rethink the definition of loneliness versus isolation. I am, by definition, not socially isolated. I have many solid social supports, a majority of whom have been super supportive along my journey with chronic migraine. Having said that, I have still felt very “alone” in my experience and in my body, knowing that it was virtually impossible for these same supportive people to understand the magnitude of my experience and what it meant for my day to day life and my concerns about my future.
I have not been much of a social media person, but I was pleasantly surprised that I found a HUGE community of chronically ill persons across the world via Instagram, and although I didn’t engage with these folks, being able to hear and see that their experiences were so much like mine was heartening. (If you’d like to learn more about this community, see below for links!) Through this network I came to be familiar with the concept of Pain Reprocessing Therapy (PRT), and its potential as a treatment for chronic migraine. I was intrigued and also skeptical. Many people with chronic, invisible conditions (especially those involving pain) have lived with the stigma that their condition is their fault, that they control their symptoms/experience, or that if they could just “do better” they’d be cured. One of the “hooks” for PRT is the idea that some pain is neuroplastic (not caused by an injury) and that in the case of chronic migraine, the brain has become overly sensitive to stimuli, mistaking safe signals (such as noise, light, mild stress activation) as genuine danger, getting “stuck” on high alert and in a chronic pain cycle.
I didn’t want this to be true for me. I really didn’t! I have a history of mental health conditions and the irrational part of me felt like, if my pain is neuroplastic, did that mean I caused it? Am I to blame? I made it worse by my life decisions or just my day-to-day decisions? It really increased my experience of internalized stigma. However, I also really, really related to this experience of my pain being triggered at any moment and at any time, and of the idea of having gotten stuck in a never-ending cycle. I wanted to know more and I wanted to take a deeper dive.
I learned more about PRT and decided to join a virtual support group that was facilitated by a clinical social worker who not only specializes in chronic pain and migraine but has lived experience with it (these two factors were very compelling in my deciding to join). It was a new group, aimed at helping those living with chronic migraine learn about the foundations of PRT and how to apply it; it also provided an opportunity to connect about their lived experience which is so often hidden from our peers, families, etc.
The group ended up being the single most impactful part of my treatment since I began having migraine. Learning about the pillars of PRT in terms of understanding how neuroplastic pain works (and that it isn’t my fault), and the idea that my brain has the capacity to build new neural pathways was eye-opening. But maybe even more powerful than that was the opportunity to understand that the darkest moments of my life with chronic migraine were experiences that these other group members also had! No one wishes these things on others, but we all know that when we hear that we are not alone in our darkest experiences, it builds a bridge between us and others and knowing that we are part of a common human experience brings relief in itself.
Our group has since ended and we look forward to a “maintenance” phase of the group where we can continue to both connect as a community and also practice our PRT skills. I am also actively practicing them via a PRT workbook and have joined a Yoga and PRT-based migraine exercise community (yoga never felt accessible to me until it was presented by someone with lived experience and who was trained in PRT). I still have chronic migraine; I still deal with daily symptoms and am rearranging life to accommodate it, however PRT combined with my more traditional medical approaches has given me renewed hope that I am safe in my body and that over time I can create a new way for my brain to respond to the world around me.
If you want to know more about how PRT can be applied to neurological or conditions or just want to hear about this unique way that a very isolated community got to connect, please join us! On Wednesday, November 19th, the group facilitator Kate Schwab, LCSW will present for CHaSCI Social Work Grand Rounds and discuss the purpose and general theories of PRT, how to identify a good candidate for PRT, and how PRT can work in a group setting. This will serve as a great example of a whole-person approach to care/how social care providers (like social workers!) can make a real difference in people’s health and quality of life. Register here to join us on Wednesday, November 19th.
This work is an example of a whole-person approach to care/how social care providers (like social workers!) can make a real difference in people’s health and quality of life. That’s why CHaSCI and our partners work so tirelessly to support the social care workforce — to make sure everyone has access to social care professionals and the services they provide.
If you’d like more information about connecting with the migraine community, please feel free to email me at Eve_Escalante@rush.edu
Online communities that support migraine and/or other chronic illness experiences:
@chronicaccounts
@yourmigrainetherapist
@amfmigraine
@blackmenhavemigrainetoo (especially helpful for information about black-identifying men affected by head pain)
@daniellefoundation (especially helpful for connection between migraine and suicide risk)
@neurahealth (for other neurological conditions)
@activelyautoimmune
@nitikachopra
@chronicloveclub (all chronic conditions)