OCD & PTSD
"Intrusive, unwanted thoughts or memories that feel impossible to control or dismiss"
What is Chronic Migraine?
Obsessive-Compulsive Disorder (OCD) and Post-Traumatic Stress Disorder (PTSD) are distinct but often comorbid neuropsychiatric conditions characterized by dysregulated fear processing, intrusive mental phenomena, and maladaptive behavioral patterns. OCD involves recurrent obsessions (intrusive thoughts, images, or urges) and compulsions (repetitive behaviors performed to neutralize obsessions or prevent feared outcomes). PTSD develops following exposure to actual or threatened death, serious injury, or sexual violence, featuring intrusive re-experiencing, avoidance, negative alterations in cognition and mood, and marked alterations in arousal and reactivity. Both conditions involve amygdala hyperactivity, hippocampal dysfunction, prefrontal cortex impairment, and HPA axis dysregulation.
Healthy Function
What your body should do
A healthy stress response system maintains appropriate threat detection through the amygdala while the prefrontal cortex provides top-down regulation to distinguish real from perceived danger. The hippocampus accurately contextualizes memories in time and place. The HPA axis responds to genuine threats with appropriate cortisol release, followed by efficient recovery and return to homeostasis. Fear extinction occurs naturally when threats pass. Intrusive thoughts are recognized as mental noise and dismissed without distress. Sleep architecture supports memory consolidation and emotional processing. The autonomic nervous system maintains balance between sympathetic activation and parasympathetic restoration.
When Things Go Wrong
Signs of chronification
- Pain threshold lowers over time
- More frequent attacks
- Brain stays in alert mode
- Medication stops working
How This Develops
Understanding the biological mechanisms helps us target the root cause
Point 1
Understanding the mechanism helps us target the root cause rather than just treating symptoms.
Recognizing All Symptoms
Chronic migraine affects multiple systems. Understanding your symptoms helps us identify the underlying mechanisms.
Physical Symptoms
12 symptoms
- Racing heart, palpitations, and chest tightness during triggers
- Shortness of breath and hyperventilation episodes
- Muscle tension, especially in neck, shoulders, and jaw
- Gastrointestinal distress: nausea, diarrhea, IBS flare-ups
- Chronic fatigue despite adequate sleep
- Insomnia and nightmares disrupting sleep architecture
- Startle response hyperreactivity
- Sweating and trembling during anxiety episodes
- Headaches and migraines
- Dizziness and feeling faint
- Chronic pain syndromes (fibromyalgia comorbidity)
- Immune dysfunction and frequent infections
Cognitive Symptoms
12 symptoms
- Intrusive, unwanted thoughts or memories
- Rumination and obsessive worry loops
- Difficulty concentrating and memory problems
- Catastrophic thinking and worst-case scenario fixation
- Mental checking and reviewing behaviors
- Thought-action fusion (believing thoughts equal actions)
- Hypervigilance and constant threat scanning
- Dissociation and feeling detached from reality
- Negative self-beliefs and distorted cognitions
- Decision paralysis and overthinking
- Flashbacks with impaired reality testing
- Impaired executive function and planning
Emotional Symptoms
12 symptoms
- Persistent fear and sense of impending doom
- Guilt and shame about symptoms or trauma
- Emotional numbing and restricted affect
- Irritability and anger outbursts
- Anhedonia and loss of interest in activities
- Overwhelming anxiety and panic
- Depression and hopelessness
- Self-blame and worthlessness
- Trust issues and relationship difficulties
- Feeling permanently damaged or broken
- Isolation and withdrawal from support systems
- Suicidal ideation in severe cases
Conditions That Occur Together
These conditions often coexist with chronic migraine due to shared mechanisms
Depression and Mood Disorders
Shared neurobiological pathways involving serotonin depletion, HPA axis dysregulation, and inflammatory processes; up to 50% of PTSD patients and 40% of OCD patients experience comorbid depression
Anxiety Disorders
Generalized anxiety, panic disorder, and social anxiety share amygdala hyperactivity and fear circuitry dysfunction; often predate or coexist with OCD/PTSD
Substance Use Disorders
Self-medication to manage distressing symptoms; 40-60% of PTSD patients develop substance abuse; temporarily reduces amygdala activation but worsens long-term outcomes
Sleep Disorders
Sleep deprivation impairs prefrontal cortex regulation while increasing amygdala reactivity; nightmares disrupt REM sleep critical for fear extinction
Chronic Pain Syndromes
Central sensitization and shared neuroinflammatory processes; trauma and chronic stress alter pain processing pathways; fibromyalgia comorbidity in 20-30%
Autoimmune Conditions
Chronic inflammation and immune dysregulation from PTSD/OCD increase autoimmune risk; shared genetic vulnerabilities and environmental triggers
Cardiovascular Disease
Chronic sympathetic activation and cortisol elevation damage vascular endothelium; PTSD associated with 2x increased cardiovascular risk
Gut-Brain Axis Dysfunction
Trauma and chronic stress alter gut microbiome, reduce vagal tone, and increase intestinal permeability; gut inflammation exacerbates neuroinflammation
Dissociative Disorders
Severe trauma can fragment identity and memory processing; dissociation serves as psychological escape when fight/flight is impossible
Eating Disorders
Trauma history common in eating disorders; control behaviors around food parallel OCD compulsions; body image distortion linked to trauma
Conditions to Rule Out
These conditions can present similarly but have distinct features
OCD (Obsessive-Compulsive Disorder)
Intrusive thoughts, anxiety, repetitive behaviors
Ego-dystonic obsessions with specific compulsions performed to neutralize anxiety; insight often preserved but resistance is difficult; no trauma history required
PTSD (Post-Traumatic Stress Disorder)
Intrusive memories, avoidance, hypervigilance
Direct link to traumatic event; re-experiencing phenomena; negative alterations in cognition/mood; symptoms persist >1 month after trauma
Complex PTSD (C-PTSD)
PTSD symptoms plus emotional dysregulation, negative self-concept
Results from prolonged, repeated trauma (childhood abuse, captivity); includes disturbances in self-organization: affect dysregulation, negative self-concept, disturbed relationships
Generalized Anxiety Disorder
Excessive worry, hypervigilance, physical anxiety symptoms
Worry is diffuse and not tied to specific obsessions or trauma; no compulsions or re-experiencing phenomena; content of worry shifts across life domains
Panic Disorder
Panic attacks, anticipatory anxiety, avoidance
Panic attacks are spontaneous and not triggered by specific obsessions or trauma cues; fear focuses on panic sensations themselves
Social Anxiety Disorder
Avoidance, fear of judgment, physical anxiety
Fear specifically centers on social evaluation and embarrassment; no intrusive obsessions or trauma-related re-experiencing
Body Dysmorphic Disorder
Repetitive checking, intrusive thoughts about appearance
Preoccupation specifically with perceived defects in appearance; compulsions focus on appearance-checking or concealing
Hoarding Disorder
Difficulty discarding, repetitive acquisition behaviors
Previously considered OCD subtype; distress centers on parting with possessions rather than intrusive obsessions; living spaces become unusable
Trichotillomania/Excoriation
Repetitive behaviors, tension reduction
Body-focused repetitive behaviors without preceding obsessions; behaviors provide gratification or relief rather than preventing feared outcomes
Adjustment Disorder
Emotional distress following stressor, functional impairment
Stressor can be any life change (not just trauma); symptoms are less severe and resolve within 6 months of stressor removal
Acute Stress Disorder
PTSD-like symptoms following trauma
Symptoms occur immediately after trauma and resolve within 1 month; if persistent beyond 1 month, diagnosis becomes PTSD
Psychotic Disorders
Intrusive thoughts, fear, behavioral changes
OCD obsessions are recognized as own thoughts (not inserted); no formal thought disorder; reality testing preserved outside of specific obsessional fears
What's Driving Your Migraines
Identifying the underlying causes allows us to target treatment effectively
Trauma Exposure (PTSD-specific)
90% - Direct exposure to actual or threatened death, serious injury, or sexual violence is required for PTSD diagnosis; trauma type, severity, and duration affect riskComprehensive trauma history including childhood adversity, combat exposure, assault, accidents, natural disasters; assess peritraumatic dissociation
Genetic Predisposition
30-40% - Family history increases risk 2-4x; serotonin transporter gene (5-HTTLPR), COMT, and BDNF polymorphisms implicatedFamily psychiatric history; genetic testing for relevant polymorphisms affecting neurotransmitter metabolism and stress response
Childhood Adversity and Attachment
50-60% for PTSD, 30% for OCD - Early life stress alters developing stress response systems and creates vulnerabilityACE (Adverse Childhood Experiences) score; attachment style assessment; developmental history including neglect, abuse, or household dysfunction
HPA Axis Dysregulation
40% - Chronic or severe stress dysregulates hypothalamic-pituitary-adrenal axis functionCortisol testing (morning, evening, diurnal curves); DHEA-S; ACTH levels; evaluate stress history and coping capacity
Neurotransmitter Imbalance
35% - Serotonin depletion, dopamine dysregulation, and GABA deficiency impair fear processing and behavioral inhibitionUrinary neurotransmitter panels; amino acid testing; methylation status (MTHFR, homocysteine); response to SSRI trial
Neuroinflammation
25% - Elevated pro-inflammatory cytokines affect neuroplasticity, neurotransmitter metabolism, and blood-brain barrier integrityInflammatory markers (CRP, IL-6, TNF-alpha); gut permeability testing; infectious disease screening; autoimmune markers
Gut Microbiome Dysbiosis
20% - Altered gut bacteria reduce GABA and serotonin production, increase systemic inflammation, and impair vagus nerve signalingComprehensive stool analysis; SIBO breath testing; assessment of antibiotic history, diet, and digestive symptoms
Nutrient Deficiencies
20% - B vitamins, magnesium, zinc, omega-3s, and vitamin D are essential for neurotransmitter synthesis and neuronal healthComprehensive micronutrient panel; RBC magnesium; omega-3 index; vitamin D levels; dietary assessment
Brain Structure and Function
25% - Reduced hippocampal and prefrontal cortex volume; amygdala hyperactivity; default mode network dysfunctionNeuropsychological testing; qEEG brain mapping; structural MRI if indicated; functional connectivity assessment
Infectious and Toxic Contributors
15% - PANDAS/PANS (pediatric autoimmune), Lyme disease, mold toxicity, and heavy metals can trigger or exacerbate symptomsASO and anti-DNase B titers; Lyme and co-infection testing; mycotoxin panel; heavy metal screening
Cognitive and Learning Factors
30% - Thought-action fusion, intolerance of uncertainty, and anxiety sensitivity maintain OCD; maladaptive cognitions maintain PTSDValidated questionnaires (OBQ, IIQ, ASI); cognitive assessment; trauma-related cognitions inventory
Key Laboratory Markers
These biomarkers help us understand your specific migraine mechanisms
What Happens If Left Untreated
Understanding the consequences helps you make informed decisions about your health
Chronic Neurobiological Dysregulation
Months to yearsUntreated OCD/PTSD causes progressive changes in brain structure and function, including hippocampal atrophy and prefrontal cortex impairment, making recovery increasingly difficult
Treatment Resistance Development
YearsLonger duration of untreated illness predicts poorer response to treatment; neural pathways become more entrenched; may require more intensive interventions
Substance Abuse and Dependence
Often within first year of symptom onsetSelf-medication with alcohol, benzodiazepines, cannabis, or other substances leads to addiction; dual diagnosis complicates treatment and worsens outcomes
Major Depression Development
Months to years60-80% of untreated PTSD and 50% of untreated OCD develop comorbid depression; suicide risk increases significantly with combined conditions
Cardiovascular Disease
Years to decadesChronic sympathetic activation and inflammation increase risk of hypertension, coronary artery disease, and stroke; PTSD associated with 2x cardiovascular mortality
Metabolic Syndrome and Diabetes
YearsChronic cortisol dysregulation promotes insulin resistance, weight gain, and metabolic dysfunction
Autoimmune Disease
YearsChronic inflammation and immune dysregulation increase risk of autoimmune conditions including rheumatoid arthritis, lupus, and thyroid disease
Relationship and Social Deterioration
ProgressiveAvoidance behaviors, emotional numbing, and symptom preoccupation damage intimate relationships; social isolation increases; divorce rates elevated
Occupational Disability
Months to yearsConcentration impairment, avoidance, and symptom severity reduce work performance; many patients become unable to work; significant economic impact
Suicide Risk
Ongoing riskOCD carries 10x increased suicide risk; PTSD associated with significant suicide risk, especially with comorbid depression; requires vigilant monitoring
Physical Health Comorbidities
YearsChronic pain, gastrointestinal disorders, respiratory conditions, and immune dysfunction become increasingly prevalent
Quality of Life Degradation
Immediate and progressiveSymptoms consume increasing time and energy; joy and fulfillment diminish; life becomes organized around symptoms rather than values and goals
Time Matters
Don't wait for symptoms to worsen. Early intervention leads to better outcomes.
How is Chronic Migraine Diagnosed?
Comprehensive evaluation to identify triggers, contributing factors, and appropriate treatment
Comprehensive Psychiatric Evaluation
Purpose:
Establish diagnosis and assess severity
Structured clinical interview for DSM-5 criteria; differential diagnosis; comorbidity assessment; suicide risk evaluation
Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
Purpose:
Assess OCD symptom severity
Quantified obsessions, compulsions, avoidance, and insight; tracks treatment progress; scores >16 indicate clinically significant symptoms
Clinician-Administered PTSD Scale (CAPS-5)
Purpose:
Gold standard PTSD assessment
Frequency and intensity of all PTSD symptom clusters; diagnostic confirmation; severity rating; treatment response monitoring
PCL-5 (PTSD Checklist)
Purpose:
Self-report PTSD screening
Symptom presence and severity; score >31-33 suggests probable PTSD; useful for tracking changes
Comprehensive Blood Panel
Purpose:
Rule out medical causes and assess biological contributors
CBC, CMP, thyroid function, inflammatory markers, cortisol, DHEA-S, vitamin D, B12, magnesium, homocysteine
Neurotransmitter Panel
Purpose:
Assess neurochemical status
Urinary levels of serotonin, dopamine, norepinephrine, GABA, glutamate; guides targeted amino acid therapy
Adrenal Function Testing
Purpose:
Evaluate HPA axis status
Diurnal cortisol curves, DHEA-S, cortisol awakening response; reveals dysregulation patterns
Stool Microbiome Analysis
Purpose:
Assess gut-brain axis contribution
Bacterial diversity, pathogenic organisms, inflammation markers, SCFA production, leaky gut indicators
Nutritional and Micronutrient Testing
Purpose:
Identify deficiencies affecting brain function
Comprehensive vitamin, mineral, amino acid, and fatty acid status; omega-3 index
Genetic Testing
Purpose:
Identify genetic factors affecting treatment
MTHFR, COMT, 5-HTTLPR, BDNF Val66Met; informs medication selection and nutrient therapy
qEEG Brain Mapping
Purpose:
Assess brain electrical activity patterns
Abnormalities in frontal lobe function, amygdala connectivity, and fear circuitry; guides neurofeedback if indicated
Trauma and Attachment Assessment
Purpose:
Comprehensive trauma history and impact
ACE score, trauma type/severity, attachment style, dissociation levels, complex PTSD features
Toxic and Infectious Screening
Purpose:
Rule out environmental contributors
Heavy metals, mycotoxins, Lyme disease, PANDAS/PANS markers when clinically indicated
Our Integrative Approach
A comprehensive, phased approach to treat chronic migraine at its source
Thorough diagnostic evaluation, safety planning, and acute symptom management
Thorough diagnostic evaluation, safety planning, and acute symptom management
Complete psychiatric and trauma-informed medical history,Structured diagnostic interviews (CAPS-5, Y-BOCS, SCID),Comprehensive laboratory testing and biological assessment,Suicide risk assessment and safety planning,Sleep stabilization and hygiene optimization,Psychoeducation about OCD/PTSD neurobiology,Establish therapeutic alliance and treatment expectations,Begin foundational self-regulation skills,Address acute substance use if present,Coordinate care with existing providers
Restore neurochemical balance and reduce symptom severity
Restore neurochemical balance and reduce symptom severity
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Process traumatic memories and rewire fear responses
Process traumatic memories and rewire fear responses
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Consolidate gains and build long-term resilience
Consolidate gains and build long-term resilience
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Sustain recovery and optimize quality of life
Sustain recovery and optimize quality of life
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Supporting Your Treatment
Evidence-based lifestyle modifications to enhance treatment effectiveness
What Success Looks Like
Y-BOCS score reduction to <16 (subclinical range) for OCD
PCL-5 score reduction to <31-33 for PTSD
Ability to experience intrusive thoughts/trauma triggers without significant distress
Elimination of compulsive behaviors or safety behaviors
Restored sleep quality with minimal nightmares
Return to full occupational and social functioning
Stable mood without significant anxiety or hyperarousal episodes
Improved relationships and social connection
Reduced physiological reactivity to triggers
Ability to tolerate uncertainty and distress
Values-based living rather than symptom-driven existence
Resilience in face of life stressors without relapse
Frequently Asked Questions
Ready to Find Relief from Chronic Migraines?
Our integrative approach has helped hundreds of patients find lasting relief from chronic migraines. Schedule your comprehensive assessment today.