If you gather clinicians caring for headache patients in any venue, the topic of mental health management will be raised. More specifically, the lack of access to psychotherapy adapted to chronic headaches will be evoked. The study by Zamir et al. describes a promising pragmatic option of an Emotional Awareness and Expression Therapy (EAET, “Creating Calm”), offered as nine weekly telehealth sessions to chronic headache patients.^{Reference Zamir, Yarns and Vyas1}

EAET may be new to neurologists, who may be more familiar with cognitive behavioral therapy and mindfulness-based stress reduction, both helpful but sometimes insufficient, not specific enough or difficult for patients with chronic pain and somatic symptom disorders.^{Reference Treadwell, Tsou and Rouse2}

The protocol used in this study was well defined, with objectives for each session, and informative regarding the underlying concepts of EAET, making it a worthy read. It goes beyond the basic concepts of pain catastrophising, which are the focus of pain reprocessing therapy (PRT). The evidence for PRT in headache is also in its infancy.^{Reference Fishbein, Schuster, Anders, Portera and Herbert3}

In this study, 72% of patients reported adverse childhood events, 94% reported a traumatic event and 79% had a psychiatric comorbidity, representing the refractory patients seen in Headache Clinics.^{Reference Sikorski, Mavromanoli, Manji, Behzad and Kreatsoulas4} The impact of the nervous system dysregulation linked to traumatic experiences is probably underestimated and difficult to address during short neurological follow-ups centered on medication adjustments, making therapy a key part of global management.^{Reference Jamil, Raza, Moradikor and Haghipanah5}

Results were encouraging from feasibility (30 of 33 of patients completed at least 7 sessions), patient satisfaction (86% of participants felt an improvement) and a clinical outcome perspective (a mean of −5 decrease in monthly headache days from a baseline of 21.6). Other patient-reported outcomes showed signals for improvement.

This pilot study is small, but it opens the path to larger trials. Its innovative design addresses the challenges of the practice. A group approach offers many advantages. It is more affordable for patients who are often financially limited. It can be part of a clinic, allowing the growth of a shared expertise. If linked to a clinic, it may inspire much-needed trust in patients who otherwise would be left on their own to find a therapist familiar with chronic headaches. It involves the strength of story sharing, which is a part of healing for many pain patients.^{Reference Yarns, Lumley and Cassidy6}

This study will probably be an encouraging addition to the discussions between neurologists and health care providers interested in behavioral approaches for headache care.