Biofeedback and other Psychophysiological Techniques

for Headache By Lisette Markham

Elise “Lisette” Markham, MA, CADC, BCN- Senior FellowCertified Biofeedback & Counseling LLC

9509 U.S. Highway 42Falsoft Building, Suite 201AProspect, KY 40059502-644-6975

certifiedbiofeedback@gmail.com

What is Biofeedback?

Biofeedback is a tool that helps people to improve their health by self monitoring, using signals from their own bodies, to improve their functioning. It is feeding back biological information is order to learn to modify it.

It is an outgrowth of learning theory (instrumental conditioning), behavior therapy, and applied psychophysiology. It is now considered by most to fall within what is called today behavioral medicine.

TYPES OF BIOFEEDBACK

GSR (Galvanic Skin Response) biofeedback:

Training to reduce electrical resistance or perspiration for stress reduction or pain reduction.

Thermal or Temperature Biofeedback:

Measuring distal temperature and training to dilate distal capillaries as part of the relaxation response for relaxation. Particularly helpful for migraine headache, stress. Hypertension, and chronic pain.

EMG (Electromyography)biofeedback:

Training to reduce muscle tension or for specific muscular rehabilitation after injury, or for stress, tension headache, or TMJ (Temporal mandibular joint) disorders. Also is quite effective for urinary and fecal incontinence.

EEG biofeedback or neurofeedback:

Training to teach control or regulation of certain brainwave signals for concentration problems, impulsivity, learning problems, migraine or other headache, stress reduction or pain reduction, for stroke or head injury rehabilitation, and for addictions.

Other Biofeedback Training in relaxed or paced breathing, blood pressure reduction, pulse or heart rate variability or other specific problems.

What is Clinical EEG Biofeedback or Neurofeedback?

Neurofeedback is a treatment technique that uses computer biofeedback to teach individuals to control their own brainwave signals. Changes in brain chemistry create brainwaves and changes in brainwaves. Learning to control or regulate these brainwaves can reduce symptoms and improve functioning and behavior. Dr. Barry Sterman calls it “learned normalization of EEG patterns.” Clients begin to recognize the healthy brain states and learn to choose the appropriate state for the activity.

Survey of research:

Joint guidelines developed by the Association for Applied Psychophysiology and Biofeedback and The Society for Neuronal Regulation identify validated or verified applications, those with clinical reports of improvement, and those that are considered experimental.

1.Validated ( Efficacious): Anxiety, Epilepsy, chronic pain, headache, Reynaud’s Syndrome , Temporal Mandibular Disorders, Hypertension and Attention Deficit Hyperactivity Disorder

2.Probably efficacious: Addictions, insomnia, closed head injuries or traumatic brain injury, and

learning disabilities.

3. Possibly efficacious:Autism, Asperger's and high functioning autism,

obsessive compulsive disorder, cerebral palsy, coronary heart disease, depression, Post Traumatic Stress Disorder, tinnitus, Tourette Syndrome and other movement disorders such as dystonia and Parkinson's, and Irritable Bowel Syndrome

4.Clinical Reports of improvement /Experimental:Eating disorders, immune function

Basic neurophysiology:

1. Beta above 12 Hz-focus or high activity like study or work. It also can be associated with anxiety or over-focus/hyper-focus.2. Alpha 8-12 Hz-Alpha-relaxed, but aware and not focused. It is a meditative state like Mindfulness. 3. Theta 3-7 Hz-Theta-day dreaming, almost asleep. Excessive amounts in the frontal areas are associated with attention problems.4. Delta 0.5-3 Hz-asleep5. SMR 13-15 Hz over sensorimotor strip-relaxed muscles, quieted motor activity and paying attention.6. Other normal rhythms- lambda, mu, sleep spindles7. Abnormal patterns- referral to neurologist

Research

There are many research studies that have confirmed a relationship between higher resting baselines of EMG in headache patients than in normal controls (Hatch et al, 1992; Lichstein et al, 1991; Schoener et al, 1991; and Ahles et al, 1988). It has also been demonstrated that environmental stress can induce headaches and that the headaches involved changes in cephalic blood flow (Haynes et al, 1990; Gannon et al, 1987). The changes in cephalic blood flow are consistent with neurogenic and vascular theories of headache.

PEDIATRIC studies demonstrate that use of biofeedback assisted relaxation as a non-pharmacological treatment of headache in children and adolescents is even more effective than its use in adults. In a survey of seven studies, 88% of the children reduced their headaches by 50% (Blanchard, 1992). Other surveys of ADULT headaches treated with biofeedback resulted in at least 80% improvement of headaches and those treated with relaxation alone improved at a rate of less than 50% (Duckro and Cantrell-Simmons, 1989).Research in clinical applications of EEG biofeedback for migraine headache indicate that migraine may be a operationally a "cerebroneural event...The data may be interpreted as an indicator of regional cerebral hypometabolism in migraineurs...[they] were able to improve regional activation levels with resultant normalization of function and cessation of migrainous symptomology..." (Tansey, 1991).

Meta-analysis of Published Data on Migraine and Tension Headaches

Biofeedback Treatment for Headache Disorders: A Comprehensive Efficacy Review, Y. Nestoriuc, A.

Martin, W. Rief, And F. Andrasik, Applied Psychophysiology and Biofeedback, Vol.33, Number 3,

pp 125-140

Screened 150 studies, included 94 published between 1973-2007, with 3500 subjects. Results in decreased frequency, duration, and intensity of both migraine and tension headaches.

Medium to large effect on both types

Remained stable for 14 months

Largest improvement was decreased frequency of headache

Significant reduction in depression and anxiety

Significant reduction in muscle tension

Significant reduction in use of medication

EEG decreased cognitive effects Average number of visits was 11-short and economic

Home training was essential for efficacy and maintenance. Increased improvement of symptoms by 20%

Comprehensive Biofeedback Programs

Help the patient recognize and control psychophysiological processes that contribute to triggering headaches or making them worse. These techniques can be used to reduce the pain, frequency, and severity of headaches; and reduce the need for rescue medications and visits to the hospital.

Headache diaryAccurately record the number, severity, and length of headaches while investigating foods, stressful events, or other factors contributing to headaches. Also to record methods used to control the headache and identify what is helping. Deep breathing exerciseBegins to train the central nervous system to relax, reducing its excitability.

Hand warming with and without thermal biofeedback Learning to initiate the relaxation response and warm the cold extremities found with migraine by normalizing circulation.

Homework- diary, breathing and hand warming

Education about triggers including dietary, environmental and emotional triggers.

Elimination or Rotation diet may be recommend to identify food triggers.

Mindfulness and Dialectical Behavior TrainingType of Cognitive Behavioral Training that helps in learning to identify thinking habits that increase stress. Working to reduce stressful thinking may eliminate another trigger.

EMG and EEG biofeedback/NeurofeedbackGives instant feedback and tracks physiology that teaches reduction of tension in muscles and nervous system excitability.(Muscle tension is often higher in migraine headache than tension headache.)

Progressive relaxation and Autogeneic Imagery TrainingInstruction in deep muscle relaxation, distraction techniques for pain, and quieting the mind. Simple acupressure techniquesBased on acupuncture trigger points found to help headache pain.

Homework-Progressive relaxation and Autogenic Imagery Training

EXERCISES

Mindful Meditation:

Paced breathing: Stare at spot or close eyes.

For 5 minutes count in your mind as you breathe.

Breathe in counting to 4

Stop for 1

Breathe out for 4

Stop for 1

Stretch at end of exercise.