NRBS, 04/21/2012 BIOFEEDBACK WITHPREGNANT WOMEN WHO HAVE MIGRAINES
BIOFEEDBACK AND MIGRAINES• Most physicians have heard about the connection between biofeedback and migraine headaches. Thermal biofeedback is generally considered the “gold standard” for migraine headaches, among people who are only peripherally acquainted with the actual procedures.• It is generally confusing to discuss details of different varieties of biofeedback. The term and the individual practitioner’s track record are all that count.
WHY DO WE HAVE MIGRAINES?• They are wonderful storm warning devices.• May be responsible for survival of large. groups of humans from 50,000 years ago.• Now they are inconveneint.• Also, probably bad for a fetus.• Medications are almost certainly bad for a fetus.
HOW COMMON ARE MIGRAINES?• Extremely varied statistics, but probably occurs in 20% of the population.• Migraines may get better, worse, or stay the same during pregnancy. The target population includes all of these.
DIAGNOSIS• A patient coming with a diagnosis of migraine does not mean that it is migraine. Misdiagnoses is common.• “contaminated” migraines are much more difficult to treat than “uncontaminated” migraines.• Starting to work with someone before pregnancy occurs is a much better scenario that meeting for the first time when pregnant.
MIGRAINES• Can mimic any other mental disorder, especially if there is an aura.• Aura: progresses in a wave at 2mm to 6mm per minute, usually from back of the brain to front, ending in a headache (tsunami effect).• Called CSD (cortical spreading depression). Wherever this wave passes, the brain malfunctions.
TYPICAL AND LESS TYPICAL MIGRAINE AURA• “GHOSTS”• AUDITORY HALLUCINATIONS• PANIC• PSYCHOTIC EPISODE• SMELLS• APHASIA (receptive / expressive)• PARALYSIS
What do women do during pregnancy to control migraines?• They suffer.• They take prophylactic medications.• They take “abortive medications” like triptans.
FETAL EFFECTS of “suffering”• Pain might be inconvenient, but the migraine mechanism itself may contribute to fetal distress..• The migraine may affect fetal blood supply during the migraine event.
FETAL EFFECTS of “prophylactic” medications• Drugs for depression during pregnancy are becoming a big issue.• SSRI’s linked to fetal cardiac problems.• SSRI’s are considered among the most gentle drugs and have been until recently considered safe for pregnancy.• All drugs during pregnancy represent a potential fetal risk.
FETAL EFFECTS of “abortive” medications• The most powerful and predictable drugs to abort a migraine are the “triptan” class of drugs (Imitrex, etc.).• These drugs have powerful vasoconstriction effects (recall the warnings on television for cardiac history).• They probably shut down the fetal blood supply.• This is not a good thing.• No solid research – yet, but OB and Neurologist physicians are very concerned.
PHYSICIAN VARIABLES• They really are concerned about health of mother and fetus.• But…• Migraine patients are time consuming to physicians.• And…• They are very concerned about the potential ramifications of prescribing these medications to pregnant women because it may come back to them via lawsuits re fetal effects.
REASONS THAT PHYSICIANS APPRECIATE HELP WITH THESE PATIENTS• Reduction of time load on physician.• Reduction of need to prescribe migraine drugs during pregnancy.• Improved mental stability which also results in fewer phone calls.
WHO SEEKS OUT THIS TYPE OF TREATMENT• These tend to be intelligent women who have read widely about managing pregnancy, are careful what they eat, don’t drink during pregnancy, etc. They widely network with each other and often arrive as self referrals based on friends who have had nice experiences.