Biofeedback and other Psychophysiological Techniques for Headache - Neuro Expo 2013
Biofeedback and otherPsychophysiological Techniquesfor HeadacheBy Lisette Markham
Elise “Lisette” Markham, MA, CADC, BCN-Senior FellowCertified Biofeedback & Counseling LLC9509 U.S. Highway 42Falsoft Building, Suite 201AProspect, KY email@example.com
What is Biofeedback?Biofeedback is a tool that helps peopleto improve their health by selfmonitoring, using signals from their ownbodies, to improve their functioning. It isfeeding back biological information isorder to learn to modify it.
It is an outgrowth of learning theory(instrumental conditioning), behaviortherapy, and applied psychophysiology.It is now considered by most to fallwithin what is called today behavioralmedicine.
GSR (Galvanic Skin Response) biofeedback:Training to reduce electrical resistance orperspiration for stress reduction or painreduction.
Thermal or Temperature Biofeedback:Measuring distal temperature and training todialate distal capillaries as part of therelaxation response for relaxation.Particularly helpful for migraine headache,stress. Hypertension, and chronic pain.
EMG (Electromyography)biofeedback:Training to reduce muscle tension or forspecific muscular rehabilitation after injury,or for stress, tension headache, or TMJ(Temporal mandibular joint) disorders.Also is quite effective for urinary and fecalincontinence.
EEG biofeedback or neurofeedback:Training to teach control or regulation ofcertain brainwave signals for concentrationproblems, impulsivity, learningproblems,migraine or other headache, stressreduction orpain reduction, for stroke or headinjury rehabilitation, and for addictions.
Other Biofeedback Training in relaxed orpaced breathing, blood pressurereduction, pulse or heart rate variability orother specific problems.
What is Clinical EEG Biofeedback orNeurofeedback?
Neurofeedback is a treatment technique that usescomputer biofeedback to teach individuals to controltheir own brainwave signals. Changes in brainchemistry create brainwaves and changes inbrainwaves. Learning to control or regulate thesebrainwaves can reduce symptoms and improvefunctioning and behavior. Dr. Barry Sterman calls it“learned normalization of EEG patterns.” Clientsbegin to recognize the healthybrain states and learn to choose the appropriatestate for the activity.
Survey of research:Joint guidelines developed by the Associationfor Applied Psychophysiology and Biofeedbackand The Society for Neuronal Regulationidentify validated or verified applications, thosewith clinical reports of improvement, and thosethat are considered experimental.
3. Possibly efficacious:Autism, Aspergers and high functioning autism,obsessive compulsive disorder, cerebral palsy,coronary heart disease, depression, PostTraumatic Stress Disorder,tinnitus, Tourette Syndrome and other movementdisorders such as dystonia and Parkinsons, andIrritable Bowel Syndrome4.Clinical Reports of improvement /Experimental:Eating disorders, immune function
Basic neurophysiology:1. Beta above 12 Hz-focus or high activity like study orwork. It also can be associated with anxiety oroverfocus/hyperfocus.2. Alpha 8-12 Hz-Alpha-relaxed, but aware and notfocused. 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 withattention 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
ResearchThere are many research studies that have confirmed arelationship between higher resting baselines of EMG in headachepatients than in normal controls (Hatch et al, 1992; Lichstein etal, 1991; Schoener et al, 1991; and Ahles et al, 1988). It has alsobeen demonstrated that environmental stress can induceheadaches and that the headaches involved changes in cephalicblood flow (Haynes et al, 1990; Gannon et al, 1987). The changesin cephalic blood flow are consistent with neurogenic and vasculartheories of headache.
PEDIATRIC studies demonstrate that use of biofeedback assistedrelaxation as a nonpharmacological treatment of headache inchildren and adolescents is even more effective than its use inadults. In a survey of seven studies, 88% of the children reducedtheir headaches by 50% (Blanchard, 1992). Other surveys ofADULT headaches treated with biofeedback resulted in at least80% improvement of headaches and those treated with relaxationalone improved at a rate of less than 50% (Duckro and Cantrell-Simmons, 1989).Research in clinical applications of EEG biofeedback for migraineheadache indicate that migraine may be a operationally a"cerebroneural event...The data may be interpreted as anindicator of regional cerebral hypometabolism inmigraineurs...[they] were able to improve regional activationlevels with resultant normalization of function and cessation ofmigrainous symptomology..." (Tansey, 1991).
Meta-analysis of Published Data onMigraine and Tension HeadachesBiofeedback Treatment for Headache Disorders: AComprehensive Efficacy Review, Y. Nestoriuc, A.Martin, W. Rief, And F. Andrasik, AppliedPsychophysiology and Biofeedback, Vol.33, Number3, pp 125-140
Screened 150 studies, included 94 publishedbetween 1973-2007, with 3500 subjects. Resultsin decreased frequency, duration, and intensity ofboth migraine and tension headaches.Medium to large effect on both typesRemained stable for 14 monthsLargest improvement was decreased frequency ofheadacheSignificant reduction in depression and anxiety
Significant reduction in muscle tensionSignificant reduction in use of medicationEEG decreased cognitive effectsAverage numberof visits was 11-short and economicHome training was essential for efficacy andmaintenance. Increased improvement ofsymptoms by 20%
Comprehensive Biofeedback ProgramsHelp the patient recognize and controlpsychophysiological processes that contribute totriggering headaches or making them worse.These techniques can be used to reduce thepain, frequency, and severity of headaches; andreduce the need for rescue medications and visitsto the hospital.
Headache diaryAccurately record the number, severity, and length ofheadaches while investigating foods, stressful events, or otherfactors contributing to headaches. Also to record methodsused to control the headache and identify what is helping.Deep breathing exerciseBegins to train the central nervous system to relax, reducing itsexcitability.Handwarming with and without thermal biofeedbackLearning to initiate the relaxation response and warm the coldextremeties found with migraine by normalizing circulation.Homework- diary, breathing and handwarming
Education about triggers including dietary, environmental andemotional triggers.Elimination or Rotation diet may be recommend to identify foodtriggers.Mindfulness and Dialectical Behavior TrainingType of Cognitive Behavioral Training that helps in learning toidentify thinking habits that increase stress. Working to reducestressful thinking may eliminate another trigger.EMG and EEG biofeedback/NeurofeedbackGives instant feedback and tracks physiology that teachesreduction of tension in muscles and nervous system excitability.(Muscle tension is often higher in migraine headache than tensionheadache.)
Progressive relaxation and Autogeneic Imagery TrainingInstruction in deep muscle relaxation, distraction techniques forpain, and quieting the mind.Simple accupressure techniquesBased on acupuncture trigger points found to help headache pain.Homework-Progressive relaxation and Autogenic ImageryTraining
EXERCISESMindful Meditation:Paced breathing: Stare at spot or close eyes.For 5 minutes count in your mind as you breathe.Breathe in counting to 4Stop for 1Breathe out for 4Stop for 1Stretch at end of exercise.