Presentation on biofeedback to treat headaches and migraines.

1. Biofeedback and other
Psychophysiological Techniques
for Headache
By Lisette Markham

2. Elise “Lisette” Markham, MA, CADC, BCN-
Senior Fellow
Certified Biofeedback & Counseling LLC
9509 U.S. Highway 42
Falsoft Building, Suite 201A
Prospect, KY 40059
502-644-6975
certifiedbiofeedback@gmail.com

3. 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.

4. 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.

5. TYPES OF BIOFEEDBACK

6. GSR (Galvanic Skin Response) biofeedback:
Training to reduce electrical resistance or
perspiration for stress reduction or pain
reduction.

7. 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.

8. 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.

9. 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.

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

11. What is Clinical EEG Biofeedback or
Neurofeedback?

12. 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.

13. 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.

14. 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.

15. 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

16. 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-asleep
5. SMR 13-15 Hz over sensorimotor strip-relaxed
muscles, quieted motor activity and paying attention.
6. Other normal rhythms- lambda, mu, sleep spindles
7. Abnormal patterns- referral to neurologist

17. 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.

18. 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).

19. 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

20. 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

21. 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%

22. 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.

23.  Headache diary
Accurately 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 exercise
Begins 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

24. Education about triggers including dietary, environmental and
emotional triggers.
Elimination or Rotation diet may be recommend to identify food
triggers.
Mindfulness and Dialectical Behavior Training
Type 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/Neurofeedback
Gives 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.)

25. Progressive relaxation and Autogeneic Imagery Training
Instruction in deep muscle relaxation, distraction techniques for
pain, and quieting the mind.
Simple acupressure techniques
Based on acupuncture trigger points found to help headache pain.
Homework-Progressive relaxation and Autogenic Imagery
Training

26. 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.