Do You Need to Tolerate Migraines?Dr. Karen Shue, PhD March 1, 2006
“I can’t remember when I last had a headache” – from someone who had daily migraines when she started HEG neurofeedback
Sydney got migraines. Serious migraines. Every day. Sometimes she would get a migraine shortly after getting up and it would last until she went to bed that night. You may know what that’s like. The one-sided throbbing or high-pressure pain that saps all your energy, makes it difficult or even impossible to keep going with daily activities, and lasts for hours or even days.
The real Sydney (not her real name) worked with me using a brain biofeedback technique called passive infrared hemoencephalography or pirHEG, for short. We worked in weekly sessions to start and the severity of her headaches went down. Way down. And she didn’t need to use medications to manage those few that happened.
Then she had to skip some weeks while she was still getting headaches, although they were less severe. When we looked at a graph of her headache log activity, it showed the direct connection. On training weeks, she was migraine-free about five to six days. On weeks she skipped, the headache activity shot up during the second week. Once we got back on a regular schedule, we were able to reduce both the number and intensity of her migraines. When we added in some heart-rate variability training, she was able to “graduate.”
The quote above is from the real Sydney and I think says it all about her success.
WHAT CAUSES MIGRAINES?
Migraines are kind of like “spasms” of the brain’s circulatory system. There at least two stages everyone who has had a migraine is familiar with, although you may also find descriptions that break this down into four stages.
1) “Readiness” for a headache: Sometimes people talk about this as the headache’s “aura” and about 20% of migraineurs get it. If you get this aura, you may experience neurological or cognitive symptoms such as small flashing lights in your vision, difficulty finding words or speaking, tingling or numbness on the side where the headache eventually happens, etc. People who get an aura sometimes use it as a signal to take a medication. For some people, there is an aura, but no headache following, which is known as a “silent migraine.”
2) The Headache: Unlike tension headaches, migraines often start after a period of severe or prolonged physical or emotional stress. During the migraine, there is expansion of blood vessels in the brain. While researchers used to think this swelling was the cause of the migraine, now they are more convinced that the migraine is started by other factors, but that the swelling creates the pain and other symptoms such as nausea, sensitivity to light, sounds, or smells, etc.
The theory of what causes migraines with the most current support is that they involve and are likely caused by spasms of the trigeminal-vascular system.
The trigeminal-vascular system includes several areas of the brain working together, including the trigeminal nerve and its branches, the entire blood circulatory system in the brain, and the brainstem. So although you feel the migraine in a specific place, it is really affecting your whole brain – leading to the other symptoms you experience.
There are even some theories that migraines evolved as a good thing; to give us warning about toxic plants (i.e. don’t eat that, it will trigger a migraine), approaching storms (i.e. get shelter, storm’s on the way), and so on.
In any event, we know we don’t want migraines now, so what can you do about it?
WHAT CAN YOU DO ABOUT MIGRAINES?
Certainly, there are some medications that can be useful for migraines. These generally come in two flavours: those intended prevent a migraine developing and others that try to stop the headache after it starts.
So why would any one go need an alternative? Well, there are a couple of reasons. One, of course, is that many people don’t like to take medications if they can help it. That may because they want to avoid the side-effects or the ongoing cost of taking regular medication. Medications may not help sufficiently or they “knock you out,” leaving you feeling less or no pain, but groggy and still needing to miss out on your responsibilities or having fun.
On the other hand, medications for the pain of migraines may be very effective at stopping the pain. So effective that some people fall into taking them too often and discover that they develop what are called “rebound” headaches. Rebound headaches are caused by the medication itself – as the medication wears off, it triggers a headache – sometimes worse and longer-lasting than the original. That leads the person to take some more medication, which leads to another headache as it wears off and . . . well, you get the picture.
RELAXATION AND HANDWRITING BIOFEEDBACK
There are studies that show alternatives to medication can be just as effective as medication. Relaxation and a type of biofeedback training that teaches you to warm your hands can help to either prevent a headache or stop it once it has started. Researchers report that headaches can be decreased by up to 50% using these techniques.
Here’s an interesting finding from one study: They taught migraineurs to heat up their hands. The idea behind doing this is to move blood away from the swollen brain areas into the extremities, thus reducing the pressure and pain. They used a comparison group who they taught to decrease the temperature in their hands – this should have made them worse, yes? But no. They also improved and just as much as the “real” treatment group.
So what’s going on? Another training method may help us understand this finding.
HEG involves placing an infrared sensor on the middle of the forehead. The sensor is attached to a box that gives a reading of the amount of oxygen being carried by the blood vessels in the frontal lobes of your brain (i.e., the part of your brain just behind your forehead).
Learning to increase the activity of the frontal lobes reduces the number and/or severity of migraines and can even stop a migraine when it’s happening.
HOW DOES HEG BIOFEEDBACK WORK?
As true for many medications and health care approaches, we don’t know exactly. But I’ll give you our best current understanding. The frontal lobes are largely inhibitory and regulatory, meaning they put the brakes on other parts of our brain when necessary and help “balance” the activities of the brain as a whole.
So by training the frontal lobes to be more active and efficient, they seem to control/reduce the spasms of the trigeminal-vascular system.
This results in either less frequent spasms (i.e., fewer headaches) and/or quicker control of the migraine (i.e. shorter headaches, even “silent migraines”).
Learning to control the blood flow in your head takes intense concentration – right in the area of the frontal lobes. This helps explain the finding of the hand warming study – it may not have been whether they increased or decreased the warmth of their hands or “moved” blood in or out of their heads that mattered – it may have been having to concentrate on making these things happen that increased the flow of blood to their frontal lobes and voila!
BUT DOES IT WORK?
Dr. Carmen has completed a study of 100 people with migraines over four years who were taught to increase the blood flow to their frontal lobes using HEG. He found that over 90% of those who completed at least six sessions got significant relief from their headaches, just like Sydney.
There have been a number of other studies that have found similar results to those of Dr. Carmen.
WHAT ARE THE SIDE EFFECTS?
Okay, good question. There is good news and better news.
First, the good news. There is a chance of “side effects” after initial sessions if you work too hard or too long. These effects will look like less efficient frontal lobes: maybe a migraine, extreme irritability, attention problems, etc. Even if they happen, you will likely feel back to normal or better after a good night’s sleep. The good news is that, firstly, these are easily avoided by being gentle during the first couple sessions and stopping when you feel you are tired; and secondly, even if they happen, you will likely still get improvements from the session after the temporary side effects go away.
Next, the better news. The long-lasting side effects of pirHEG training for migraines includes: improved attention and concentration, less emotional sensitivity when it’s not needed (e.g., irritability, tears, anxiety), better planning and organization – all associated with improved frontal lobe functioning.
So it may be worth exploring HEG training if you suffer from migraines.