Migraine Headaches

HEADACHE....IT ISN’T ALL IN YOUR HEAD

It’s also in your neck, or upper traps, scalenes, levators, sternocleidomastoids, and these are only some of the muscles involved in triggering headache. The ultimate cause of headache pain is usually located away from the areas where pain is felt. Doctors Janet Travel and David Simons pinpointed specific pain referral patterns from trigger points in a variety of muscle groups causing typical headache patterns. Inappropriate use of these muscles over time perpetuates headaches of all types, tension as well as migraine. Physicians’ most common referrals to the Brain Wellness and Biofeedback Center of Washington (BWB) for headache are of patients who have not responded to other headache treatments. Rene Cailliet in the forward to Myofascial Pain and Dysfunction, The Trigger Point Manual, notes that the medical community frequently overlooks pain resulting from soft tissue problems. “Yet, patients continue to present themselves with symptoms that are attributable to myofascial trigger-point pathophysiology. These patients often fail to receive proper evaluation and, therefore, appropriate treatment.” (Travell, J. 1983)

At BWB we offer an interactive computerized assessment of these pain patterns. This reveals any muscle activity contributing to chronic headache. Once the inappropriate usage patterns are revealed and understood our patients are taught how to use that information to practice appropriate muscle use at home and begin to replace the pain-producing patterns with functional movements. We begin with a history, and a painless surface electromyography (sEMG) evaluation of muscle imbalances. We are interested in all causes of trauma to the CNS (Central Nervous System), whether the result of blunt head trauma, whiplash, coccyx injuries, toxic exposure, among other causes. Mild traumatic head injury (TBI) is far more prevalent than most realize and can have profound effects upon muscles involved in headache. The treatment plans often include stress-reduction biofeedback.

BWB therapists have developed biofeedback treatment protocols that have proven very successful in treating a variety of headaches of mixed or unknown etiology in both adults and children. By combining various types of biofeedback technologies our clients usually complete treatment in fewer than 15 sessions. In this program the client is an integral part of the treatment team because much of the corrective treatment is practiced at home. Lifestyle changes are usually needed. Well-meaning attempts to be active may actually perpetuate the condition by working (or attempting to strengthen) a muscle that already has trigger points. This will only aggravate the problem. The underlying issue of appropriate muscle use involving posture and imbalances must be addressed. The biofeedback processes teach how to restore balance that reduces headache frequency and intensity.

Chronic pain affects many organ systems. Researchers presenting at the America Pain Society and the American Academy of Pain Management reported “...clear evidence that chronic pain produces cardiovascular and immunologic complications. Even more compelling was a study by Sora and Associates from Northwestern University that compared brain mass in chronic pain patients with normal controls. The chronic pain patients’ gray matter had significantly less density”. “Although nervous system-type pain, per se, is in early stages of research, practitioners and patients need to be keenly aware that there is growing evidence that uncontrolled pain may produce pathologic, neurologic, immunologic, cardiovascular and endocrine changes.” (Tennant 2003) For these reasons BWB has several biofeedback and stress management treatments available to our pain patients. Biofeedback treatments, including its use for stress reduction, are becoming “standard components of the armamentarium for management of migraine and tension-type headaches. Meta-analytic literature reviews of these behavioral interventions have consistently identified clinically significant reductions in recurrent headache. Across studies, (such treatments) have yielded approximately 35-50% reduction in migraine and tension-type headache activity.” (Penzien 2002)

Examples of typical patients with headache successfully treated with biofeedback therapies at BWB.

A fifty-four year old female struggled with constant occipital pain and some forehead pain for 4 years. The pain started in her right arm after hitting her elbow. Her medications included ½ Ambien at night, Relafen, and Robaxin . After 14 EEG treatments and 10 sEMG sessions, her occipital pain was completely gone. Her TMJ pain resolved as well. Upon completion of treatment she reported occasional body pain but could go weeks without medication.

A fifteen-year-old male had been suffering with debilitating headache for 6 years, along with poor sleep, fatigue, & hyper-reactivity to stress. After 13 EEG treatments, 4 sEMG sessions, and 4 heart rate variability sessions, he enjoyed significant improvement. He experienced only a few headaches per month; and this was after suffering from pneumonia, taking the practice SAT for 3 ½ hours, and taking final exams. His energy remained good despite increased stress.

Ever since she could remember, this 46-year-old female suffered with headache. She took Advil (250 mg) up to 3 times per day and Ambien at night. Her daily life consisted of waking up with constant daily headaches, with a gradual worseneing throughout day, & long work hours. After 10 EEG treatments, 11 sEMG sessions, and breath work, her daily headache went away. Subsequently, this woman was able to travel for a 3-week training conference without her sleeping pills! She reported to only suffer from1 or 2 headaches during that time. When last seen, she had experienced 1 headache in 1-½ months for which she had not needed Advil. She had not resumed the Ambien.

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Related Research and Articles
Adler, C. S.& Adler, S. M. (1989). Strategies in General Psychiatry. In Basmajian, J.V., Biofeedback, Principles and Practice for Clinicians, 3rd ed. Williams and Wilkins, Baltimore MD, pp 233-248. This is a 10-year study comparing 2 headache groups, biofeedback treatment group and a psychotherapy-only group. 10 – 12 years after treatment ended the biofeedback group had an average of 5.8 migraines/year, a drop from an average of 36/year (compared with a non-significant statistical drop from 35 – 20/year for controls.) Medication use also dropped significantly only in the biofeedback group.

Budzynski, T. H. (1989). Biofeedback Strategies in Headache Treatment. In, Basmajian, J.V., Biofeedback, Principles and Practice for Clinicians, 3rd ed. Williams and Wilkins, Baltimore MD, pp 197 – 207. (An historical overview of the use of biofeedback and various types of headache and the various types of biofeedback that are used as interventions see.)

Penzien, D.B., Rains, J.C.,& Andrasik, F. (2002). Behavioral Management of Recurrent Headache: Three Decades of Experience and Empiricism. Applied Psychophysiology and Biofeedback (27), 2. p. 163–181.

Tennant, F.A. (2003). Time to be more aggressive. Editorial. Practical Pain Management. May/June. p.8

Travell, J.G. & Simons, D. (1983). Myofascial Pain and Dysfunction, The Trigger Point Dysfunction. Williams and Wilkens, Baltimore, MD. p. vii