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Do You Need to Tolerate Migraines?

Posted Sep 13 2008 1:27am
"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 (she's not really named Sydney - I'm protecting her privacy) worked with me using a neurofeedback 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. (Don't we all tend to do that? -- We get a little success and then the "cheating" starts... ;-) When we looked at a graph of her headache log activity, it showed the direct connection. On training weeks, she was migraine-free about 5-6 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 (more on that in another post), she was able to "graduate".

The quote above is from the real Sydney and I think says it all about her success.

What causes migraine?

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 what?? Speak English, Karen...)

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.

There are even some theories that migraines evolved as a Good Thing (!), to give us warning about toxic plants (Don't eat that! It will trigger a migraine!), storms approaching (get shelter - storm's on the way!), etc.

In any event, we know we don't want migraines now -- so what can you do about it?

What can you do about migraines?

Medications

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 to the trouble of neurofeedback?

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...well, you get the picture.

Relaxation and Handwarming 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 de crease 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: Hemoencephalography

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").

I've included some "before and after" pictures taken using an infrared camera. These pictures are courtesy of Dr. Jeffrey Carmen
, the developer of the pirHEG system. Notice how the dark areas in the first picture are lighter after training -- that's the effect of the increased blood flow to the frontal lobes.


Before HEG session After HEG session

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 4 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 6 sessions got significant relief from their headaches, just like Sydney.

There have been a number of other studies that have found similar results.

What are the side -effects?

OK, good question.

I have some good news and some 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:
(1) these are easily avoided by being gentle during the first couple sessions and stopping when you feel you are tired and
(2) 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. Cool, eh?

So it may be worth exploring HEG training if you suffer from migraines -- I'd be happy to speak with you more about HEG training.

For more about pirHEG:
Contact me at my email address or the phone number at my website: www.BrainandHealth.com

Read my article on " Thick Skinned or Thick-Brained?"

For more about migraines:

Migraines and Serotonin
Headache and Migraine News Blog
Interesting blogs on migraine:
Living with Migraines
My Migraine Battle


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A book about migraines, written by the famous neurologist (who gets migraines himself).

From the review: "The many manifestations of migraine can vary dramatically from one patient to another, even within the same patient at different times. Among the most compelling and perplexing of these symptoms are the strange visual hallucinations and distortions of space, time, and body image which migraineurs sometimes experience. Portrayals of these uncanny states have found their way into many works of art, from the heavenly visions of Hildegard von Bingen to Alice in Wonderland. Dr. Oliver Sacks argues that migraine cannot be understood simply as an illness, but must be viewed as a complex condition with a unique role to play in each individual's life."

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A different approach -- a novel about migraines and what's like to live with them.

From one Amazon reviewer: "Claire's Head is a stunning depiction headache pain and treatment, desperation, and hope. The novel is an examination of the relationship that someone with migraines has with him or herself and with others. Even if your headaches aren't migraines, the struggle is probably familiar."
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