Information on Study of Headache Relief {3 long articles}

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Greetings List: For information of others on the list here are 3

articles that explain migraine headache relief.

McGrady A et al : Effect of biofeedback-assisted relaxation on migraine

headache and changes in cerebral blood flow velocity in the middle

cerebral

artery.

McGrady A et al:

Effect of biofeedback-assisted relaxation on migraine headache and

changes in cerebral blood flow velocity in the middle cerebral artery.

Headache, 34(7):424-428, 1994. 14 References Dept. of Psychiatry,

Medical College of Ohio, PO Box

10008, Toledo, OH 43699-0008 (Ms A McGrady, Ph.D.) JAC.08 DC9409/339 ©

1994

This study examined the effects of thermal biofeedback-assisted

relaxation on migraine headache (HA) pain and medication use. It also

examined whether there is a relationship between central blood flow

(CBF) velocity in the middle cerebral artery (MCA), and improvement of

HA mediated by biofeedback-assisted relaxation. Two types of relaxation

were involved in migraine patients: one was biofeedback-assisted

relaxation therapy and the other was a self-relaxation control.

Assessments were made of HA pain, medication use, and CBF velocity of

the MCA before and after treatment.

A total of 23 migraine HA patients volunteered for the study. They were

mailed HA log sheets to record the intensity, frequency, and duration of

HAs, and prescription and over-the-counter medication use for a 15-24

day period before group assignments were given. Patients reported the

use of analgesics, antidepressants, non-steroidal anti-inflammatory

drugs, and calcium channel blockers. At the first visit, patients

completed a medical history questionnaire on their HAs, other medical

problems, and general health habits, eg, smoking, exercise, and caffeine

use. Forehead muscle measurements, electromyographs (EMGs), and finger

temperatures were recorded during a 15 min period with the patient

reclining with their eyes closed. CBF was measured in the left and right

MCA with a transcranial Doppler. Psychological measurements included

anxiety and depression tests administered pre- and post-test.

Patients were randomly assigned to one of two groups following

pre-tests: the experimental (EXP) group (n = 11) and control (CON) group

(n = 12). The EXP group underwent 12 sessions of biofeedback (4 EMG

biofeedback and 8 temperature biofeedback) over a 12 wk period. EMG

feedback from the forehead muscles was added to relaxation because

excessive contraction of facial and head muscles may contribute to HAs.

Autogenic relaxation was presented at the first treatment session. Two

10-15 min daily at-home practice periods using taped autogenic

relaxation were recommended. During treatments, patients were trained

to decrease forehead muscle tension and to increase finger temperature

with feedback and autogenic relaxation. The CON group (self-relaxation)

was told to relax on their own for 10-15 mins. bid, concentrating on

peaceful thoughts or on their breathing. No tapes or scripts were used.

This group was seen twice during the 12 wk period. Both groups continued

to monitor HA pain and medication use. At the conclusion of the study,

both groups returned for post-test measurements. For another 6 wks.,

patients were asked to monitor their HAs and the information was

included. The data was analyzed and success was defined as 50% reduction

in pain

score.

The EXP group lowered forehead muscle tension and increased finger

temperature, whereas the CON group did not. The EXP group decreased pain

by 35%. Six of eleven patients decreased pain by more than 50%. The CON

group increased pain by 7.7%; three of twelve patients decreased pain by

50%. In the EXP group, no patients increased medication intake, whereas

nine decreased. In the CON group, four patients increased medication,

while only five decreased. The group difference in medication change

between pre- and post-test was significant. The MCA blood flow data

revealed that the EXP group decreased peak systolic velocity and mean

blood flow velocity on both the right and the left sides. The CON group

decreased peak systolic velocity and mean blood flow velocity slightly

on the right side and increased on the left side. Of the eleven patients

in the EXP group, nine had a left/right difference in peak systolic

velocity of > 10 cm/sec in comparison to three of eleven in the CON

group (CBF on the right could not be determined in one patient). The

anxiety and depression measurements showed decreases in all measures in

both groups. Pain scores in the EXP group showed a decrease from 1.09 at

pre-test to 0.86 at post-test, with a further decrease to 0.42 at

follow-up. The percentage

of success (60%) was identical at post-test and follow-up. Ten patients

reported continuing their practice of autogenic relaxation at least once

a day.

The results show that the biofeedback-assisted relaxation therapy was

superior to the self-relax in pain and medication reduction. Fifty-five

percent of the EXP group and 25% of the self-relax group met criteria

for success. Decreases in all types of medication use supported the

reductions in HA intensity, duration, and frequency. Follow-up data

suggest persistence of the success of the treatment for 4-6 wks..

Evidence from other studies suggests success lasts for several yrs..

Of special interest is the suggestion that a higher blood flow velocity

(related to vasoconstriction of the MCA or vasodilation in the

arterioles) exists on one side of the head in migraineurs even during

the interictal period. In fact, the EXP group significantly reduced peak

systolic velocity and mean CBF velocity on the side with the highest

velocity. Interpretations of this data are limited. However, future

studies will include measurements of CBF velocity in other intracranial

vessels where abnormalities in flow may be related to migraine.

2

Blanchard EB et al : The role of perception of success in the thermal

biofeedback treatment of vascular headache.

Blanchard EB et al:

Headache Quarterly, 5(4):231-236, 1994. 12 References Center for Stress

and Anxiety Disorders,

University at Albany, 1535 Western Ave., Albany, NY 12203 (Dr EB

Blanchard) DN.03 MY9528/148 ©1995

Biofeedback is a popular, well-accepted form of non-drug treatment for

chronic headache (HA) which consistently leads to meaningful improvement

in 40-80% of patients. The most widely accepted explanations for these

improvements posit that the benefits are the result of patients'

learning to control peripheral responses which mediate the physiological

pathway of the HA (increased muscle tension in tension HA; peripheral

vasoconstriction and vasodilation in vascular HA).

The participants in this research were 28 chronic vascular HA patients

(15 with migraine and 13 with combined migraine and tension HA), average

age 38.5 yrs., who had an average 16.9 yr. history of HAs. There were

four males and 24 females. The patients were started in a HA diary in

which they recorded level of HA activity on a zero (no HA) to five

(intense, incapacitating HA) scale four times a day. They also recorded

all medications taken. The diary was continued throughout treatment, and

for a four week post treatment observation period. All participants

received 12 sessions of thermal biofeedback (TBF) for hand warming,

spread over approximately six wks.. At the initial session, a rationale

for the hand-warming treatment was given which emphasized the

prophylactic effects of learning the hand-warming. The patients were

given the positive expectancy that learning the hand warming response

would lead to a decrease in HA activity. Patient's expectations of

relief of HAs were assessed by questionnaires. All biofeedback sessions

had the same format.

After attaching the temperature sensor to the dorsal surface of the most

distal phalanx of the left index finger, a 3-7 min adaptation phase

followed. Next was a 4 min in-session baseline during which the patient

sat quietly. Next followed a 4 min self-control phase during which the

patient was to warm his or her hand without the benefit of feedback.

Finally, there was a 16 min feedback trial during which feedback was

available and the patient was asked to warm his or her hand as much as

possible.

The average baseline temperature and the highest temperature in

self-control or during feedback training were recorded. The primary

independent variable was the manipulation of the participant's

attributions about how successful she/he was at biofeedback.

Attributions were manipulated by computer and given to the patient at

the end of each session. The printout compared the patient's performance

to other similar HA patients. For the patients in the high success

condition, by the third session, they were depicted as performing at an

average percentile value of 80%. For the modest success condition,

values averaged about the 50th percentile. For the subjects in the high

success condition, increases in temperature were doubled while decreases

were halved. For the subjects in the modest success condition, increases

in temperature were halved, while decreases were unaffected; therefore,

the biofeedback was accurate in reflecting changes and correctly

indicating direction of

change.

The HA index was calculated by summing four ratings/day times seven days

and dividing by seven to get an average HA index for the week. This

value incorporates intensity and duration and was considered most

sensitive. For the medication index, each medication was " scaled " and

multiplied by the number of doses taken, to represent the level of

weekly HA medication consumption.

There was significant reduction in HA activity and a trend for the

attributional manipulation to lead to differential HA relief. These

results confirm our previous finding (Blanchard et al, 1991) that

thermal biofeedback for hand-warming, can lead to significant reduction

in the HA activity of vascular HA sufferers. Our main difficulty in this

study was that a sizable minority of the vascular HA patients in the

modest-success condition thought they were doing very well. This could

be because they were experiencing success at the hand warming task,

which is inherent in the biofeedback treatment. We believe that some of

the HA relief experienced by vascular HA patients receiving thermal

biofeedback is due to the inherent success experience built into the

task and to its consequent effects on patients' self-efficacy.

Vijayan N:

Head band for migraine headache relief.

Headache, 33(1):40-42, 1993. 6 References Headache & Neurology Clinic,

1020 29th Street, #360,

Sacramento, CA 95816 (Dr N Vijayan) JAC.04A 184.1 7/93 © 1991

Abortive therapy of migraine headache (HA) is usually achieved by the

use of vasoconstrictor agents, analgesics, sedation, and anti-emetic

agents. Various non-pharmacological methods have also been tried in the

past, ice pack being the most common of these procedures. Some patients

have also reported relief from hot baths or hot packs applied to the

neck and scalp. A large number of patients reported using finger

pressure in the temporal region for temporary pain relief. One hundred

consecutive patients with a diagnosis of migraine HA with and without

aura were interviewed. Ninety-two percent of these patients had

attempted some type of local measure in an attempt to control the pain;

85% used finger pressure, a tight towel, or a piece of clothing around

the head. Seventy-five percent of those using these techniques reported

some degree of relief of pain as long as the pressure was maintained.

Pressure was applied over the area of maximum pain, with 90% applying

pressure over one or both temporal regions, 5% in the sub-occipital

regions, and the rest over the forehead. Those who used finger pressure

often sought the help of other family members to help them with

continued application of pressure. After several attempts at designing a

pressure band for the head, it was found that a firm rubber disc 1 cm

thick and 3 cm in diameter inserted under an elastic band (4-5 cm wide

and 60-65 cm long) and secured with Velcro was effective in applying

desired localized pressure. One or more of the rubber discs could be

used. Twenty-five patients with a diagnosis of migraine with and without

aura, according to criteria established by the Headache Classification

Committee of the International Headache Society, were tested with these

bands. A pain log of 0-10 was used to assess the severity of pain. The

band and the discs were applied when the pain reached > 5 on the pain

scale. The amount of pressure applied was determined by the patient to

obtain maximum relief without discomfort, and one or more discs were

used over the maximum pain areas. Pain was assessed at 10 min intervals

for 30 mins.. The band was then released and pain severity was assessed

every 10 mins for 30 mins. Each patient used the band during three HAs.

No analgesics or vasoconstrictors were allowed for the duration of 60

mins.. Two patients could not apply adequate pressure because of

tenderness of the scalp and did not remain in the study. Twenty-three

remaining patients used the band in a total of 69 HAs for which data was

collected. HA relief was reported in 60 HAs (87%). There was no

improvement in nine HAs (13%). Of the 60 HAs which improved, 40 HAs

(67%) decreased by over 80%, 15 HAs (25%) improved between 50-60%, and 5

HAs (8%) showed < 50% improvement. All 23 patients continued to use the

band as an adjunct to other therapy during the initial follow-up period

of 6 mos. A simple elastic band applied around the head and secured with

Velcro, along with the use of rubber discs inserted beneath the band for

additional local pressure over maximum pain areas, appears to be

beneficial for temporary and partial control of migraine pain, and is

effective as an adjuvant with use of analgesics and vasoconstrictors.

The exact mechanism of this remains unknown.

Peace & Blessings

D.

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