Biofeedback and Migraines
For people who’ve never had a migraine before, it’s easy to dismiss migraines as “just a really strong headache”. But for those who’ve had a migraine, it’s easy to see that a migraine is different. But despite the misunderstandings surrounding migraines, they’re not uncommon; The American Migraine Prevalence and Prevention (AMPP) Study revealed that 12% of adults in the United States have suffered from a migraine.1
Who Gets Migraines?
The majority of migraine sufferers are female (Stewart, 66), and migraines appear to be the most common in the lower economic classes (Stewart, 68). In the AMPP, Stewart theorizes that migraine sufferers in a higher socioeconomic group are more likely to receive adequate treatment from their physician. Stewart’s alternate theory is that in some individuals, headache-related disability may disrupt the ability to move to a higher socioeconomic class.
What is a Migraine?
A migraine is not just a headache. For many migraine sufferers, the headache is only a small part of the problem. Migraines often progress through four stages.2
The earliest phase of a migraine (usually 1 to 2 days before the attack), the prodrome phase, is sometimes serious enough to be disabling, and sometimes it’s so mild that it’s not even noticed. According to the Mayo Clinic, the prodrome phase may include:
- Food Cravings
- Neck Stiffness
- Uncontrollable Yawning
Some migraines (called “classic” migraines) present with an aura. It can occur during the prodrome phase or the attack, and it may include visual disturbances (seeing shapes or flashes of light), vision loss, “pins and needles” in the arms or legs, and speech problems. Common migraines do not present with an aura.
The migraine attack can last anywhere from four hours to several days (Mayo Clinic). While most people associate migraines with the headache, a migraine attack frequently presents with additional symptoms. Sensitivity to light and sound is common, as is nausea (and sometimes vomiting). Blurred vision is a frequent symptom, and lightheadedness can be problematic and can sometimes lead to fainting (Mayo Clinic).
After the migraine, most people feel fatigued and exhausted. Some people feel happy and even euphoric, but the majority of migraine sufferers feel weak, shaky, or extremely fatigued after an attack. This phase is called the postdrome. Additionally, if the migraine is severe or isn’t properly treated, some of the symptoms of the attack (like the nausea or lightheadedness) may continue in a milder form into the postdrome.
When to Call the Doctor
If you’ve never had a migraine before, you need to seek immediate medical attention. In rare cases, a migraine can be a sign of a neurological problem.3 Even if you’ve had a migraine before, go to the emergency room or seek immediate care if:
- Your headache is associated with paralysis, speech difficulties, mental confusion, seizures, personality changes, or other neurological symptoms
- Your headache presents with a fever, difficulty breathing, stiff neck, or a rash
- The headache is severe enough to wake you in the middle of sleep
- The headache causes severe nausea or vomiting
- A headache occurs after an injury or accident (even an accident that didn’t directly impact the head)
- You have a new type of headache and you’re over the age of 55
If your headaches aren’t urgent, you may still need to contact a doctor if you:
- Have more than two headaches a week
- Have headaches that continue to get worse and won’t go away
- Take an over-the-counter pain reliever for your headaches every day (or every other day)
- Take more than two or three doses of over-the-counter headache medicine each week
- Have headaches that are triggered by exertion, like coughing, exercise, or strenuous activity
- Notice anything different or new about your headaches
Treating a Migraine
There are three types of migraine treatment: Preventative treatment, acute treatment, and rescue treatment.4
Preventative treatment is intended to help prevent migraines from happening. If you have a single migraine every few months, your doctor may not prescribe you a preventative treatment. If you’re having several migraines a month, preventative treatment can be effective in helping to reduce that number.
Acute treatment is designed to give you relief and possibly stop a migraine attack. Many migraine sufferers are treated with a class of drugs called triptans (Migraine Trust), but in order for these to be effective, they must usually be taken at the earliest onset of the migraine. You can discuss your acute treatment options with your doctor.
Rescue treatment is what you use if your acute treatment doesn’t work, or doesn’t give you enough relief from an attack. In some cases, if you don’t catch the migraine early enough, your acute medication may not work and you’ll need a rescue medication. The goal with acute treatment is to stop the migraine, whereas the goal of rescue treatment is simply to mediate the symptoms.
For some mild migraines, over-the-counter pain relievers can help mitigate the symptoms. The most common of these are NSAIDs, like ibuprofen (Advil). NSAIDs taken at doses higher than the over-the-counter dose should be approved by your doctor. If you’re taking these drugs regularly (more than two or three doses a week), check with your doctor, as these medications can cause serious cardiovascular risk (including heart attack and stroke) or serious gastrointestinal problems (including bleeding, ulceration, and perforation of the stomach or intestines).
In some cases, acetaminophen (Tylenol) may be prescribed for mild migraines. However, an overdose of acetaminophen can cause serious liver damage, and it may react with some prescription medications.
Two of the most common medications used to prevent migraines are topiramate (Topamax) and divalproex sodium (Depakote). Topamax can cause drowsiness, dizziness, loss of coordination, diarrhea, weight loss, and mental problems (confusion, trouble concentrating, etc.). Depakote can have side effects such as dizziness, diarrhea, drowsiness, hair loss, changes in vision, shakiness (tremor), and weight changes. In some people who take it, either medication can cause depression or other mood problems.
Triptans or ergots are sometimes prescribed as an abortive medication for migraines. Triptans (Imitrex, Maxalt, Zomig, etc.) can cause dizziness, drowsiness, and muscle weakness, and they’re not recommended for people at risk of a stroke or heart attack. Ergots aren’t as effective as triptans, and they can cause nausea and vomiting, as well as causing more frequent headaches.
In rare cases, a doctor may prescribe opioids for migraine, but this is unusual. Most doctors are extremely hesitant to prescribe opioids (like codeine, Hydrocodone, or Oxycodone) because of the high risk of addiction, as well as the high rate of side effects.
A study conducted in 2002 and 2003 compared migraine patients who received acupuncture with patients who received no acupuncture, as well as with patients who received “sham” acupuncture. While acupuncture was effective in reducing migraines, it was no more effective than sham (placebo) acupuncture in helping to prevent migraine.5 Additionally, acupuncture can have complications. Improper sterilization of acupuncture needles has transmitted HIV and hepatitis. Acupuncture needles applied improperly can traumatize tissues and organs, or can become broken and fragments dislodged into organs.6
Several studies have indicated that regular massage may help to prevent migraines.7 Regular massage may help to decrease anxiety, heart rate, and cortisone production.8 However, many of these studies do not provide continuing benefits; that is, the migraine prevention seems to continue only as long as the regular massage therapy continues.
Biofeedback has been extensively studied as a preventive measure for migraine headaches. In addition to the immediate reduction in migraine frequency, biofeedback often provides improvement that remains stable even after treatment is discontinued.9
- Stewart, W. F., Lipton, R. B., Celentano, D. D., & Reed, M. L. (1992). Prevalence of migraine headache in the United States: relation to age, income, race, and other sociodemographic factors. Jama, 267(1), 64-69.
- Migraine. (n.d.). Retrieved February 19, 2015, from http://www.mayoclinic.org/diseases-conditions/migraine-headache/basics/symptoms/con-20026358
- When to Call the Doctor About Your Migraines or Headaches. (n.d.). Retrieved February 19, 2015, from http://www.webmd.com/migraines-headaches/guide/when-call-doctor-migraines-headaches
- Treatment. (n.d.). Retrieved February 19, 2015, from http://www.migrainetrust.org/treatment
- Linde K, Streng A, Jürgens S, et al. Acupuncture for Patients With Migraine: A Randomized Controlled Trial. JAMA. 2005;293(17):2118-2125. doi:10.1001/jama.293.17.2118.
- Ernst, E. (1995). The risks of acupuncture. The International Journal of Risk and Safety in Medicine, 6(3), 179-186.
- Lawler, S. P., & Cameron, L. D. (2006). A randomized, controlled trial of massage therapy as a treatment for migraine. Annals of Behavioral Medicine, 32(1), 50-59.
- Hernandez-Reif, M., Dieter, J., Field, T., Swerdlow, B., & Diego, M. (1998). Migraine headaches are reduced by massage therapy. International Journal of Neuroscience, 96(1-2), 1-11.
- Nestoriuc, Y., & Martin, A. (2007). Efficacy of biofeedback for migraine: a meta-analysis. Pain, 128(1), 111-127.