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Page reviewed July 2005
1. MIGRAINE
Migraines are vascular headaches. That means they are caused by changes in the blood vessels going to the scalp and brain.
Initially these blood vessels constrict (get smaller - vasoconstriction). For sufferers of the "Classic Migraine" this constriction produces an "aura" or "prodrome" which may create visual distortions such as flashing lights or changes in hearing or smell. There may be a partial paralysis down one side of the body or a change in sensation. Sometimes speech and thinking become distorted.
During the "Common Migraine", although the blood vessel constriction still occurs, there is no warning "aura". In both types of migraine there is, however, a constriction to the vascular periphery - stomach, intestines, skin, hands and feet and it is this that the applied psychophysiologist makes use of when applying biofeedback.
At some point in the migraine cycle, either when the sufferer takes a break, or when the constriction has been going for long enough they reach a rebound point where the blood vessels suddenly dilate (get larger - vasodilatation) and it is then that the tremendous throbbing headache occurs. The first of these explains why so many individuals get a migraine at the weekend or when they start a holiday.
Traditional medicine has tended to use minor tranquillisers to prevent the initial constriction and ergot derivatives to constrict the blood vessels when they have dilated and the headache has occurred. These, though, only deal with the symptoms, not the causes. It is thought that if you have more than two migraines a month they may be caused by your medication. Many of my students have reduced but not eliminated their headaches by reducing or eliminating the pills they take for the condition. If you are getting more than two migraines a month talk to your GP about doing this.
Most of the clients who come to me with migraine headaches are actually suffering from combined headaches - migraine and tension headache - and so self help training homes in on both. Although there was a technique that taught vasoconstriction during the dilatation phase of migraine, this was quite difficult to do and in consequence training now is aimed at reversing the constriction phase so that the sufferer never reaches the rebound point and gets a headache in the first place. For "Classic Migraine" sufferers this is easy to do. They just carry out their self-regulation practice on a regular basis but at the very least as soon as they get the warning prodrome. For Common migraine students it is the preceding reduction in hand temperature that is of importance.
After helping the student to become more self aware, training begins by looking at breathing patterns, teaching the student to change to slow, relaxed diaphragmatic breathing. We then go on to use myographic biofeedback (muscle) and finally temperature feedback of the hands and feet as an indicator of peripheral vasoconstriction /vasodilatation. All of these are augmented with general relaxation training, the biofeedback being used to check that quite specific criteria are being reached.
Thus a self-help-training programme would include:
- Diaphragmatic breathing.
- Relaxing the muscles of the head, neck and shoulders.
- Learning to dilate the blood vessels in the hands and feet using mental techniques, on the assumption that the other constricted blood vessels are also dilating.
- Looking at precursing thoughts and behaviours that might trigger the migraine cycle.
Theoretically migraines disappear when the student successfully warms hands and feet at will on a regular basis but certainly every time they notice a decrease in hand temperature not due to the temperature of the environment. In practice most of them seem to get rid of the headaches at the beginning of training just through changing their breathing patterns. For many of them this means that the migraines disappear within a few weeks of starting training. This assumes, however, that they diligently practice what they have learnt in the training sessions and that they have no psychological blocks.
Any tension headache component there might be seems to take a lot longer. In other words it seems to be much more difficult to reverse the habit of tensing and bracing head, neck and shoulder muscles than it is to produce a change in the use of the involved blood vessels.
My partner got rid of her migraines within a week of starting her training but still gets tension headaches if she sleeps heavily or in an awkward position.
What about triggers, such as red wine and cheese, they cry! Well I have good news on this front. Although anything that contains tyramine does seem to affect some of my students before they start training, afterwards they seem to be able to eat and drink anything they like without the migraines returning, providing they keep practising the skills they have learnt.
It is with interest that I read in Health Which recently that Biofeedback for the relief of Migraine has finally been accepted as a treatment of choice after research carried out at the University of Exeter. It only took the British 20 years to acknowledge what the rest of the world has accepted! Ah well!
DISORDER FILE TENSION HEADACHE
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