What is Migraine Headache?

A migraine is a severe, painful headache that is often preceded or accompanied by sensory warning signs (called migraine "aura") such as flashes of light, blind spots, tingling in the arms and legs, nausea, vomiting, and increased sensitivity to light and sound. The excruciating pain that migraines bring can last for hours or even days and can result in substantial functional impairment that can have bopth physical and psychological ramifications.  

In 2001, the World Health Organization cited migraine as the 19th leading cause of years lived with disability among both males and females of all ages combined and the 12th leading cause of years lived with disability among females of all ages.

Migraine can be characterized as a chronic disorder with episodic attacks, with potential for progression to more frequent and severe patterns, possibly even chronic migraine.

To see a brief YouTube video on diagnosing and treating migraine headache in Canada, please click on this link... http://www.youtube.com/watch?v=YEtbbHrJj08 

A migraine headache is a form of vascular headache. Migraine headache is caused by vasodilatation (enlargement of blood vessels) that causes the release of chemicals from nerve fibers that coil around the large arteries of the brain. Enlargement of these blood vessels stretches the nerves that coil around them and causes the nerves to release chemicals. These chemicals cause inflammation, pain, and further enlargement of the artery. The increasing enlargement of the arteries magnifies the pain.

Migraine attacks commonly activate the sympathetic nervous system in the body. The sympathetic nervous system is often thought of as the part of the nervous system that controls primitive responses to stress and pain, the so-called "fight or flight" response, and this activation causes many of the symptoms associated with migraine attacks; for example, the increased sympathetic activity in the intestine causes nausea, vomiting, and diarrhea.

• Sympathetic activity also delays emptying of the stomach into the small intestine and thereby prevents oral medications from entering the intestine and being absorbed.
   
• The impaired absorption of oral medications is a common reason for the ineffectiveness of medications taken to treat migraine headaches.
   
• The increased sympathetic activity also decreases the circulation of blood, and this leads to pallor of the skin as well as cold hands and feet.
   
• The increased sympathetic activity also contributes to the sensitivity to light and sound sensitivity as well as blurred vision.

Migraine afflicts about 3 million Canadians, with females suffering more frequently (17%) than males (6%). Missed work and lost productivity from migraine create a significant public burden. Nevertheless, migraine still remains largely underdiagnosed and undertreated. Less than half of individuals with migraine are diagnosed by their primary care physician and less than 15% have been seen by a headache specialist.

Some people who suffer from migraines can clearly identify triggers or factors that set off the headaches, but many cannot. Some of the more commonly reported potential migraine triggers include:

• Allergies and allergic reactions
• Bright lights, loud noises, and certain odors or volitile aerosol chemicals such as in perfumes
• Physical or emotional stress/distress
• Changes in sleep patterns or irregular sleep
• Smoking or exposure to smoke
• Skipping meals or fasting
• Alcohol consumption, especially red wine and brandy
• Menstrual cycle fluctuations, birth control pills, hormonal fluctuations
• Tension headaches
• Foods containing the amino acid tyramine, monosodium glutamate, or nitrates
• Other foods such as chocolates, nuts, peanut butter, avocado, banana, dairy, pickles, etc.

Not all migraines appear to have specific triggers, and avoiding common triggers does not always prevent migraines. 

Symptoms of migraine can occur a while before the headache, immediately before the headache, during the headache, and after the headache. Although not all migraines are the same, typical symptoms include:

• Moderate to severe pain, usually confined to one side of the head, but switching in successive migraines.
• Pulsing and throbbing head pain.
• Increasing pain during physical activity.
• Inability to perform regular activities due to pain.
• Nausea, vomiting, diarrhea
• Increased sensitivity to light, sound, odors

Many migraineurs experience migraine auras just before or during the onset of headache, but most do not. Auras are perceptual disturbances such as confusing thoughts or experiences and the perception of strange lights, sparkling or flashing lights, lines in the bvisual field or blind spots, pins and needles in the arms or legs, or unpleasant smells.

Migraineurs may also have premonitions called "prodromes" that can occur several hours or even a day or more before the headache. These prodromes may consist of feelings of elation or intense energy, cravings for sweets, thirst, drowsiness, irritability, or depression.

To see a brief YouTube video with information on the pathophysiology of migraines, please click on this link...  http://www.youtube.com/watch?v=yZr9Joe85wg&feature=related

EEG Neurofeedback for Migraine

Although neuroimaging studies using MRI are usually normal in uncomplicated migraine, QEEG assessment will usually show abnormalities in persons with recurrent migraine (Bjork, et al., 2009; Sprenger, 2010; Sprenger & Goadsby, 2009) and when followed up by EEG neurofeedback to normalize the QEEG, the majority of migraineurs become drug-free and no longer experience headaches.

Routine clinical EEG, done between episodes of headache, has not proven to be useful in the evaluation of patients with headaches. However, QEEG abnormalities have been reported in a number of studies. Most recently, Dr. Jonathan Walker (Walker, 2011) reported finding significantly increased high-frequency Beta (21-30 Hz) activity in 1-4 cortical areas; most commonly in central, centro-parietal, and parietal regions.

In the Walker study (Walker, 2011), 71 patients (aged 17-62 yrs) with recurrent migraine headaches, from one neurological practice, completed a QEEG assessment. All QEEG results indicated an excess of high-frequency beta activity (21-30 Hz) in anywhere from one to four cortical areas. Forty-six of the 71 patients selected neurofeedback training while the remaining 25 chose to continue on drug therapy. Neurofeedback protocols consisted of reducing 21-30 Hz activity and increasing 10 Hz activity (5 sessions for each affected site). All the patients were classified as migraine without aura. For the neurofeedback group the majority (54%) experienced complete cessation of their migraines, and many others (39%) experienced a reduction in migraine frequency of greater than 50%. Only 4% experienced a decrease in headache frequency of <50% and only one patient failed to experience any reduction in headache frequency. The control group of subjects who chose to continue drug therapy as opposed to neurofeedback experienced no change in headache frequency (68%), a reduction of less than 50% (20%), or a reduction greater than 50% (8%).

Based on Dr. Jon Walker's recent study, QEEG-guided neurofeedback appears to be dramatically effective in abolishing or significantly reducing headache frequency in patients with recurrent migraine. Drug therapy of any kind rarely eliminates migraine headaches. Peripheral biofeedback procedures such as temperature training or muscle relaxation training or pulse training, may decrease the frequency of migraines but rarely eliminates them (see Nestoriv & Martin, 2007).

An earlier clinical study by Stokes and Lappin in 2008 examined the effectiveness of two types of neurofeedback--i.e., EEG and HEG neurofeedback--combined with a more conventional peripheral biofeedback therapy--i.e., temperature biofeedback from the fingers--in the treatment of migraine headache. In their study, 37 migraine patients were given an average of 30 EEG and 10 HEG neurofeedback training sessions combined with 5-10 finger temperature biofeedback training sessions (to train handwarming) over an average six-month period. They reported that 62% of their patients obtained major improvement or total remission of their migraines, 18% obtained moderate improvement, and only 21% obtained slight improvement. Fully 70% of the patients obtained a greater than 50% reduction in the frequency of their headaches and no patient experienced a worsening of their headaches. As well, most patients also experienced significant improvements in their sleep, mood, and mental focus.

To see brief news reports on EEG neurofeedback for migraine, please click on these links...  http://www.youtube.com/watch?v=SKY-TlAt4co&feature=related  and http://www.youtube.com/watch?v=PwT0iEmCcVU&feature=related 

To see a brief Youtube video of a migraineur talking about her success with EEG neurofeedback treatment, please click on this link...  http://www.youtube.com/watch?v=uizZ_9t7IJk&NR=1

What is HEG Neurofeedback and How Can It Help Migraines?

HEG neurofeedback involves placing an infrared sensor on the middle of the forehead. The sensor 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).

For more detailed information on HEG neurofeedback, GOTO: http://www.edmontonneurotherapy.citymax.com/neurofeedback_therapies.html 

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.

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").

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

What are the Side-Effects?

There is a chance of "side-effects" after initial sessions of HEG neurofeedback 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 these are easily avoided by being gentle during the first couple sessions and stopping when you feel you are tired and, even if they happen, you will likely still get improvements from the session after the temporary side-effects go away.

The really good news is that the long-lasting "side-effects" of HEG neurofeedback training for migraines include: 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.

References

Bjork, M., Stovner, L., Nilsen, B., Stjern, M., Hagen, K., Sand, T. (2009). The occipital alpha rhythm related to the "migraine cycle" and headache burden: A blinded, controlled longitudinal study. Clinical Neurophysiology, 120(3): 464-471.

Nestoriv, Y. & Martin, A. (2007). Efficacy of biofeedback in treating migraine: A meta-analysis. Pain, 128: 111-127.

Sprenger, T. (2010). Abnormal brain activity in migraineurs is not restricted to attacks. Paper presented at 52nd Annual Scientific Meeting of the American Headache Society.

Sprenger, T., Goadsby, P. (2009). Migraine pathogenesis and pharmaceutical treatment options. BMC Medicine, 7:71.

Stokes, D. & Lappin, M. (2008). EEG biofeedback, hemoencephalographic biofeedback, and thermal biofeedback with 37 migraineurs. EEG Spectrum Clinical Interchange Conference, Los Angeles, CA. April 25, 2008.

Tansy, M. (1991). A neurobiological treatment for migraine: Response of four cases of migraine to EEG biofeedback training. Headache Quarterly: Current Treatment & Research, pp. 90-96.

Walker, J. (2011). QEEG-guided neurofeedback for recurrent migraine headaches. Clinical EEG & Neuroscience, 42(1): 59-61.   

The Edmonton Neurotherapy approach to treating migraine combines EEG neurofeedback with HEG neurofeedback. In cases where there is also a strong emotional response to the migraines, we will add BAUD therapy to the mix as a means of ameliorating the emotional suffering aspect of the migraine response. For more information on BAUD therapy go to the "Brain Stim Therapies" tab on this website and scroll down the page to the section on BAUD therapy. In some cases, home use of a cranial electrotherapy stimulation (CES) device can also be helpful.