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Beyond Biofeedback – Drs Elmer and Alyce Green

Joseph Sargent, director of internal medicine at the foundation, felt it would be useful to conduct a pilot study of headache patients in a clinical setting.

In 1967 he began a study of temperature feedback for migraine control. Migraine headaches have been described in medical lore and in literature for two thousand years, and studied scientifically for the last forty years. Yet no effective treatment was known. Powerful drugs have been used, but they are not effective for everyone: Their side effects are often bad, and often dosages must be increased as the body adapts.

 It is estimated that as many as ten million persons in the U.S. suffer from migraine attacks. Because this type of headache poses such a difficult problem, Dr. Sargent felt that any new approach that might safely help merited study.

He saw the use of Autogenic Feedback Training to normalize blood flow as such an approach (Sargent, Green, and Walters, 1972). A vascular theory of migraine was set forth by H.G. Wolff (1963) and his colleagues, who were among the first to study migraine headache scientifically. They concluded that it results from dysfunction of cranial arteries.

First, the blood vessels of the head become unusually constricted (vasoconstriction), producing the preheadache sickness, and then unusually dilated (vasodilation), which results in the headache itself.

Something initiates the process that constricts cerebral blood flow, which quite often is a response to pressure or stress, and if an adequate supply of blood to the brain is endangered, other automatic processes that control blood flow start to unfold. One of their effects is to cause blood vessels in the scalp to dilate. If this physiological response is great enough and persists long enough, biochemicals are released which produce edema and other effects that are experienced as pain. Some authorities feel that this view of migraine, consisting of phases of vasoconstriction and vasodilation, is not basic enough. They suggest that emotional factors that modify the behavior of subcortical brain structures have a causal role in migraine headache. This last fits well with our own concept of the psychophysiological causes underlying psychosomatic disease, …...

One aspect of the general migraine syndrome - that is the set of symptoms associated with migraine headache - is a decrease of blood in the hands. Voluntary increase in blood flow in the hands, learned through temperature feedback training, reflects a voluntary decrease of "nervous tension" (neural firing in the sympathetic section of the autonomic nervous system).

This self-induced sympathetic relaxation in the hands is apparently a reflection of "relaxation" in the subcortical neural center that regulates blood-flow behavior throughout the body. It appears that the entire vascular system of the body tends to rebalance in response to hand-temperature training and the vascular dysfunction in the head is correspondingly corrected. In other words, this undesirable vascular response to stress, the general migraine syndrome, is brought under voluntary control as a "side effect" of hand warming.

More than two hundred patients have completed Dr. Sargent's ongoing migraine-control study. The standard procedure is as follows. For one month prior to beginning biofeedback training each subject charts daily the type of headache, severity and duration' presence or absence of associated symptoms, and degree of disability. The patient also records the type, strength, and total number of units of each medication taken in a twenty-four-hour period and lists any side effects associated with the drug(s). Before a patient is accepted into the project, a detailed medical history is taken, a complete physical examination is given, and laboratory studies are made. In the initial session he or she learns the use of the temperature-feedback trainer and the Autogenic Training phrases for relaxation and warmth, and then takes the trainer and a typewritten copy of the phrases home, with instructions to practice daily, recording temperatures of the hand at the beginning and end of each practice period.

The patients continue to keep the daily headache and medication charts during training. They are seen at weekly intervals until a consistent positive response on the meter and an associated awareness of warmth in the hands are achieved.

Practice with the meter usually can be discontinued within a month, but daily practice without the meter continues, with the aim of learning to initiate relaxation and warmth in a few seconds to prevent or abort headaches. After training, participants return to the clinic at intervals, pertinent data are gathered, and a refresher practice session with the temperature trainer is offered.

Medical follow-up continues for a minimum of one year, and is extended whenever possible to two to three years.

About 80 per cent of the migraine-headache patients have obtained relief, ranging from slight to excellent. A few have reported a migraine-free life since completing the program.