Narrator: Hi! I'm Dr. Hamer, a clinical psychologist who'd like to talk to you about biofeedback and
how it can be used to treat headache disorders. My colleagues and I are working very hard to get
information to patients about headache treatments that many may not know about. We hope that this
video will help you understand how biofeedback therapy may relieve your headache symptoms
and improve your overall quality of life. Before we get into the specifics, let's take a look at how
the information is organized in this video. First, we'll learn about the headache disorders for which
biofeedback is most helpful, then I'll describe biofeedback and explore how it works, finally
we'll take a look at what biofeedback therapy will require from you as a patient.
Headaches cause significant disability and the symptoms are often difficult for people to deal with.
Many patients reports headache-related disability and suffering that don't allow them to live their
lives in ways that they would like. There are many types of headaches but biofeedback therapy is most
effective for two types of headache disorders and those are migraine and tension-type headache.
These two headache conditions cause different symptoms that should be discussed with your
provider. For instance, migraine occurs with pain that's typically moderate to severe in intensity
and has a pulsating or throbbing pain quality. Migraines also usually worsen by routine physical
activity and occurs with nausea and or vomiting or with a sensitivity to both light and sound.
Generally though, the symptoms of tension-type headache are less severe compared to those of
migraine regarding pain intensity, the type of pain, and co-occurring symptoms. Tension-type headache
and migraine are ranked as the second and third most common medical conditions worldwide and the
World Health Organization ranks these two headache disorders among the top 10 causes of disability.
Ultimately, many patients report headaches as having a negative impact on their moods, such
that headache patients experience greater symptoms of depression and anxiety than people who don't
experience headache conditions. Biofeedback therapy is a useful symptom management tool
that's used across many health professions with no long-term negative side effects. In fact,
it's helpful for managing symptoms of many psychological and physical health conditions.
So, what is biofeedback therapy? Biofeedback therapy takes advantage of the mind-body connection.
The mind and body are much more interconnected than initially thought. Using biofeedback strategies
helps to enhance your psychological awareness of what's going on inside your body and this
improves your ability to manage your headache symptoms. We can use biofeedback to assess and
change various responses in your body to minimize the impact that headaches have on your daily life.
We're able to do this because biofeedback itself is the detection of information through sensors
that are placed on your body. This information comes in the form of small electrical current
and other physiologic activity. For instance, when your muscles contract they produce small
electrical signals. The biofeedback sensors detect these signals and feed them into an
electrical device such as a computer. The computer then amplifies these signals and
feeds them back to you in the form of visual and auditory outputs, such as moving images and
simple tones and beeps. This allows you to become aware of the physiologic processes that occur in
your body so that you can learn strategies for modifying them. How does biofeedback work exactly?
One of the first methods of biofeedback is breath retraining. This form of biofeedback uses strain
gauges to determine breathing patterns. These gauges are stretchable devices that are wrapped
around the abdomen or chest to determine if breathing patterns are too shallow, too slow,
too fast, or just irregular in some other way. The major function of breathing is gas exchange and
many patients engage in rapid and shallow chest breathing or what we call hyperventilation.
This way of breathing doesn't allow as much oxygen into the bloodstream and ultimately may lead to bodily
pains. That is, you experience pain because not enough oxygen is being released to your muscles.
The goal of breath retraining is to help you engage in deep diaphragmatic breathing at a
consistent pace and reduce the impact of irregular breathing on your headaches and your body.
As a patient in biofeedback therapy, at this point your responsibility will be to practice diaphragmatic
breathing at a pace determined by your provider and based on assessment data. Generally, it's
good to achieve a 10 second breath cycle to prepare yourself for the next phase of therapy.
The next type of biofeedback is heart rate variability training. This form of biofeedback is
commonly done by using a sensor to indirectly measure your heartbeat using infrared light.
Heart rate variability is a subtle variation in the time interval between heartbeats.
Our heart beats are always changing and heart rate variability reflects the rhythmic speeding up
and slowing down of your heart rate. Your heart rate variability is an indication of the
body's ability to regulate internal processes. Hyperventilation and dysfunctional breathing
patterns decrease your heart rate variability and this can make your headache symptoms worse.
The goal of heart rate variability training is to synchronize your breathing pattern with your heart
rate through effortless diaphragmatic breathing. If you look at the graph on the right side of this
screen, you can see that one way you'll be able to do this is by using visual feedback of mechanical
or electronic tracers. For instance, using a breath tracer and a tracer that tracks your heart rate
variability will allow you to align changes in your breath cycle with changes in your heart rate.
As you inhale, the light green line will go up and as you exhale this green curved line will
go back down. We expect to see a similar pattern in your heart rate variability as the two become
synchronized such that as you inhale your heart rate variability shown here by the red line will
increase and as you exhale your heart rate variability will decrease or go back down.
Surface electromyography, or sEMG, is another form of biofeedback in which your muscle activity is
measured and reduced. Surface electrodes detect weakened electrical signals from your muscle
fibers and this form of biofeedback along with breath retraining really helps to take the strain
off your upper body that may be contributing to your headaches. Common areas with excessive
muscle activation that often contribute to headache include your forehead and temporal
regions of the head, your scalp, your shoulders, trapezius muscles, your neck, and your jaws.
sEMG training will continue to build off the breath retraining and heart rate variability
training in that you'll be able to make specific postural adjustments to figure out which areas
of your shoulders neck and head carry unnecessary tension that may be contributing to your headaches.
At this stage, you'll see spikes in your sEMG readings as you increase muscle activation.
As you decrease your muscle activation, your sEMG readings will go back down.
Your provider will use the scientific evidence to help determine appropriate thresholds
for deactivating your muscle activity. The next form of biofeedback is thermal biofeedback.
This type of training is used to raise the temperature of the skin by helping you relax
the blood vessels of the peripheral nervous system or in your hands and feet, put simply.
Your body's peripheral skin temperature is usually an indication of your relaxation response.
When the blood vessels relax and more warm blood flows to the surface of the skin
your peripheral skin temperature increases. There's been a linkage between disrupted blood flow and
headache activity. At this point in therapy your responsibility will be to learn to consistently
practice relaxing the peripheral blood vessels and warm the surface of your skin to stabilize blood
flow. You'll work with your provider to determine which skin warming strategies work best for you.
Examples of these strategies range from purely visual feedback to guided imagery
to encourage skin warming and enhance your body's relaxation response. For both tension-type headache
and migraine, biofeedback has been linked to reduced overall days per month that
patients experience headache. Additionally, headache severity is reduced with regular
use of biofeedback practices to reduce overall tension and stress. Biofeedback indirectly targets
distressing internal thoughts and feelings by inducing a sense of calm and well-being. If after
you've successfully mastered these modalities of biofeedback you still experience difficulties with
your headaches, neural feedback may be considered. So what are some next steps then? You should speak
with your primary care provider about a referral to determine if this may be a good option for you.
You should also discuss your individual risks and benefits with a provider who's trained in
biofeedback. Please understand that biofeedback isn't a one-size-fits-all and it may work better
in combination with other treatments. In summary, muscle activation and tension make headaches worse.
This muscle activation and tension may be the result of co-occurring mental
health or physical health conditions biofeedback uses mechanical sensors to help you change your
body's physiology and symptoms. This headache treatment indirectly targets internal thoughts
and feelings by reducing arousal and promoting a sense of calm and well-being.
And finally, you should speak with your provider about next steps regarding biofeedback.