Stress, Migraines, and Mindfulness
If you’re familiar with migraines, you probably know that stress can be a major migraine trigger. In fact, stress is one of the most commonly reported causes of migraine, as it stimulates the release of stress hormones throughout the central nervous system, which can cause all sorts of changes in the brain like altering levels of norepinephrine, corticosteroids, and serotonin (Martin and Behbehani, 2001). So, the relationship must be simple; if we reduce the amount of stress in our daily lives, we can lower our migraine trigger load and keep ourselves below our trigger threshold, thus decreasing our overall migraine symptoms. If only it were that simple!
Unlike other migraine triggers, such as caffeine or MSG, stress can’t be easily evaded. We can’t avoid experiences like work projects, car accidents, or family emergencies like we can a cup of coffee or a cheap buffet. And when it comes to stress, migraineurs are often full of it. I mean, what else can you expect from someone who’s faced with the daily struggles of being a professional patient?
Enter mindfulness– the practice of staying in the present by being aware of our surroundings, bodily sensations, thoughts, and feelings. Derived from Buddhist meditation, the practice of mindfulness is known to decrease stress and increase relaxation. Rather than worrying about how you’re going to manage your to-do list, you focus on the task at hand. You stop and take a moment to think about the way your thighs feel against the chair you’re sitting in, or the sensation of your clothes against your body. (This is one of my favorite strategies for managing the internal vertigo I feel as part of my vestibular migraine– grounding myself by focusing on the specific ways in which the world around me is not moving– and will be the subject of a future blog post.) A simple Google search can tell you all you need to know about mindfulness, complete with videos and guided meditation. But here’s where things get interesting, when mindfulness meets medicine: biofeedback.
Biofeedback Efficacy and Procedure
Biofeedback is a technique in which you learn to control processes in your body that are generally considered to be involuntary, including: breathing, heart rate, muscle tension, blood pressure, skin temperature, pain perception, and even brain waves5. It is scientifically proven to be an effective strategy in the treatment of migraine, anxiety, depression, and chronic pain 1,2,3,7. In fact, a study conducted by the world-renowned Jefferson Headache Center in Philadelphia showed that 100% of their patients receiving 7 or more sessions of biofeedback reported headache status improvement. Of those patients, 75% reported a reduction in headache frequency, and 60% reported a decrease in headache intensity. Additional studies conducted by Holroyd and Penzien (1990)2 and Kaushik et al. (2005)3 comparing biofeedback directly to pharmacological methods of migraine control rated certain medicines as equally effective to this form of therapy. The latter study by Kaushik et al. (2005)3 took these results a step further by examining the long-term effectiveness of pharmacological methods versus biofeedback, and found that after one year post-treatment, biofeedback was significantly better than pharmacological methods in reducing migraine prophylaxis. So how does biofeedback work?
In a biofeedback session, a participant’s biological functions are monitored using medical instrumentation. This can include all or some of the involuntary processes listed above (heart rate, breathing, blood pressure, etc.). In real-time, the participant receives feedback from these medical instruments, either through a display on the instrumentation itself, or on a computer screen. The participant can then alter their thoughts, behaviors, and emotions to achieve desired physiological changes. For example, if the participant is thinking about something stressful like an assignment due date, their stress will be visualized on the screen in the form of raised heart rate, rapid breathing, increased muscle tension, increased skin temperature. Now, they can intervene by replacing these anxious thoughts with more calm, proactive thoughts about how they’ll focus on the task at hand rather than future outcomes and watch in real-time as the numbers related to these biological functions start to decrease. Over time, and with regular practice, the use of these medical instruments can be discontinued while the benefits live on– the ability to end a stressful train of thought and replace it with mindfulness.
Starting Biofeedback at the Jefferson Headache Center
A few months ago, on the recommendation of a friend who suffers from vestibular migraine, I made an appointment to be seen at the Jefferson Headache Center. To be admitted as a new patient, you must be seen by a staff psychologist and neurologist on your first visit. During my consultation with the psychologist, we got to talking about the substantial impact stress has on my migraine symptoms, and I was pleasantly surprised when she brought up starting biofeedback therapy. While I had heard of this technique, I had never before thought about the benefit it could have on my migraine symptoms. As a fan of non-pharmacological treatments for migraine, like the migraine trigger avoidance diet, which has worked wonders for me, I was feeling very excited about trying this form of therapy.
My first session of biofeedback starts next week, and my goal is to continue posting articles like these about my experiences with this technique. From my orientation session last week, it seems that we’ll not only be working on managing my biological functions, but also changing my way of thinking in general to become more positive, productive, and goal-oriented. I’m feeling enthusiastic and optimistic about what biofeedback can do for me as a vestibular migraine and Postural Orthostatic Tachycardia Syndrome (POTS) sufferer, and can’t wait to get started!
Additional Biofeedback-related Resources
If you’d like to read my future biofeedback blog posts, you can subscribe to My Migraine Blog here. To learn more about biofeedback, you can check out Dr. Kaiser’s website– the psychologist supervising the biofeedback program at Jefferson– which is called The Mental Health Gym. Or, if you don’t live in the Philadelphia area and are interested in trying biofeedback yourself, you can reference the website for the Board Certified in Biofeedback International Alliance. There are a number of apps available in the Apple Store and Google Play Store relating to biofeedback, none of which I’ve tried, but some of which may prove helpful.
As always, this site is for educational purposes only, and does not provide medical advice, diagnosis, or treatment. Please consult your doctor.
- Fentress DW, Masek BJ, Mehegan JE, and Benson H. 2008. Biofeedback and relaxation– response training in the treatment of pediatric migraine. Developmental Medicine and Child Neurology. 28(2):139-146.
- Holroyd KA and Penzien DB. 1990. Pharmacological versus non-pharmacological prophylaxis of recurrent migraine headache: a meta-analytic review of clinical trials. Pain. 42(1):1-13.
- Kaushik R, Kaushik RM, Mahajan SK, and Rajesh V. 2005. Biofeedback assisted diaphragmatic breathing and systematic relaxation versus propanolol in long term prophylaxis of migraine. Complementary Therapies In Medicine. 13(3):165-174.
- Martin VT and Behbehani MM. 2001. Toward a rational understanding of migraine trigger factors. Medical Clinics of North America. 85(4):911-941.
- Nestoriuc Y, Martin A, Rief W, and Andrasik F. 2008. Biofeedback treatment for headache disorders: a comprehensive efficacy review. 33(3):125-140.
- Sutarto AP, Wahab MN, and Zin NM. 2012. Resonant breathing biofeedback training for stress reduction among manufacturing operators. The International Journal of Occupational Safety and Ergonomics. 18(4):549-561.
- Yucha C and Montgomery D. 2008. Evidence-based practice in biofeedback and neurofeedback. The Assoication for Applied Psychophysiology and Biofeedback. 1-96.