biofeedback

22 June 2020

Could this App Train You to Avoid Migraine Attacks?

We all know that the body has amazing abilities for self-healing. So what if an app could help your body to train itself to fight migraine?

That’s what Nordic Brain Tech wants to achieve with an app that they’re building as a medical device.

“Biofeedback” is a migraine treatment that is fairly common in headache and migraine clinics. It has excellent scientific evidence behind it. So why aren’t we talking about it more often?

For the uninitiated, biofeedback basically helps you to train your body to change functions that are normally involuntary. Most commonly, when we talk about biofeedback, we’re referring to the use of technology to give us information about physical responses.

A common example is changing the temperature of your hands. Changes in blood flow, easily seen in hands and fingers, are strongly connected to migraine and other conditions. (If you have migraine, have you ever noticed that your hands and nose seem to be colder than other people’s? It’s more common than you might think!)

Biofeedback is a well proven treatment for all ages, but is especially recommended for children, and other demographics that have fewer medicinal options.

So if specialists recognize the value of biofeedback, if clinical trials are putting it on the level of many medications for migraine treatment, why aren’t we talking about it more?

For one thing, to be skeptical for a moment, biofeedback puts treatment into the hands (no pun intended) of the patient. It should be possible to use biofeedback in an inexpensive, widespread way. No one is making billions of dollars on biofeedback at the moment.

But another issue is that biofeedback devices are few and far between. Devices that I’ve mentioned in the past seem to quickly disappear off the market. Or they’re more affordable for a doctor’s office than for individual use.

So it’s great to see some serious research and development going into a personal device that can be used with your smartphone.

So how will this app work?

The app is designed to give you ten minutes of training a day – training that should eventually help you full time. A small sensor is placed on the lower back of your neck, and another on one finger. The first measures muscle tension, the second measures heart rate and skin temperature.

If you’ve had biofeedback treatment, you know that a short ten minute session can lead to immediate improvements. But it can also gradually improve your health long term.

Nordic Brain Tech’s general manager explains more:

We built in artificial intelligence so that the app can adapt to the individual user. The artificial intelligence component compares the information about the body’s signals with the migraine diary and provides the patient with feedback to optimize their training. We also added a game element so that the user earns a score between 0 and 100 for their training. The goal is for the app to eventually be able to predict attacks, their duration and intensity.
Cathrine Ro Heuch

The app probably won’t be available for another two years. But hopefully it will encourage more research and innovation in an area that has been greatly lacking in migraine treatment.

For more information:

Nordic Brain Tech (official)
App to treat migraines without the use of medication
Biofeedback Treatment App for Pediatric Migraine: Development and Usability Study (clinical trial as part of this app’s development)

13 September 2019

Veterans Affairs: Biofeedback for Migraine/Headache a Useful Tool

James Discoveries & Stats, Treatments 0

A recent study done by Veterans Affairs in the USA has confirmed again the value of biofeedback as a migraine and headache treatment.

Biofeedback for veterans — Original photo thanks to Army Medicine

We have actually talked about biofeedback here frequently. Biofeedback is a treatment that helps the patient take control of some normally “involuntary” processes in the body, such as heart rate and breathing patterns. Sometimes this is done using technology, other times without.

Veterans Affairs is very interested in the headache field for obvious reasons. But in this case, the research was a little bit wider. They wanted to find out which conditions were effectively treated by biofeedback, according to previous clinical trials. A study like this involves searching for past trials, as well as evaluating whether or not the trials were done properly.

The study found that biofeedback was indeed effective for migraine and headache conditions (more on that in a moment), and also for incontinence (both urinary and fecal). For other conditions there was less evidence, however, that’s at least partly because not many studies have been done for many other conditions.

So what did the researchers find? Biofeedback was effective in treating both tension-type headache and migraine. Specific types of biofeedback were especially effective. EMG (electromyogram) in biofeedback is used for muscle function. Measuring and controlling skin temperature and blood pressure were also helpful for migraine and headache.

Biofeedback decreased frequency, duration, and intensity of attacks – a very encouraging result. Interestingly, the most evidence of all was that it helps with the frequency of headaches. Helping with the headache/migraine attacks themselves, biofeedback also helped fight related issues, such as muscle tension, anxiety, and depression. It also helped decrease medication use.

Biofeedback has always been one of the treatments with the most good evidence behind it. It’s non-invasive and doesn’t involve medication, making it excellent for anyone but an especially valuable choice for children and pregnant women, where more caution is required for many other treatments.

For more information, listen to this Biofeedback for Migraine and Headache podcast. The study abstract is available here: Efficacy of Biofeedback for Medical Conditions: an Evidence Map

For an excellent overview of the study, see Review: Biofeedback could help treat a number of conditions from ScienceDaily.

30 March 2018

Migraine and Headache and Pregnancy Q&A

James Information, Treatments 0

We have talked about headaches and migraine and pregnancy frequently at Headache and Migraine News. For example, don’t miss The Myth-Busting Guide to Migraines and Pregnancy for a good overview. We’ve also looked at some fascinating statistics about migraine during and after pregnancy.

We’ve also talked about the hot topic – How Dangerous are Migraine Drugs during Pregnancy?

For more information, just do a search here.

It’s always good to get another perspective, and NeurologyAdvisor recently published a Q&A on the topic with Dr. Matthew Robbins, associate professor of neurology at Albert Einstein College of Medicine, and director of inpatient services at Montefiore Headache Center New York.

I’ll let you read the article yourself, but I especially appreciated Dr. Robbins simple but helpful advice near the end.

I think some of the commonsense strategies of avoiding triggers is critical. Pregnancy is a time when usual routines can be disrupted, so the normal lifestyle strategies to help migraine should be especially emphasized during pregnancy. These include staying well hydrated (especially in early parts of pregnancy if someone has morning sickness), and getting regular sleep and maintaining low-grade or normal-level exercise. Nonpharmacologic treatments that are strongly evidence based for migraine, including biofeedback and relaxation training, certainly are good treatment strategies as well as preventive measures.

Your schedule is naturally disrupted during pregnancy. So – this is a great time to stop and evaluate your habits. And it’s important to develop healthy, regular habits that will help you avoid headache attacks.

Read the full article here: Managing Headache in Pregnancy: Q&A With Matthew Robbins, MD

7 December 2015

The Myth-Busting Guide to Migraines and Pregnancy

James Tips 1

If you’re reading this article, you’ve probably already heard some of the common myths about migraines and pregnancy. Some of these myths include:

Headaches during pregnancy are normal and nothing to worry about.
Your migraine attacks will go away when you get pregnant.
You can’t use medications for migraine when you’re pregnant.
You can take “painkillers” during pregnancy, but not migraine meds.

Let’s take a look at these myths and find some solutions.

Do Migraine Attacks Disappear During Pregnancy?

Migraines and Pregnancy This is a difficult question because the statistics vary depending on the source – and depending on the trimester. You can read more details in Migraine During and After Pregnancy, but the short answer is that things probably do improve for some (more than half of) women during pregnancy and even up to a year after the birth of the baby (especially if the baby is breastfed). The biggest improvement is during the second and third trimester.

However, a significant number of women either experience no change, and a few actually get worse. For some women, the medication they have always relied on for migraine no longer works. You’re probably reading this article because you’re one of the many women struggling with migraine during pregnancy.

Are Headaches During Pregnancy Normal?

Common, yes. Normal, no.

Headaches can be dangerous, and that includes migraine headaches and other migraine symptoms (for example, migraine during pregnancy may increase your risk of stroke). In a moment we’ll discuss what to do, but for now let’s remember that your suffering actually can affect both you and your baby. Ignoring your pain because you think it will somehow help your baby is a strategy which probably won’t work well.

Drugs During Pregnancy

There are all kinds of myths about drugs during pregnancy. So let’s be honest. Prescribed medications for migraine may be an excellent choice for both you and your baby. However, not all “painkillers” are perfectly safe.

Also, many non-drug options have good scientific evidence behind them. If you choose not to use medications, you are most certainly not doomed to use “inferior” options.

What to do about Migraines and Pregnancy

Migraine and headaches should not be ignored. Although you have many other things to think about, including so many changes in your body, it is very important that you pay attention to your pain and what it may be telling you. (This actually includes more than just head pain – migraine itself can lead to pain in various parts of the body. Read more about the importance of identifying non-headache pain related to migraine: Warning Flag: Do you have non-headache pain?)

Keep a journal of any pain and other symptoms that you’re experiencing. Make a note of how long a symptom such as headache lasts, how severe it is, what treatment you had for it (if any). For tips on using a simple page-a-week option, check out A Migraine Diary: The Lazy Way. You can also use an app on your phone, a document on your computer – whatever works for you. Your doctor may recommend an option especially for your pregnancy.
Talk to your doctor. If your headache symptoms are new, see a doctor as soon as possible. Some headaches can be a signal of immediate danger. For example, some women with cerebral venous thrombosis may have headache as their only symptom. Neurological conditions, which may include headache as a symptom, are now a significant cause of death among pregnant women. (For more, read Headaches during Pregnancy: Not What You Think?) Even the pain of a tension-type headache or the symptoms of migraine may be dangerous – it’s worth it to check things out and find treatment as soon as possible.
Talk to your doctor before taking “painkillers”. Some people still think that taking Tylenol or Advil is completely safe. We now know that there are risks (see for example this information about anti-inflammatory medications such as ibuprofen, and this research on acetaminophen / paracetamol). Although most doctors still consider acetaminophen/paracetamol to be low risk, these medications may not be the best for migraines and pregnancy anyway, as we’ll see in a moment.
Weigh the risks of medications with your doctor. Going through severe migraine attacks during pregnancy is not good for you or your baby. Of course you do not want to take a medication that will harm your baby, but there are low-risk options available. For example, recent research has shown that triptan medications, abortive drugs that specifically target migraine, are safe for the baby during pregnancy (read more here), though they still may pose some risk to the mother. (See also Triptans are the first line migraine drugs in pregnant women) Your doctor will recommend medications based on your own situation and medical history, but don’t be afraid to consider these options.
Consider non-drug treatments. There are excellent non-drug treatments, and some of them may work better for you than medications. In cases of a severe attack, intravenous magnesium will often stop the pain cycle. Magnesium supplements are also one of the best preventative treatments for migraine overall (more information here). Other excellent treatments include biofeedback, feverfew (particularly in combination supplements such as MigreLief), massage, the SootheAway device, and trigger point therapy, to name just a few. Do talk to your doctor – non-drug options sometimes carry risks as well.
Find support. Although there are many excellent treatments available, they often take time. Don’t be afraid to ask family and friends for support during this time. When you’re experiencing so many changes, with headache or migraine symptoms on top of it all, you’re not going to be able to continue “life as usual”. Be patient, and ask for help if you can.

Finally, here are four things NOT to do when you’re struggling with migraines in pregnancy:

Don’t expect that everything will go as expected: You’ve read 27 books, talked to your friends and gotten advice from your Mom – and this is your 4th baby – but things may still not go as planned. You’re unique, and your baby is unique, and you’ve changed even over the past year.
Don’t panic! Yes, migraine is serious. Yes, you need to talk to your doctor. But you’re probably going to be all right. The above information is supposed to encourage you to pay attention and seriously consider treatment, it’s not supposed to make you panic about every headache. Many many women have made it through pregnancy just fine, and have even had some really happy times, in spite of headaches.
Don’t ignore what your body is telling you: It might seem like it’s just sending too many messages at times, but do your best to pay attention.
Don’t focus on the challenges and problems: Oh, easier said than done! Who does this writer think he is – emphasis on the he?! Yes, there’s no doubt it can be hard. You may need to get more help and support than you expected you would ever need. But you also need to make the choice to see the good things that are happening, if you possibly can. As I have said before, it is possible to experience happiness even when you’re plagued by migraine and/or headache. We can be realistic about the suffering that migraine can cause, and still encourage one another to be thankful for the good around us.

There is good help available for migraine. Following the steps above will give you a higher than average change of finding the treatment you need.

For more information, read about natural solutions for migraines and pregnancy from the Mayo Clinic, and this overview of migraines during pregnancy from WebMD.

15 June 2015

A Message to Youth with Migraine

James Information, Resources, Tips 1

You just heard it from the doctor – migraine. I’m sure you’ve heard the word before – it conjures up images of headache, throwing up, missing school. But just what is migraine, and where do you go from here?

Teen headache When you unwillingly entered the world of “migraine”, you entered a world of cutting-edge medicine, history, politics, scams, misunderstanding and community. We know that migraine as a disease has existed since earliest recorded history. It’s a massive problem in the modern world – considered by many to be one of the top 10 disabling conditions globally. So it’s a real condition, and a very big deal socially, financially – and personally!

I’ve been there. Diagnosed as a teen (although I probably had symptoms long before I was diagnosed). Trying many treatments that didn’t work. Literally writhing on the floor in pain. Well, you don’t want to hear the gory details!

Here are some of the things that you need to know now in order to navigate the world of migraine.

Learn the basic vocabulary. There is no cure for migraine, and no one is sure of the cause. We know a lot about the migraine chain-reaction, a lot more than we knew when your parents were your age. However, experts still disagree about underlying cause. You’ll need to know the word “trigger” – something that sets off the migraine chain-reaction. For example, for some people, if they eat a banana, this will “trigger” a migraine attack. The banana doesn’t cause the attack, but it sets it off if you’re predisposed. It’s preferable to say that someone has migraine (the disease), and sometimes has migraine attacks.
This is not something to “just live with”. Although it is common to have migraine, it’s not something that is “normal” and that you should just settle down and live with. You should not be getting headaches, and you should get help and find good treatment. Migraine can take a lot of time out of your life, and it may even lead to permanent damage. Don’t panic – but don’t give up either. Early treatment can mean a huge improvement in quality of life down the road.
Why now? It is very common to be diagnosed with migraine for the first time in your teens. Naturally, there is a connection with development and hormones in both males and females – but particularly in young women. This can be a blessing in disguise, and can help you narrow down what is triggering your attacks. More on that below.
Diagnosis can be tricky. Chances are that your doctor did diagnose you correctly. The most likely challenge is learning what type of migraine you have, and what treatment will be most effective. Don’t assume that the diagnosis of “migraine” is final.
Everyone is different. Our bodies are very complex. Just because your Mom or best friend has migraine, doesn’t mean your symptoms will be the same. Attacks may be severe or mild, frequent or rare, regular or unpredictable. Symptoms can vary widely – some people with migraine don’t even get headaches, but experience visual auras. Some throw up, some can’t stand light or the slightest noise.
Treatment takes time. Migraine is in the category of neurological disorders (such as epilepsy). Many preventative drugs and other treatments need to be tried for 3 months before you can tell if they’re working.
You need to prioritize. There are so many treatments for migraine today that you could never try them all. However, there are some that work for many people, some that only work for a few, some that may not work for you because of your personal make up and medical history. Your doctor will help you try the treatments that are most likely to work for you, so that you won’t waste time and money (and discomfort!) on the many treatments (and sometimes scams) that you will see online.
Take notes. Doctors and specialists rely heavily on information about your symptoms in order to help you. They need to know how often you have an attack – how long – where is the pain (if there is pain) – what the symptoms are. Find a way to keep a “migraine diary” that works for you. For a flexible method using paper, try A Migraine Diary: The Lazy Way. Many apps are also available, but be sure they allow you to include all relevant information. Also, if you notice a significant change in symptoms, tell your doctor right away.
For the women: If the attacks are somehow related your monthly cycle, there are treatment approaches that may work better for you. There are two common types of menstrual migraine. For more on the challenges of treating migraine related to your cycle, see 8 Reasons why Menstrual Migraine is “different”
It’s not “stress”. I hate to add this to the list, but it is still far too common for even doctors to say that you’re “just stressed”. You know, you have all those exams coming up – that must be it. Well, that’s not it. Lots of people have been under huge amounts of stress and have never had a headache. Do not let the “stress” diagnosis keep you from proper diagnosis and treatment.

Treatments

As I mentioned above, there is a long and sometimes confusing list of possible treatments for migraine. Your doctor will help you decide if you need abortive treatment (something to do/take when a migraine attack hits) and possibly a preventative treatment (something to do/take on a regular basis) (see How many headaches are too many in a week?).

Your doctor may recommend lifestyle changes, such as avoiding certain foods, or getting on an exercise schedule that works for you.

Youth migraine Some of the best treatments that your doctor may recommend first include: magnesium, triptan type medications (such as sumatriptan), and biofeedback. Beta blockers and antiseizure medication (the same meds used for epilepsy) are also common.

Keep an open mind and take the time to try what your doctor suggests. However, if you feel your doctor doesn’t understand or is not listening to you, or doesn’t really understand migraine treatment, it’s time to go to someone else. A neurologist who specializes in migraine treatment is the way to go if possible.

Finally…

I hope that you will get rid of these symptoms soon – and there is a lot of reason to hope. You’re probably not going to die from these symptoms, and you probably will find good treatment options soon.

Yes, the road has been long for many people. But we know a lot more than we did 20 years ago. And there are many, many people who are looking for answers with you – advocates and researchers like myself, doctors and specialists (many of whom have migraine too), and scientists who are working on the cutting-edge. You are not alone.

Although migraine sufferers are still sometimes stigmatized, that is happening less, as good information gets out there and good research is being done. You can be a part of the fight against migraine, the fight for positive research and treatment.

If you know a teen who has been newly diagnosed with migraine, feel free to share this article.