A Program for Migraines

by Siegfried Othmer | August 18th, 2005

Aging is not what it used to be. I have the impression that in some significant respects my own health is actually improving over the years, and that has mainly to do with my increasing understanding of self-regulation in the context of a general growth in awareness of alternative health. The same is true most likely for anyone who has committed some time and energy to that enterprise, whether it be through meditation, attention to nutrition, the adoption of an exercise regimen, taking time for biofeedback/neurofeedback, or even just an accommodation of the need for sleep. This may or may not have much to do with the fundamental risk of disease, but it has a lot to do with perceived quality of life.

This is happening among an increasingly aware public in the face of a continuing effort by the pharmacological/medical/university complex that matters of health should be left to the professionals. Life is increasingly being defined as a medical condition, with every important life transition from conception to organ harvesting after death being attended by the medical priesthood. The tribute paid to this enterprise is already at the level of 15% to 18% of our total personal expenditures in this country (depending on what all gets counted), and this fraction is still rising briskly. Medical dependency promotes yet greater dependency, in a progressive spiral that likely ends in the person being maintained on life support in a nursing home, at the same time heart-healthy and brain-dead. Nevertheless, I write as someone who has had his life saved a number of times by “real” medicine (as opposed to lifestyle or boutique medicine), and I have reason to be very grateful.

With what we now know about biofeedback and neurofeedback, it is clear that people can take effective responsibility for their own lives to a much greater degree than they now do. Further, the spiral in medical costs probably allows no other outcome than for us to undergo a major transition into self-care in this society. But once this transition gets underway, it may be much more than a matter of redressing the balance between self-regulation approaches and traditional medical procedures. Self-regulation modalities will also encroach upon that terrain where “medicine” thought it had a perpetual lease. Examples are seizure management, migraine abatement, panic disorder, asthma, and cardiac “events.”

What may be difficult to appreciate is that the severity of presentation of something like a seizure or a migraine or a panic or asthma attack has essentially nothing to do with the difficulty of remediating it beforehand. Further, the difficulty we have in controlling these events through medical procedures tells us every little about the intrinsic capacity for remediation. The process of initiation of these ‘brainstorms’ can only be fully understood if we also have the vantage point of the bioelectrical functioning of the brain along with our growing understanding of neurochemical mechanisms. At the moment, medicine targets mainly membrane excitability to control seizures, whereas we must also focus on network stability. That is what we bring to the table with neurofeedback, and how far that takes us has yet to be fully documented.

It may be helpful to draw on an example from another field. When we balefully watch the progress of hurricanes across Florida it is almost impossible to predict their trajectories with any accuracy except in the short term. Yet the forces acting on them from the outside are miniscule compared to the energy involved in the hurricane itself. Small forces can have huge impacts. If we now trace back the hurricane to its first origins in the Caribbean, we observe that even if all of the conditions that give rise to hurricanes are met, the probability of their actually getting started is nevertheless small. There needs to be a coalescence of events that begins the birth process of the hurricane–that “fluttering of a butterfly wing” that triggers the whole chain of events. If that process were better understood, it might take only a slight alteration of the prevailing conditions to have a major impact on hurricane gestation. Recently it has been proposed that something as commonplace as ocean spray could play a central role in kicking things off. Altering the surface tension in areas of vulnerability and at times of risk could effect a remedy. A layer only a molecule thick on the water surface in the areas of vulnerability may make all the difference. I have no idea whether that is realistic. The point is merely that the remedy need bear no particular relationship to the size of the problem being addressed.

The fact that conditions favoring hurricanes are not microscopically predictive of them has relevance for our interests. The good news is almost too obvious for words: Most seizure patients spend most of their life not having a seizure. The same goes for the other conditions listed above. This means that the brain is already managing to stay below the seizure threshold most of the time. If a person is already 99.9999% successful in staying seizure-free, should it necessarily be very difficult to improve that ratio by a factor of ten or even one hundred? Our experience suggests that it may not be difficult at all. The essential conditions for the brain’s maintenance of its own stability are largely already in place. Most likely, they merely have to be augmented modestly, and we now know how to do that. When these methods are combined with the best of pharmacological management, the prospects are attractive indeed. Unfortunately, the neurologists will be the last to come aboard, since we threaten their worldview so brazenly. So epilepsy is not a good place for us to plant our flag. Matters are very different when it comes to migraine.

Migraine, the slow seizure

First of all, our clinical success with migraine is much greater and more predictable than it is with seizures. We fully expect to succeed with every case of migraine that walks in the door, and we simply do not have that assurance when it comes to seizures. There is a long and favorable research history for biofeedback with migraine, and most recently Jeff Carmen has published on 100 cases using passive infrared-based training and obtained some 95% clinical success. This is in line with our own findings, so there are now several established pathways to clinical success. The same techniques are also effective in aborting an ongoing migraine with great regularity, so it is not necessary to mount a blinded controlled study to prove that neurofeedback is the effective agent here. Also, migraineurs are not perpetually medicated, as are epileptics, so we have less difficulty claiming the high ground when we succeed. Migraines develop on a much longer timescale than seizures, so there is much more time to engage the problem even if prevention has not worked. Finally, insofar as the medical world thinks in terms of biofeedback at all, it accepts it with respect to pain management.

The high level of clinical success notwithstanding, neurofeedback strategies should be embedded in more comprehensive self-regulation strategies. What might such a program look like for migraine? At the annual conference of the American Academy for Pain Management last year, a migraine specialist said that he would not even talk to incoming patients about migraine medication until they cleaned up lifestyle and nutritional factors that increased migraine risk. For a significant percentage, that was all that was needed. For an MD, such a posture is almost heroic. (Unsurprisingly, he came from a small community where he was the only medical authority.)

We can take the same approach as the MD above, but we need not hold off on the neurofeedback because the latter actually facilitates the former. Neurofeedback will help people with their caffeine dependency, their chocolate craving, their relationship to red wine, etc. Meanwhile, the neurofeedback training also raises the migraine threshold. Still, during the first few weeks of training the person may experience breakthrough migraines, and there may remain some finite risk thereafter. For this we could offer home use pIR HEG, to be resorted to immediately when the first signs of a migraine crop up. If pIR HEG can abort established migraines, then it can certainly throttle them in the crib. If the person cannot afford to rent the home-use HEG, then they can just do temperature training with a little digital thermometer when the need arises.

Additionally, we offer the person a new device called the Enermed. This is an electronic device worn around the neck that emits a very low-level electromagnetic signal within the range of common EEG frequencies. The brain perceives this activity and reacts to it. This low-level engagement has been shown in controlled research to be effective in suppressing migraines. Users purchase the device from clinicians and wear it continuously during the waking day. Breakthrough migraines are sometimes observed even with the Enermed, so it is best to make this device part of the more comprehensive strategy of remediation that we are recommending. The Enermed is still in a research mode at the moment. Clinical trials are planned at some eight sites around the country, and our office has been asked to participate.

Finally, there are the medical remedies that are just not up for discussion presently. With the combination of all of these approaches, we can offer not only eventual success in the control of migraine at the end of a regimen of neurofeedback training, but we may be able to turn the person’s life around almost immediately. It may be possible that the vast majority of migraineurs, once they come to see us, need never undergo an unremitting migraine with its familiar time course ever again. From the very first day on, they may be able to report that any migraine they still suffer was either briefer, or less severe, or self-aborted in the starting blocks, or was set upon a course toward resolution with a home remedy. At this moment, that still remains a hope rather than an expectation. But the objective is not unrealistic, given how far we have come already.

So what would be left? Clinicians know that when it comes to long-term established migraine histories, which is what we tend to see, it is not really about the migraines any more. The migraines are likely to be enmeshed in a much larger matrix of psychopathology. Fortunately, neurofeedback is not just about the migraines either. By enhancing self-regulation in general, it will constitute a large part of the remedy for the larger issues as well. I suspect that Jeff Carmen’s few treatment failures, which were mostly among women, probably had to do with these larger issues. We generally subsume these under the trauma model, in which a cumulative trauma history results in a cascade of disregulation that affects the person physiologically and psychodynamically. Neurofeedback should be the first resort for both.

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