08:23pm Thursday 27 February 2020

Using Non-medicinal Techniques to Manage Migraine Headaches

At the age of 18 she first felt the effects of what she calls “classic migraines,” the pain of which drove her to the sanctuary of her bedroom.

“They would last a day,” Price says. “You’d take your medicine and go to bed, and hopefully they’d be gone the next day.”

Five years ago the character of her migraines changed. When the vestibular migraines from which Ann now suffers announce themselves, the pain is not nearly as intense as it used to be. Instead, Ann is overcome by symptoms similar to motion sickness and vertigo.

“I’m very susceptible to light and sound. I get very nauseous,” she says. “These migraines are pretty incapacitating. Pretty much 80 percent of the time I am homebound.”

She’s not alone. Some estimates put the number of people stricken by migraines at 37 million in the U.S. alone, with women more than twice as likely as men to get migraines. At 47 Ann is right in the middle of the age demographic – 35 to 55 years old – most afflicted.

“Headaches are one of most common complaints in medicine,” says Dr. Shilagh Mirgain, a UW Health psychologist who has organized, with fellow health psychologist Dr. Norann Richard, a group to help people like Ann anticipate the stimuli that trigger migraines and take non-medicinal measures to manage them. “Our group is unique in that we teach behavioral strategies patients can use themselves, beyond medications.”

One of those behavioral strategies is something we all do, all the time – breathing.

Migraine symptoms often affect stress responses in the body, creating an imbalance in the autonomic nervous system. In response, shallow breathing, muscle tension, decreased blood flow to the extremities and incoherent heart rate can occur, making headaches and mood worse.

“One of the aims of the headache coping group is to teach relaxation mind-body strategies to calm the stress response, which, in turn can lessen the effects of headaches,” says Dr. Richard. “Through techniques such progressive muscle relaxation and autogenic training, participants learn to reduce tension in their bodies, which can also help to ease headache pain.”

“We teach proper diaphragmatic breathing, to increase the relaxation response in the body,” adds Dr. Mirgain. “The optimal breathing rate is to breath in for four seconds and breathe out for six seconds.”

Group participants can use a special handheld biofeedback device that clips to their earlobes to monitor their breathing and heart rhythms, know as heart rate variability training.  Another biofeedback device used in the group measures participants’ hand temperature tracking improved blood flow to the arms and hands.

“We actually print out graphs of their training sessions, so group members can monitor their progress,” says Dr. Mirgain. “It’s a nice measure of balance in the autonomic nervous system.”

Ann has witnessed firsthand the benefits of breath control. Her migraines begin with auras – distortions of the visual matrix that can include blind spots and blurred vision. When Ann senses an oncoming aura, she slows her breathing patterns, paying particular attention to taking long, measured breaths.

“I count my breath, a five-count in and a six-count out,” she says. “It makes me think of the counting more than anything else going on in my body, and takes my mind away from thinking, ‘Oh my gosh. Here comes the migraine.’ That makes the migraine worse.”

It’s called catastrophic thinking, a thinking pattern common to migraine sufferers and one the headache coping group strives to interrupt.

“At the early signs of headaches, the tendency is to fall into automatic negative thinking,” says Dr. Richard. “Migraines engender a sense of powerlessness and make people feel they’ve lost control. It’s helpful to challenge those thoughts, so people realize there is something they can do in response to the early signs of headaches.”

A key element in Ann asserting control over her migraines has been the support she’s received from her fellow participants. Group participation has broken the isolation that migraines too often confer, and mitigate the social withdrawal they impose. Participants also learn specific strategies for communicating assertively with family members and friends about their headache condition and its effects on their day-to-day lives.

“All of our relationships have changed, and not for the better as a result of chronic headaches. We shy away from making plans, because you never know when you’re going to have a migraine or how long they’re going to last,” Ann says, adding that the burden of migraines can strain even the most solid relationships. “It makes people uncomfortable. And you really don’t want to always tell that story about feeling miserable, so you gloss over it. You’re lucky if you have one person in your life who really knows what’s going on with you.”

“People who have persistent headaches really start to get isolated,” says Dr. Mirgain. “It can lead to a pattern of hopelessness. The group format enhances motivation. If you see a fellow patient doing well, you become more motivated to practice these coping strategies.”

The headache coping group, then, provides participants with both an avenue for support and a learning environment enhanced by its collective nature.

“What we are suffering from is a very isolating condition. It isolates us from our family and from our friends,” Ann says. “Being in a room full of people who have gone through the same thing you have is a powerful experience. And as we are learning, everyone is coming back and saying, ‘Wow, this is really making a difference with my migraines.’ People are shocked at how well it works.”

 University of Wisconsin Hospitals and Clinics Authority

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