By Michael Lasalandra
BIDMC Correspondent


Jennifer has suffered from headaches since she was 10. By the time she got to college, they had gotten more severe and more frequent. She tried a variety of medications and even trigger point nerve block injections, but nothing really worked until she discovered biofeedback and meditation.


“Sometimes the headaches were so bad, I’d have to go to the school nurse’s office and sit there in the dark,” says the psychology major who asked that her last name not be used. “Sometimes, I’d have to go home. It definitely was distracting me from my school work.”


At the worst point, she was getting severe headaches at least three times a week. Aspirin, NSAIDS and prescription medications called triptans didn’t work. She was eventually referred to the Arnold Pain Management Center at Beth Israel Deaconess Medical Center, where she first tried trigger point nerve block injections, but, because she also suffered from muscle spasms, found them too painful.


Then she tried biofeedback under the direction of Dr. Joshua Wootton, Director of Pain Psychology at the Arnold Pain Management Center.


“Biofeedback has proven to be an effective treatment for migraines, tension and cluster headaches,” he says. “It is both an instrument and a process that we combine with cognitive behavioral therapy in which the patient learns deep relaxation techniques.”


Biofeedback is a non-invasive intervention that helps patients and their doctors better understand how stress, negative emotions and other factors impact the body. Bodily changes are measured via sensors attached to the body, with the results displayed on a computer screen.


Bodily responses that are typically measured include musculoskeletal tension, skin temperature, heart rate, blood pressure, oxygen saturation and sweat gland activity, Dr. Wootton says.


“People can actually see on a computer screen what is happening in real time,” he says. “By increasing their awareness of how their bodies respond, patients can more easily devise strategies for improved response. For headache pain, we focus on musculoskeletal tension and autonomic nervous system dysfunction. Patients can see that by just being in pain they are raising their adrenaline levels and putting further strain on their bodies, exacerbating their pain and making it less treatable.”


At the same time, patients are taught relaxation techniques, usually basic meditation.


“I teach them an easy form of meditation and ask them to practice it twice a day for 15 minutes each time,” he says.


The biofeedback machine can measure what effect, if any, the relaxation is having on their relevant bodily functions. The goal is to reduce tension and quiet the autonomic nervous system, lessening adrenaline production.


The cognitive behavioral therapy part of the process amounts to “me being more of a coach, teaching them a skill, the ability to relax in a more concerted manner than they have previously known, and rehearsing the benefits with them on a regular basis,” Wootton says.


“I ask patients to make a four to six-month commitment,” he says. “After that time, patients generally know whether it is working or not.”


The techniques may be used in conjunction with the typical medications patients take for headaches.


Dr. Wootton says most patients who keep to their meditation schedule generally find relief from their headaches. “Almost all report some benefit,” he says. “The goal is always better management of pain, but most patients also report improved sleep, less anxiety, and a better ability to cope with the stress of daily life.”


Jennifer says she noticed improvement within a few weeks. “After a couple of months, there was a huge difference,” she says. “Now, if I feel a migraine coming on, instead of taking some pills, I just sit and meditate. I’m still shocked, because I was a little skeptical. But it completely zaps the pain.”


Today, still on the program, Jennifer says her headaches are down to about once a week at most.


“But they’re not as bad,” she says. “It really has made a big difference.”


Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.