My Story: Biofeedback Therapy For Migraine

My Story: Biofeedback Therapy For Migraine

By Cindy Perlin

Cindy Perlin

Cindy Perlin

The following is an excerpt from Ms. Perlin’s recent book: The Truth About Chronic Pain Treatment: The Best and Worst Strategies for Becoming Pain Free.

Susan Antelis, a licensed mental health counselor and board-certified biofeedback practitioner on Long Island, experienced dramatic healing results from biofeedback that inspired her career direction.  Biofeedback uses sensitive electronic instruments to measure a person’s bodily processes and then feeds back that information to the person so that control of the physiology can be learned. Several types of biofeedback—including muscle tension (EMG), temperature (blood flow) and brain wave (neurofeedback)—have been shown to be helpful for reducing migraines. Biofeedback is often paired with coaching in relaxation techniques.

Susan had started having hormonally triggered classic migraines with aura monthly when she was 13. Migraine headaches had occurred in her family for generations, and Susan’s would last for days at a time. At that time, in 1966, medication was not used in children. Susan’s headaches worsened to the point that she was experiencing them three days a week. Her father was a doctor, and his partner told Susan that she’d have the headaches for the rest of her life.

The headaches were so bad that Susan didn’t know if she’d be able to finish high school or go to college. At age 19, Susan consulted another doctor, who put her on medication for headaches. The medication left her wired and hung over for three days after a headache. By age 20, Susan was very depressed and almost suicidal. That’s when she decided to find a therapist.

Psychologist Glenda Axel was up on new ways and referred Susan to Gretchen Randolph for biofeedback. Susan was treated weekly with hand temperature biofeedback and EMG (muscle) biofeedback. Though she found it frustrating at first, after 10 months, Susan was almost headache free. She continued to carry her medication around with her for three years, but she never used it again. In 1980, Susan took her first professional biofeedback training course and bought her own equipment. Her migraines stopped completely in 1981. Susan started training her own two daughters in biofeedback when they were three years old. When they were 13, they started having migraines but were able to stop them with biofeedback.

A review of migraine treatments published by the American Academy of Neurology in 2000 concluded that temperature and muscle biofeedback with relaxation training were effective and recommended biofeedback as a treatment option.

In recent years, neurofeedback has been used to treat migraines, often based on the results of a Quantitative EEG. Quantitative EEG, or QEEG, is a brain mapping technique that identifies abnormalities in brain regions and brain connections, which can then be corrected with neurofeedback. In 2011, a migraine headache study compared QEEG-guided neurofeedback to pharmaceutical treatment. Fifty-four percent of patients in the neurofeedback group experienced a complete remission of migraine headaches. An additional 39% experienced a decrease in migraine frequency of greater than 50%. In contrast, of patients in the study who elected to continue on drug therapy, 68% experienced no change in headache frequency, and only 8% achieved a reduction of greater than 50%.

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Authored by: Cindy Perlin

There are 32 comments for this article
  1. Cindy Perlin at 3:12 pm

    Hi Jen,

    Feel free to use the excerpt and please mention my book. There’s lots more in it that would be helpful to migraine sufferers.

    Cindy

  2. Jen at 1:34 pm

    Cindy, can I post some of this (obviously, I will give you full credit as author!!!) in a migraine resource packet I will give to patients? Look forward to hearing from you and thank you for sharing your story.

    Best,
    Jen

  3. Cindy Perlin, LCSW at 8:32 pm

    Jeff, here is a link to a study published in a clinical EEG journal about neurofeedback therapy of migraines: http://www.stresstherapysolutions.com/kb_file/BrainMaster_Migranes.pdf

    Here is a link to a bibliography of hundreds of peer-reviewed scientific journal articles on the efficacy of neurofeedback for dozens of conditions: http://noviancounseling.wix.com/bibliography

    Here’s a partial list of peer-reviewed scientific journal articles and bibliographies on peripheral biofeedback:
    http://www.aapb.org/i4a/pages/index.cfm?pageid=3318

    From the American Family Physician (the journal published by the American Academy of Family Physicians) – November 15, 2000 Practice Guidelines on Migraine: Part 4. General Principles of Preventive Therapy:

    Recommendations for Nonpharmacologic Therapy

    The U.S. Headache Consortium also analyzed data on the use of various nonpharmacologic therapies in the prevention of migraine. According to the guidelines, such approaches may be well suited for patients who have exhibited a poor tolerance or poor response to drug therapy, who have a medical contraindication to drug therapy, and who have a history of long-term, frequent or excessive use of analgesics or other acute medications. Nonpharmacologic intervention may also be useful in patients with significant stress or in patients who are pregnant, are planning to become pregnant or are nursing.

    Members of the headache consortium reviewed data on behavioral therapies such as relaxation training, hypnotherapy, biofeedback training and cognitive-behavioral therapy. In addition, studies of physical treatments were analyzed. Physical treatments included acupuncture, transcutaneous electrical nerve stimulation (TENS), occlusal adjustment, cervical manipulation and hyperbaric oxygen.

    The level of the evidence in support of a particular intervention was classified into three categories: Grade A, which indicated multiple well-designed randomized clinical trials relevant to the recommendation and yielding consistent findings; Grade B, which indicated some evidence in support of the recommendation but the evidence was not optimal; and Grade C, which signified that the U.S. Headache Consortium arrived at a consensus on the recommendation but there were no data from relevant randomized controlled trials.

    The treatment recommendations for nonpharmacologic therapies are as follows:

    Findings: According to the guidelines, relaxation training, thermal biofeedback combined with relaxation training, electromyographic (EMG) biofeedback and cognitive-behavioral therapy are somewhat effective in preventing migraine. On the basis of the evidence reviewed, no conclusions could be made regarding the equivalence or superiority among the behavioral therapies.

    Recommendations: Relaxation training, thermal biofeedback combined with relaxation training, EMG biofeedback and cognitive-behavioral therapy may be considered as treatment options for prevention of migraine (Grade A recommendation).

    It took me a while to respond to your posts because I have been very busy with my biofeedback/psychotherapy practice, promoting my book The Truth About Chronic Pain Treatments, taking advantage of the beautiful summer weather to ride my bicycle, swim laps every day and spend time with friends–all of which I was unable to do for more than three years because of disabling back pain, which biofeedback helped me heal over 35 years ago after doctors told me there was nothing they could do for me other than give me drugs that didn’t work. For the last 35 years, I have not taken a single prescription pharmaceutical for pain and have only taken a handful of ibuprofen in all that time. I use skills rather than pills, and, when needed, alternative healthcare practitioners such as chiropractors, massage therapists and acupuncturists. I have had numerous other pain challenges that I’ve overcome rather than endured while managing the symptoms. That may be anecdotal to you, but it’s a high quality of life for me.

    And, by the way, anecdotal evidence is not meaningless in scientific inquiry. It often forms the basis for further scientific study.

  4. Bob Schubring at 11:36 am

    Jeff Poteet and Cindy Perlin argue whether it is possible to stop a migraine with biofeedback techniques. To settle this dispute, we must use the principle of causality, which is the basis of all scientific thinking. For biofeedback to relieve migraines (what Cindy calls “cure”), there must exist a mechanism, controllable by the brain, which regulates the swelling of blood vessels inside the brain. The existence of such a mechanism would make biofeedback therapy possible. Absence of such a mechanism would make it impossible.

    Anatomy research published in 1981, asserted discovery of a unicellular smooth-muscle structure in the brain, called a precapillary sphincter. The sphincters were though to act as valves, regulating blood flow in the capillaries of the brain.

    If the valve structures are real, they control blood flow in the brain, and swelling of blood vessels in the brain.

    If the valve structures aren’t real, then something else controls swelling of the blood vessels in the brain.

    Ushiwata and Ushiki say precapillary sphincters do not exist in rat brain blood vessels, in this article
    ( http://www.ncbi.nlm.nih.gov/pubmed/2161912?dopt=Abstract ). Nakai et al say the sphincters exist, in this article (
    http://www.ncbi.nlm.nih.gov/pubmed/7303053?dopt=Abstract )
    as did this study by Castenholz ( Scan Electron Microsc 1983: 161-170 ).

    There also was a lengthy argument in this thread, between Stephen Rodrigues and Jeff Poteet, relating to the health of muscles. Poteet took the position that brains do not contain muscles. Rodrigues was silent on the subject. But Castenholz and Nakai both claim to have found muscle cells in brains, located at the beginning of each capillary that circulates blood through the brain. And Ushiwata and Ushiki claim no such cells are in brains.

    That factual dispute is probative of the entire controversy between us all. If the sphincters do not exist, they are not controllable by biofeedback or by any other means. If the sphincters are real, they may be controllable by one or another means. If the sphincters are controlled only by hormonal means, then drug therapy will always be necessary to treat migraines. If the sphincters are controllable from the nervous system, in the way that voluntary muscle is, then biofeedback has a possible physical explanation.

    What Cindy has done is apply Bayesian logic…arguing from effects to knock out potential causes. This is rather common in engineering practice. Engineers rarely wait for settled scientific proof of phenomena, but instead, invent ways to exploit the phenomena and ultimately contribute to the scientific understanding of the phenomena. Watt did not need an understanding of the formation of hydrogen bonds between water molecules, to exploit the phenomenon in his steam engine. However, steam engines occasionally exploded, killing people. Watt’s invention became more reliable as various phenomena were studied, and the safety improved.

    Is it conceivable that Cindy taught herself to interrupt a migraine attack, as it begins? She believes she has.

    So the ethics question this raises, brings us full circle to my original comments. We should stop forcing people to abandon treatments that they observe to be helpful. And we should never force people to undergo a treatment, that those people find not helpful or harmful.

  5. Jeff Poleet at 10:08 pm

    Cindy,

    You wouldn’t have any idea what my neurologist has cured or has not cured. I will continue taking my pills as they are the only thing with scientific evidence to support helping migraine patients. Neither I nor science has any use for your anecdotal stories of supposed cures for migraines, nor your claims of being able to teach people how to control involuntary processes in the brain. Nothing you have asserted or any biofeedback proponent has asserted is supported by peer reviewed scientific evidence, all you have is anecdotal stories. In regards to your comments about 4 year olds experiencing trauma, you have completely missed the point. There simply is no debate; migraines are a result of DNA and genetic factors. Like I said, if you have one peer reviewed study which demonstrates otherwise, I would be happy to read it and change my mind. That is what scientists do when presented with evidence they are wrong. They don’t scramble to imply the other person has a “limited perception of reality” and they don’t get offended when their scientific claims are challenged.

    If my view of reality is limited, it is only because it is limited to reality, which you seem to have a problem with.

  6. Cindy Perlin at 10:16 pm

    Jeff Poleet, your neurologist with his headache specialty/clinic and four books has not cured a single patient of his migraines, including you. You need to keep taking your pills, which sometimes work and sometimes don’t, but you continue to be vulnerable to migraines. Biofeedback teaches people how not to have migraines and some, after adequate training, never have another one. Susan, whose real name is given in my article, has not had a migraine in 35 years, despite migraines running in her family and being told by a doctor that she would have them the rest of her life. So, you can stick to your limited vision of reality and continue to have times where you have headaches and vomit for 24-72 hours or you can try something different. It’s up to you.

    Incidentally, many four year olds have already had many trials and tribulations, including birth trauma, early medical trauma such as early hospitalizations and surgery, as well as physical, emotional or sexual abuse or parental abandonment. Trauma can also come from natural disasters, accidents or being exposed to something frightening in the media.

  7. Cindy Perlin at 9:48 pm

    Cynthia, the psychologist you contacted probably only does neurofeedback and not peripheral biofeedback. The latter includes temperature (hand warming) and EMG (muscle) biofeedback. Neurofeedback does take a lot of sessions (not necessarily 40-50) but often migraines can be reduced or eliminated just with peripheral biofeedback. Please go to http://www.bcia.org and search for practitioners in Nevada. There are several with a “BCB” designation, which probably means they do peripheral biofeedback, as opposed to the BCN designation, where they probably only do neurofeedback. Also, there is a practitioner listed at http://www.aapb.org in Reno.

  8. Jeff Poleet at 9:07 pm

    Anyone thinking of trying biofeedback for treatment of any disease, disorder or defect should read the investigative articles done my the Washington Post, Seattle Times, and a myriad of medical researchers who regard biofeedback as a complete scam. Again, there is no scientific evidence that biofeedback works to solve any health issue, let alone cure them.

    Read this before you spend thousands of dollars on a pseudoscientific “therapy” that works as well as taking a sugar pill. All of the studies below are placebo controlled, double-blind, and peer reviewed studies that were published in actual peer reviewed medical journals. This is just a sample of the studies that demonstrate biofeedback/neurofeedback has no scientific evidence supporting its efficacy.

    Biofeedback: How one man’s invention is part of a growing worldwide scam that snares the desperately ill. Source- Seattle Times 2007
    http://www.seattletimes.com/seattle-news/how-one-mans-invention-is-part-of-a-growing-worldwide-scam-that-snares-the-desperately-ill/

    Actual studies showing “biofeedback therapy for children with ADHD was no more effective than placebo.”- 2013
    1. http://www.ncbi.nlm.nih.gov/m/pubmed/24021501/
    CONCLUSION: EEG neurofeedback was not superior to placebo neurofeedback in improving ADHD symptoms in children with ADHD.

    2. EEG Neurofeedback for ADHD
    Double-Blind Sham-Controlled Randomized Pilot Feasibility Trialhttp://jad.sagepub.com/content/17/5/410.short
    Conclusion: Participants could not tell if they were receiving genuine neurofeedback or sham neurofeedback. In this study both conditions led to equal improvements in the participants.

    3. The American Journal of Psychiatry 2013 (this was a meta-analysis of all studies done on biofeedback or neurofeedback therapies.)
    http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2012.12070991
    Conclusion: Better evidence for efficacy from blinded assessments is required” before neurofeedback (and other interventions including cogntive training) can be recommeded as a treatment for core ADHD symptoms.

  9. Stephen Rodrigues, MD at 5:53 pm

    These statements are based on the laws of nature as to how the human body works:
    The most common primary location of everyday and long-term aches, pains and stiffness can only come from the soft, connective and muscle tissues.

    The most common primary cause of everyday soft tissues aches, pains and stiffness is simply the trial, tribulations, falls, contusions, stresses, strains of life, living from work, play and fun.

    The specific organ system which is inherently designed to collect stresses, strains, fractures and micro-scars is the muscular system.
    Historically, the treatments for soft, connective and muscle tissue pain, dysfunction and diseases were done by physical therapy providers (PT).
    The CNS, nerves, nerve roots, skeleton, joints, cartilage, discs, facets, sciatic – all cannot be the first or primary location or source of long-term pain. Without a huge smoking gun. This means MRIs X-rays or blood test cannot detect this pain. This means joint amputation or re-constructions, spinal fusions epidurals or botox injection do nothing to address the primary source of the most common source of pain – muscles.

    Your statement is packed with incompleteness mostly based on the Allopathic error-filled paradigms.

    We have to start from scratch so that we can be on the same page and then we hopefully will be able to understand the disconnect.

    When I hear a migraine, pain on top, side, or back of the head, jaw, ear or cheek pain or pain in the neck – all of these pain problems have the same sources. The hundred or so muscles between the shoulders and the top of the head. All are treated with hands-on PT w and w/o intramuscular stimulation + proactive.

    If you went into the hospital with belly pain and the surgeon, determined that you have appendicitis, so they removed it. What would you think if you were still living with the original belly pain?

    Wouldn’t you disagree that they were correct?

    I would wonder what they were thinking, what were the tests and why did they choose to remove your appendicitis?

    If you are still living in your original pain, you and your treatment team of providers still have work to do.

  10. Jeff Poleet at 1:37 am

    @ Stephen Rodrigues, MD

    There is no evidence whatsoever that migraines are due to muscles or lack of physical therapy. I started having migraines when I was 4 years old, and I was diagnosed at the age of 8 years old. The facts you are talking about may have bearing on back pain or other types of musculoskeletal pain, but they have absolutely nothing to do whatsoever with a proven neurological disorder like migraines, which are known genetic and hereditary disorders. I appreciate your opinion, but even with your MD your opinion flies in the face of known science and genetic research. I am certain at this point you are not a Neurologist, but probably a PCP. Musculoskeletal pain by definition deals with pain in muscles, ligaments, tendons, and bones – none of which exist in the brain. The pain from migraine is caused by vasodilation of the arteries in the brain which encroach on pain receptors in the brain and nausea receptors in the brain, and cortical spreading depression which creates a chemical “storm” in the brain resulting in depression, aura, visual disturbances, and a myriad of other symptoms. We know of 3 genes which are linked to migraines and they are the same genes which are related to epilepsy, which is why migraines in general respond well to anti-seizure medications. Muscle tension in the myofascial trigger points can certainly “trigger” migraines, but they are absolutely not the cause of migraines, which is why they are called triggers. I write professionally for one of the top Neurologists and Headache Specialists on the planet, and what you are asserting has no basis in science. Again, migraines are genetic, hereditary, and no amount of physical therapy will cure migraines, period. I shared your comments with the Neurologist I write for and he responded to your comments with one word, “poppycock”. I have invited him to share his comments in this thread, but as he is busy running an actual clinic for headache disorders, is a Master Pharmacologist, and editor of several peer reviewed medical journals, and has written 4 books on the subject of headache disorders, I doubt he has time to entertain random comments on the Internet.

    There simply is no muscle in the brain, and migraine patients do not feel pain in their muscles during a migraine attack, unless it is caused after the prodrome or aura phase in which pain in the brain has already started, which can then cause extreme stress and tension leading to some neck pain. There is a reason that migraine disorders run in families, and that is because they are genetic in origin and hereditary. Epileptic patients cannot cure their brain disorder with physical therapy, and the same is true for migraine patients. You might as well blame cancer on muscle atrophy, as logically and scientifically it makes as much sense. Again, I was 8 years old when I was diagnosed with migraine disorder, but they started when I was 4 years old, which pretty much blows your assertion out of the water that my muscles suffered from “the trials, tribulations of life and living, slips, falls, contusions and accidents.” How many 4 year olds do you know that have lived a hard life of straining muscles through the trials and tribulations of life? How many 4 year olds do you know that have had their “muscles underrated for decades”? Exactly, none.

    If you are going to deny that migraines are genetic and hereditary, then you have simply failed to educate yourself on the current science regarding migraine disorders, all of which overwhelmingly conclude they are genetic and hereditary, which is why any parent diagnosed with migraine disorders stands a 50% chance of passing on the disorder to their children. They don’t pass the disorder on to their children because of a lack of physical therapy for the child. What you have asserted simply has no basis in reality when it comes to migraine disorders, and even if it did, how would you suggest one would go about exercising the muscles in the brain, which do not exist? What type of physical therapy do you suggest to exercise the neurons in my brain?

    Besides migraines I am in excellent health and do not have any muscle pains unless I have been vomiting in the toilet for 24-72 hours because of the pain in my BRAIN or because I have worked too hard in the gym. There is not a weak muscle in my body I can assure you. Migraines don’t make me or any other migraine patient have pain in their back, pelvis, abdominals, pectorals or any other muscle group, period. The pain originates and exists in the brain, and all of the scientific evidence supports my claims. If you can find one study that even suggests that migraine disorders are caused by muscle atrophy or lack of taking care of muscles, that has been accepted and published in a medical journal, I would be happy to read it.

  11. Cynthia at 11:04 pm

    Cindy Perlin…the psychologist who does it here has a high hourly rate and said it would take 40-50 sessions. I was shocked too. I am a retired LMFT (forced to quit working due to sitting pain), living on a small fixed income, if it were just 2 or 3 sessions, I could do it. I will look into it again, as it’s been a year or so since I did. Are there any machines that you recommend for home use? Thanx

  12. Cynthia at 10:58 pm

    Dr. Rodrigues….where would you suggest we get all that wonderful help for our muscles.? Do you happen to know if Medicare covers any of th things you mention? I know some of them can be done by ourselves, at home. But I have yet to meet a PT (have tried 4 times in 8 yrs) who Will spend time with hands on. They always put me on machines, or with a ball doing exercises. And massage isn’t covered by Medicare. Would appreciate any suggestions….age 69, DDD, sciatica, non diabetic neuropathy. Thanks.

  13. Cindy Perlin, LCSW at 7:46 pm

    Cynthia, one more thing. I see no reason why biofeedback treatment should cost $10,000 dollars for treatment of back pain. Biofeedback is usually billed at an hourly fee, commonly between $100 and $200 per hour session, and even a few sessions of biofeedback with coaching in relaxation techniques should make a difference for back pain, especially if you have a home training device like the Stress Thermometer. When I was suffering from back pain, I was really broke and could only afford two or three sessions. Those sessions saved my life. As a practitioner now, I definitely prefer that clients stay with me until they’re feeling better and avail themselves of all the skills and information I have to offer, but if they can’t financially I try to send them home with the tools they need to do it on their own.

  14. Cindy Perlin, LCSW at 7:36 pm

    Cynthia, I was disabled by back pain for over three years starting when I was 25 years old and temperature biofeedback got me better. I’ve used it for myself now for over 35 years and with my clients for over 23 years. It’s a safe and effective treatment for many kinds of pain.

  15. Stephen Rodrigues, MD at 3:25 pm

    @Poleet

    What I believe is not the issue.
    I’m referring to what are known biological facts as to how nature and the human body works.

    David Simons, MD left the world a profound clue. He stated, “Muscle is an orphan organ. No medical specialty claims it. As a consequence, no medical specialty is concerned with promoting funded research into the muscular causes of pain, and medical students and physical therapists rarely receive adequate primary training in how to recognize and treat myofascial trigger points.”
    http://www.myofascialtherapy.org/myofascial-therapy/index.html

    A few biological facts on the CNS and skeleton:
    These two organ systems rarely if ever are the primary location of long-term or chronic pain.

    A few biological facts on the muscle system:
    The muscular system is sandwiched between your skin and bone.
    The most common primary location and source of pain is in our muscles.
    Everyone will have muscle pain.
    Muscle pain is caused by the trials, tribulations of life and living, slips, falls, contusions and accidents.
    Muscle derive pain will only benefit from physical therapy.
    Physical therapy is the application of tender loving care to your muscles.
    All 700 of your muscles will require some physical therapy.
    Muscle derive pain will not fully benefit from medications.
    It is not logical to try to treat muscular derived pain in the operating room with a knife.
    Muscles diseases which if left untreated or undertreated will corrupt cellular efficiency which is the definition of organ system failure.

    Under treated muscle system dysfunction and failure is a number one cause of all these syndromes: migraines, trigeminal neuralgia, RSD, neuropathic pain syndrome, pelvic floor pain, erectile dysfunction, elevated blood pressure, fatigue, diabetic neuropathy, degenerative joint disease and many others.

    If your muscles are left undertreated over decades, the metabolic and cellular corruptions will leach into and infect the other ten organ systems. Pain, dysfunctions, and malfunctions will present as; dizziness, vertigo, gut-brain syndrome, IBS, mood disorders, Mental and Spiritual distressing, cognitive functioning, memory, depression, suicidal and homicidal thoughts to outright suicides.

  16. Cynthia at 12:20 pm

    Cindy Perlin….thank you for mentioning the stress thermometer. I’ve been looking at those for years. Now that I have a recommendation, and it’s inexpensive, will get one. I don’t have migraines, have back pain/sciatica/neuropathy, but I do know that , for me, at almost 70, with burnt out adrenals from 8 yrs of pain, I MUST relax. I’ve always wanted to do biofeedback. I hope it becomes more widely available. And covered by Medicare. There’s one dr. Who does it here in Reno, NV, it would cost me $10k to do it.

  17. Cindy Perlin at 7:00 am

    Christine Taylor, I may have not been clear when I said that keeping the hands warm can prevent migraines. It is not about wearing gloves, immersing the hands in warm water, etc. It is about using the mind to reduce stress and thereby vascular constriction and muscle tension, which for most will reduce migraines. One of the very best things about biofeedback is that it is completely safe and without side effects. It is also, according to established criteria for “proven effective” considered by even conventional medicine to be a treatment for migraines that has a top A rating for proven effectiveness. This is in contrast to, for instance, Topamax, which is widely used for migraine prevention, but has zero scientific studies behind its use, only “medical consensus”. One of my clients developed acute wide angle glaucoma and needed surgery in both eyes to avoid blindness as a side effect of Topamax. It was only the fact that she had actually read the package insert when first prescribed and vaguely remembered something about eye damage (there’s actually a black box warning) that saved her vision. Her doctors missed the connection completely.

  18. Christine Taylor at 11:41 pm

    Keeping the hands warm does not prevent a migraine, nor would I think that it would cause one. ( severe Raynauds sufferer here) .Hands and fingers, toes etc will often be cooler than the rest of the body and a temperature reduction does not necessarily mean that the mind is stressed.

    I have tried many ways to reduce pain and it takes a balanced approach to get things to a tolerable level. Exercise, heat and cold depending on the pain, relaxation techniques, awareness of body positions, balanced diet with or without medication.

    I am very skeptical of the biofeedback described and would believe it to be more of a placebo effect. Many people in pain are on reduced income and cannot afford to waste money on unproven treatment.

    If a person is in pain and finds relief then good for them, they likely should continue but unless there is sound science from many reputable sources I will remain skeptical.

  19. Jeff Poleet at 10:11 pm

    I don’t know if I am understanding your post, as it seems like you are saying that all pain, even migraines, are a caused by pain in the muscles. If that is your assertion, I don’t understand how muscles have anything to do with a neurological disorder in the brain, which is the basis for migraine disorder. No amount of PT, massages, yoga/stretching, and especially acupuncture (a known placebo lacking evidence of efficacy) will cure a neurological disorder. The pain of a migraine is caused by the nerves in the brain, cortical spreading depression, and there is no way to massage or stretch this neurological disorder out of the body.

    Massages and stretching are great for reducing stress, which can be a trigger of migraines, but it will not cure the migraines or prevent them from occurring. If I am misreading your post I apologize. Migraines have nothing to do with muscles, again it is a neurological disorder, not something you can massage away or cure by sticking needles in your back or burning incense while meditating.

  20. Cindy Perlin at 9:01 pm

    Jeff Poleet, The study you referenced notes in limitations of the study that treatment compliance was low and the dropout rate was high, so it’s hard to draw any firm conclusions from this study. Here is a link to the study on neurofeedback treatment of migraines, authored by a neurologist: http://www.stresstherapysolutions.com/kb_file/BrainMaster_Migranes.pdf.

    The essence of biofeedback is that bodily functions previously thought to not be under voluntary control can be brought under voluntary control by providing feedback. The yogis in India have been doing this for thousands of years. Biofeedback brings the ability to do this to ordinary people. In fact, the Mayo Clinic made a video about this in the early ’70s called “Biofeedback,Yoga of the West”. The Mayo Clinic, by the way, is a proponent of biofeedback and has been since it was invented. Some of the early biofeedback research was done there.

    One recent advancement in medical knowledge has to do with gene expression. It’s now known that genes are not your destiny. Whether genes “express” or not is often dependent on lifestyle factors.

  21. Cindy Perlin at 8:48 pm

    Cynthia, there is an inexpensive biofeedback device that I recommend to all my migraine clients, called the Stress Thermometer. It is $21.95 on Amazon. You measure hand temperature with it, which is an indicator of stress and also constriction of blood vessels, which is a factor in migraines. Learning to warm your hands and keep them warm helps prevent migraines. Please note that I have absolutely no financial interest in this product or in Amazon.

  22. Cindy Perlin at 8:38 pm

    Carol Hammond, of course biofeedback has improved since 1965. Biofeedback uses electronic instruments and we are light years ahead in technology since 1965, including the invention of the computers. We are now able to give more sensitive, engaging feedback and measure multiple modalities at once. In addition, neurofeedback (brain wave biofeedback) was not even invented in 1965–the first human study (on seizures) was published in 1968. Neurofeedback has also evolved. We now have normative databases and brain mapping technology that allows us to determine what is wrong in each patient and target it for treatment. There have also been advances in the understanding of migraines that have been incorporated into treatment. In 1965, biofeedback was in its infancy and it is also possible you didn’t get optimal care even given the state of knowledge in the field at that time.

    In terms of being self-serving, why doesn’t anyone who takes meds ever point out that every study done of medication effectiveness is done by the drug companies who make the drugs and stand to make billions of dollars from any they can convince the public to use.

  23. Cynthia at 11:19 pm

    Would love to do,biofeedback. But Medicare doesn’t cover it, and it’s very very expensive, where I live in Nevada. Wish there were a home machine that is affordable.

  24. Stephen Rodrigues, MD at 8:57 pm

    Mindfulness, meditation, prayer, singing, puzzles, fishing, and knitting are all VALID options for the proactive preventative options for the pains of life’s stresses, strains, trials, and tribulations.

    They are all kind of the same type of remedy. Meaning you should remove yourself from the realities of our insane world of human crazy behaviors and thinking.

    These are of tremendous value but 1 part of an entire proactive plan of action or Treatment Action Plan -TAP is way better.

    As the depth of the intramuscular pain disease increases so does the treatment intensity in “force of efforts” applied to the body. So not just a weaker 30 min massage, you will need a longer and deeper 90 min massage.

    “Any complaint of experiencing “pain in the body” is most commonly and primarily sourced from the muscular system and thus mandates receiving treatments with the various modalities of physical therapy.” -SSR

    PT is the application of treatment options on the surface or inside of the muscles all over the body.

    A migraine, tension, trigeminal neuralgia, occipital neuralgia, jaw pain, facial pain, sinus pain mouth pain can all be deconstructed as pain in the upper part of the body of muscles, from the shoulder to the top of the scalp.

    This is where hands-on PT must be applied. PT is now added into the TAP as an entire recipe to prepare the body for full, complete and restorative healing. So the patient has to be engaged in a self-care plan of action with is mandatory to keep the healing fueled and activated. This will speed up, add certainty and predictability to the overall recipe.

    Self-massages, aerobic exercise program, i.e. take the stairs, walking, house or yard chores, gardening, using hand weights or doing floor exercises.

    Take time every day for yourself by relaxing by Breathing, Mindfulness, Eye Exercises, Tai Chi and/or Yoga. Stretching … all of the major joint areas.

    Massage, kneading, pulling, punching, chopping etc of all of your sore and achy muscles and areas on a daily basis.

    The add-in, layer on top and blend in – all of these:

    Hands-on PT options @ 2-3 x per week: a) Massage. b) Tissue release options. c) Strain and counter-strain. d) Joint and spinal Manipulations. e) Spray and Stretch.

    Thin Intramuscular Needling options @ 2-3 x per week: a) Dry needling b) GunnIMS c) Chinese, Japanese, French Energetic and various other “Acupuncture.”

    Hypodermic intramuscular needling options @ 1-2 x per week: a) Wet Needling.

    Cherry picking, watering down, adulteration, half-stepping, weak tea PT in modern worthless TAP should be avoided. The idea of using “a single ingredient” in a full recipe has been adapted by ignorance of how the human body works. The Allopaths who only use pills and scalpels want you all to believe that a single option will do it all. NO! Use the whole recipe or TAP.

  25. Bob Schubring at 7:37 pm

    Thanks, Jeff.

    Certainly when legal claims are made against someone’s money or time, on a theory of strict liability, there must be proof of causation.

    This principle holds in all cases.

    Whether the quack cure stops working.

    Or the victim seeks compensation for the accidental injury that caused the pain.

    Or any other imaginable issue…we cannot very well have law courts awarding damages based upon sheer guesswork. That was tried at Salem in the witchcraft prosecutions and is still being taught to law students and lay people, as a textbook example of what happens when guesswork substitutes for rigorous proof.

    In pain cases, the principal issue is that the victim alleges he or she feels pain.

    Up until recently, this assertion lacked any means of proof or disproof. (Those acquainted with a particular patient would notice the rise in blood pressure, sleeplessness, and muscle movements in the face, and conclude the patient to be suffering a pain flare. Those too stupid to pay attention to such evidence, remained clueless about the patient’s condition.). Now, however, there are analytic techniques, notably the PET Scan to detect glial activation in the brain, that proves the presence of a pattern of brain inflammation caused by unrelieved pain.

    In the case of a corrupt health insurer who is refusing to pay benefits to an insured person, the insured person can prove their chronic pain exists and is untreated.

    The kicker is that at present, these tests cost several thousand dollars. It would be best for patients if the corrupt insurer, who had a pattern of never paying pain-care claims until sued by a patient and confronted with PET scan results, could be ordered by the law court to cease advertising that chronic pain is a covered condition.

    Understanding proof of causation is fundamental to human understanding of objective reality. The scientific method is rooted in causation: “By performing Steps A,B, C, I cause Result G to happen…and Result G does not accidentally happen by itself.”. That’s the basis of everything people actually know.

    No real scientist objects to the use of the scientific method, to confirm a theory.

    If people do not grasp the importance of this, then our educational systems are clearly failing to teach epistemology.

  26. Marty at 2:21 pm

    I do not suffer from migraines but do suffer from headaches due to Hydrocephalus which was caused by my neck giving way. That said some treatments may work for some and not for others. It is just the way things work. I do not look down on anyway anyone finds relief, be it biofeedback, medical MJ, opioids or if going to church helps you then more power to you. We should have access to any and all treatments and no one other than the patients and their doctors should make that decision.

  27. Jeff Poleet at 1:34 pm

    To a great extent I agree with you Bob, and you make a good point. However, where do we draw the line between real treatment and pseudoscience? If we cast aside science and reason then we end up with people taking advantage of people who are in desperate need of real treatment, but they end up wasting their time, health, money, and sanity on things like crystal healing therapy, magnets, astrology, psychic healers, spiritual healers, etc.

    My goal is not to prevent someone from therapy that will help them, my goal is to stop desperate people from being taken advantage of by snake oil salesmen. My goal is to stop the stigmatization of legitimate migraine patients by doctors and the public at large because they think we are crazy when they see people claiming to be “healed” by therapies that have no basis in reality or science. My goal is to keep people who are in pain from losing hope when once again the new magical “cure” fails them, and they become even more hopeless.

    We already have a hard enough time getting appropriate pain treatment and to get insurance to cover therapies that we have actual evidence that it works. How are we supposed to get insurance to cover therapies that have no basis in reality, that have no evidence of efficacy?

    I don’t want to control anyone or demand that one treatment fits all, but there must be some standard of quality in which treatments are measured, otherwise we are left with nothing but a dowsing rod, misled and hopeless, wandering around the desert searching for a cure that is not there.

  28. Bob Schubring at 11:23 am

    This article and the responses to it, show the difficulty of imposing treatment decisions on others by force.

    In Cindy Perlin’s personal experience, biofeedback now works better for her than drugs.

    In Carol Hammond’s personal experience, biofeedback did not work at all.

    What’s reasonable to infer from this, is that Cindy should have access to biofeedback and Carol should have access to drugs.

    Instead of doing something reasonable, politicians try to impose one solution on everyone. Which is unreasonable, because not everyone responds in the same way, to any particular treatment.

    I don’t see this as a conflict of interest.

    I see it as personal experience. And what we need to do, is stop trying to force everyone to use the same treatments, and instead, focus on matching people up with treatments most likely to work for them.

  29. Carol hammond at 7:33 am

    Susan , a licensed mental health counselor and board-certified biofeedback practitioner.

    I don’t know if biofeedback improved since I tried it in 1965. It certainly never worked for me. The first thing I thought of was she is comprised because her father was a doctor and she board certified councilor so they make money using and praising this. I guess I don’t believe anything like this because of the lies we are hearing from our government. ..sounds funny. I know. Again, Biofeedback never worked great for me. Is there an unbiased study associated with this doctors claims? I don’t mean to be negative and don’t do it to cause trouble for Susan.

  30. Jeff Poleet at 3:57 am

    I am very skeptical of biofeedback as a cure for migraines or any other medical issue, as the evidence is lacking in this regard, and none that I am aware of that demonstrates biofeedback is better than simple relaxation techniques. Physiologically there is no forensic evidence to determine how or why biofeedback is actually working, if it actually does work. I also find it a conflict of interest that this woman makes money offering biofeedback treatments, and yet does not link ONE single study to back her claims of efficacy.

    I find the assertion that the ability to cure migraines completely with biofeedback specious at best. Where is the evidence? Where are the supposed studies that show efficacy? The idea that you can stop a genetic and hereditary disease by thinking about INVOLUNTARY actions in the body is frankly absurd. Being aware of stress levels and taking measures to reduce stress is one thing, claiming to be able to control involuntary physiological actions in the body is something completely different.

    Here is an actual study done in 2009 and the conclusions of the study, which is 9 years more recent than the supposed AAN study done in 2000, and I will even provide my source, something everyone should do when making claims about cures of any disease or mentioning “studies” and their pro-ported effects.

    “CONCLUSION: Biofeedback is an extremely costly and time-consuming treatment modality that, in our study, provided no additional benefit when compared to simple relaxation techniques alone, in the treatment of migraine and tension type headaches in adults.
    Conclusion”

    Source: http://www.ncbi.nlm.nih.gov/pubmed/19935987