Biofeedback is a technique for developing greater awareness of and voluntary control over physiological arousal of the stress nervous system (like muscle tension and shallow breathing) that is often beyond our awareness. Studies show that chronic arousal of the stress nervous system or sympathetic nervous system is strongly linked to headache. In biofeedback treatment, self-monitoring and self-regulation skills are learned using sensitive and non-invasive recording instruments to help the patient actively manage ways their bodies are affected by pain and by other stresses in their lives. The training often leads to surprising insights about ways we carry tension and worries.
We know from studies that optimal improvement with headache patients can often be achieved with short-term biofeedback therapy. Fifty percent of patients report improvement by the 6th session, and more than 90% report significant improvement by the 10th. Studies also show that more than 90% of patients who continue to practice skills developed in biofeedback therapy report lasting improvement, based on 1-5 year follow-up studies.
Headache patients tend to carry higher tension levels in their shoulders when under stress compared to those without headache. They also take longer to recover to lower levels of muscle tension after stress. Accordingly, a major focus of current biofeedback treatment is muscle tension in the shoulder area. Muscle tension in other areas may also be addressed, especially around the face and head. Sensors are used to measure increased electrical activity in the muscles that is associated with increased muscle tension. These sensors are attached to the skin like a band-aid. Tension in the shoulders, neck, forehead, and jaw are common areas targeted for treatment.
Problems with breathing are almost always linked to stress and worry. For this reason, patients begin biofeedback with respiration training using an expandable belt that is placed around the waist. The sensor expands as the person breaths in, revealing problems with breathing such as shallow breathing, rapid breathing, and breath holding. Problems with breathing usually involve breathing into the chest, called thoracic breathing. This means that with every breadth, muscles in the chest and shoulders contract slightly, contributing to chronic muscle tension and soreness. Respiration training is used to help the patient breathe into the belly diaphragmatically. This more relaxed form of breathing helps quiet the entire stress response and sets the stage for more advanced biofeedback training.
We also monitor the relationship between breathing and heart rate in biofeedback. I introduce this more advanced form of breathing as the patient begins to master other relaxation skills. Patients learn how to breathe at a rate that results in a close correspondence between breathing and heart rate. When this occurs, powerful reflexes are released in the body that helps quiet the stress response, leading to a deep sense of well being and relaxation.
In the second half of biofeedback training, patients learn how to warm their hands just by thinking about it. This skill is called thermal biofeedback. It involves focusing on sensations in the hands associated with increased blood flow, like warmth in the palms and a feeling of tingling or pulsing in the fingers. When the sympathetic nervous system or stress system is turned off, blood vessels in the hands (and feet) begin to dilate. Small changes in the size of blood vessels in the hands and feet lead to dramatic changes in blood flow. Headache patients often report that they have cold hands. This is one sign of chronic arousal of the sympathetic nervous system. With training, patients learn to warm their hands when they notice their hands becoming colder.
By the end of treatment, patients have learned these and other skills and can apply them easily and quickly throughout the day. With practice, patients are able to use these skills at any time. One of the strengths of biofeedback is that skills learned during treatment do not require stopping what you are doing to relax. The ability to use skills quickly and throughout the day often leads to dramatic improvements. Even when the training is complete, patients who continue to practice often report increased improvements over time as they continue to learn about ways their bodies respond to stress and how to stay calm.
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