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It is mystifying why the efficacy of biofeedback for headaches is not widely recognized, because this has been the case for a very long time. The answer may simply be that over time headaches have become more and more a medical issue, and medical docs tend to resort to their own methods, which in this case is medication. But if the medications worked well, why would we then still have some 30 million migraine sufferers in this country? The medical remedy is clearly not adequate.
So let us spread the good news: Biofeedback and Neurofeedback are excellent remedies for both what are called "tension" headaches and for migraines. In fact, treating migraines is not substantially more difficult, and it is not significantly less effective, than treating ordinary tension headaches. What this is really saying, of course, is that nearly every person is already carrying the remedy for their own headaches with them. Their nervous systems simply need to be trained toward better self-regulation.
We can go further. Clinical success in dealing with migraines is greater for Neurofeedback than for almost all other conditions in our own experience. And we can go further still. Most people who seek out Neurofeedback for migraine are not those who have an occasional migraine. These people tend to make do with whatever medical remedies are available. We tend to see clinically those who have had a debilitating migraine history for many years, and they finally found their way to our office. And yet the Neurofeedback training is efficacious for such people.
Again it needs to be emphasized that anyone who has suffered such a debilitating illness for so many years is no longer just dealing with migraines. Neurofeedback can also be helpful with any trauma aspect of their life histories. Surprisingly, many migraineurs are not laid low even by the long-term siege of migraines. Get rid of their migraines, and they are back into their lives. Such resilience is remarkable. It goes together with an incredible capacity for forgetting one's migraines. No sooner is the migraine gone than it is forgotten.
In the event that there should be a breakthrough migraine now and then even after the Neurofeedback training series is completed, the client may choose to have a booster session along the way, or else avail themselves of Neurofeedback home remedies.
One of the newer approaches just involves the training of cortex to a higher level of activation. This tends to abort an incipient migraine. One is reminded of research with cluster headaches showing that breathing pure oxygen can abort the headache. Training the cortex to higher operating temperature may be accomplishing the same thing: making more oxygen available to the pre-frontal circuitry, sufficient to abort the migraine mechanism.
Our objective, of course, is not merely to abort migraines as they are coming on, but to get rid of them entirely. With modest attention to lifestyle issues and risk factors, this should be achievable with Neurofeedback for the vast majority of migraine sufferers.
Heart health is predominantly a matter of how we live our lives, as opposed to being determined by the miracles of Medicine, spectacular though they are. The central message from the biofeedback perspective is to make people aware of how much control they can in fact exercise over their own heart function. It is not just a matter of diet, exercise, weight loss, and if necessary, medical management of cholesterol and of high blood pressure, with perhaps a baby aspirin thrown in for good measure.
We can also influence our heart function immediately and directly, both through our control of the breath and through the management of our emotional state. Simply by attending to our own breath, by moving it toward calmer and slower rhythms and by shifting toward abdominal breathing, we can alter the state of our physiology profoundly in the moment. Extended practice, conducted at moments of opportunity, can promote healthier habits over the long term. Similarly, attending to the extremes of our emotions can also be very helpful. The stealth killer in heart disease is uncontrolled anger. But unrelieved grief can also lead quite literally to a "broken heart."
The most straight-forward intervention is training toward healthy heart dynamics, a technique now known as Heart Rate Variability (HRV) training. Ideally the heart exhibits healthy variation from moment to moment in its function, as it responds to the external and internal environment. When it ceases to be able to do that, cardiologists look upon this as the best predictor of cardiac mortality. It was shown in Russian research that this measure is directly trainable, and it appears that people are better off for having made the effort. No long-term outcome data are available yet, as this technique is relatively new in the United States.
With general Neurofeedback training, the whole enterprise of improved regulation can be significantly helped. The body will gravitate toward calmer and more stable regulation, and the person may no longer be in the grip of extreme emotions. Neurofeedback does not erase either anger or grief, but it can help to tame the experience and moderate the physiological excursions.
Neurofeedback can also help by allowing people to function with lower levels of those medications that may influence the heart unintentionally. This includes some of the medications for the ADHD spectrum, such as the stimulants and Clonidine. People at risk of cardiac events should consider a combination of HRV and Neurofeedback training to gain a higher level of mastery over their condition.
Heart emergencies may be attributed to arterial occlusion, but such occlusion most likely did not have sudden onset. The immediate emergency was likely caused by the disregulation of heart rhythms. The deliberate training of heart rhythms makes sense as a contributory preventative measure.
- Hormone Replacement Therapy (HRT)
Hormone Replacement Therapy appears in this listing because a study published in 2002 found it to be a risk factor for heart disease, stroke, and breast cancer. This came as a considerable surprise since prior studies had suggested HRT might actually be beneficial for one or all of these conditions. Women largely heeded the new warnings, and prescriptions for the principal medications have dropped by two-thirds since 2002. Most recently (JAMA, April 2007) it has been found that the judicious use of minimal HRT for a few years during menopause can be recommended without fear of increased risk of heart disease, although there remains a modest risk for stroke and breast cancer.
Such increased risk might be acceptable if there were no alternative to HRT. But with Neurofeedback we have another option to address the matter of hot flashes and night sweats. Neurofeedback may not lead to complete symptom suppression, but even in those cases it will likely reduce the medication dose necessary for symptom suppression. Given the risk factors, any such reduction is to be welcomed.
Even though a direct comparison with a medication option is possible here for the symptoms of menopause, one should really not think of Neurofeedback simply as an alternative to medication. It is brain training, and the benefits of such training fall out much more broadly. Menopausal symptoms are attributable to large swings in hormone levels that occur somewhat erratically, and these can have varied impacts on brain function beyond the above classic symptoms---effects on cognition, on emotional state, and on the feeling of well-being.
The effect of the Neurofeedback training should be lasting, once a training program has been completed. However, booster sessions should be tried in the event of the recurrence of symptoms.
Just as we deal nicely with the varied PMS symptoms, Neurofeedback training can also be helpful for menopausal symptoms, including hot flashes. The remedy is not categorical here, but substantial symptom improvement should be expected. The person involved may want to use a combination of methods. With the questions raised recently about hormone replacement therapy, one option might be to use Neurofeedback as a first resort, and to add HRT at a very low level if necessary to support more stable regulation.
Peter Kramer suggests in his book "Listening to Prozac" that being hypomanic may in fact constitute a kind of ideal for the American white collar worker, a virtue almost sure to get a man hired. But from the standpoint of health, it may represent less of an ideal way to live. Training the nervous system to live in calmer states is the strong suit of biofeedback and Neurofeedback techniques. This does not restrict the nervous system in any way from rising to a demand when that is called for. It merely allows the brain to work at a more efficient (i.e., lower) level of activation to get its work done.
The brain needs to be sufficiently activated to get the job done, but any higher levels of activation than that do not contribute to additional efficiencies but rather begin to cost the person.
The Neurofeedback training gives the brain more ready access to different states, so that it can manage more optimally. Our Western lifestyles tend to move us incrementally toward more engaged states, and that is even more true of the person with a propensity toward hypomania. Eventually such states become the comfort zones in which the person "hangs out" even in the absence of a challenge. Brain training allows the person once again to experience calmer states, and eventually the person learns to live there. Occasional refresher sessions may be called for, perhaps only once a year or so.
This is one of the stock symptoms associated with Attention Deficit Hyperactivity Disorder. From the standpoint of brain function we can look at this in a number of ways. It can be looked at as a deficiency in behavioral inhibition. It can be seen as the consequence of an inappropriate level of activation of the motor system. It can also be seen as a consequence of discontinuity in mental processing which may happen generally in the ADHD child. Such discontinuity disrupts the internal narrative that accompanies our life experience. On the input side, the child becomes highly distractible. On the output side, the child may be seen as hyperactive. Hyperactivity can be related to the child's level of physiological arousal, so that the child's nervous system cannot sustain vigilance.
It is not actually necessary for either the clinician or the parent to sort out the details here. Providing the brain with a greater competence to regulate its own affairs is all that is required, and that can usually be accomplished with brain training. Enhancing the brain's ability to control itself has broad benefits for the behavioral deficits in the child. When one witnesses this process as a parent, it becomes clear in retrospect that the child was probably not able to control his or her behavior before because of brain-based reasons.
Many years ago, when remedies for hypertension were at issue, it would be routine to mention biofeedback among the available remedies. Nowadays, that is less and less the case. What has happened here? Did authorities change their minds over the years? To an extent, the answer is yes. But the earlier truths did not at some point cease to be true. In fact, they have become even more true! Biofeedback is an effective remedy for hypertension.
The earlier methods consisted largely of biofeedback techniques that involved "peripheral" physiology: hand temperature training, skin conductance work, muscle relaxation training, and the learning of abdominal breathing. More recently, we have had significant success with EEG-based biofeedback. This should be no surprise. Regulation, after all, is centrally controlled, even if the measurements are peripheral. Either way, we are talking to the central nervous system - even when matters concern the heart.
A few years ago I inquired with the head of the NIH Heart, Blood, and Lung Institute as to whether the Institute would be interested in a proposal to study of EEG biofeedback for hypertension. She did not see how that would add significantly to the body of literature. It was already clear from the literature that biofeedback was effective for hypertension. That did not have to be proven all over again with a different modality. As for the question why cardiologists were not routinely recommending biofeedback for their patients, that was not in her job description. She turned up her hands as if to say, that's a much bigger issue.
One suspects that cardiologists are just much more comfortable with the new medications that are coming along, and of course these have a lot of marketing pressure behind them. There is also a kind of safety in sticking with what colleagues are doing, so the medical management of hypertension has essentially taken over. Along with that, we have seen an increasing aggressiveness with regard to hypertension. The standard of what is normal keeps being lowered, with the result that a larger and larger percentage of quite functional people are being recommended for aggressive drug treatment.
Whereas it used to be considered that anything under 140mm Hg of systolic pressure and 90mm of diastolic pressure was normal, the new targets are as low as 120mm over 80. It appears that an obvious tendency may be at work here: If low blood pressure is good, then lower must be better. The frustrating data driving this are that a high percentage of cardiac events occur even in the absence of any of the obvious risk factors. So we push even harder on the risk factors we know about.
This ignorance extends to hypertension itself. From the strictly medical perspective, the cause of some 90% of cases of hypertension is unknown. Perhaps a new perspective is needed. And perhaps the fact that biofeedback "works" routinely for hypertension gives us a clue. The clue is that in up to 90% of the cases the cause may not be organic at all, but rather functional, which in turn opens the door to a functional remedy. What do we mean by a functional deficit? Let's just say that the central nervous system has gotten into bad habits. Over time, and under the various stresses of life, it has learned dysfunction.
As soon as we ask the question about how well the control mechanisms governing heart function are actually working, we find that the two numbers we get while the person is lying inactive on a bed at the doctor's office don't really tell us very much. We have to know how the person functions under the stresses of life: that is to say, we must inquire into the "dynamics" of the heart.
The first and most obvious "stressor" or modulator of the heart is our breath. Our heart rate and blood pressure both follow our breath. In a well-regulated system, the heart rate tracks the in- and out-breath fairly closely, and the blood pressure follows with some delay. The resulting fluctuation is referred to as "Heart Rate Variability (HRV)." The concept is well known to cardiologists. In fact, it is already known within cardiology that HRV is the best single predictor of cardiac morbidity! What is not generally appreciated within the field, however, is that HRV is not only a passive measure, but also a pathway toward an active intervention, namely biofeedback.
Here we have yet another "figure of merit" for heart function that we can use for training our physiology. In fact, we are even better off here than in the usual case of biofeedback. Ordinarily, the functions we are training are "autonomic," under our body's control but not directly under our volitional control. Hence the extended biofeedback training process is necessary to "retrain" our autonomic regulation. When it comes to HRV, however, we can intervene voluntarily because the breath can be put under our voluntary control. So the training of heart function begins with the voluntary control of the breath. This is a course that no one can fail. It is unfortunately a course that very few people take.
Simply slowing down our breathing rate does two wonderful things: the first is that it gives heart rate variability greater range. The heart rate swings more widely simply because it has more time to do so. And that exercises the control loops all by itself. The heart will be kept under "healthy stress" with every breath. The second impact is on the CO2 or carbon dioxide level of the blood. By breathing more slowly, we allow our blood chemistry to equilibrate. Fast breathing short-circuits that process, and that causes all kinds of cumulative mischief with our health.
The dictum that most chronic health conditions involve issues of human behavior is particularly relevant to the condition of our hearts. If the cardiologist reaches directly for the prescription pad without also mentioning the importance of the behavioral realm, then his patient is likely not well served. And the behavioral realm now extends beyond the matter of reducing salt intake to how one lives one's life day-to-day, moment-to-moment, breath-to-breath.
Now we cannot be expected to pay attention to our breath during all of our waking moments. But by placing the breath under our voluntary control for even a while, such as we might do in a biofeedback therapy session, we allow our system to acquire new habits that it then takes home.
In this larger perspective, then, the "success" of the medication in reducing blood pressure occurs at a price of foregoing the conversation that should be taking place, and of avoiding the essential remedy of training dynamic heart function. The combination of Heart Rate Variability training and EEG Neurofeedback should be the remedy of choice for "essential" hypertension. Medication can be of help along the way, but it should not be relied upon as the long-term remedy. Medication targets the symptom; biofeedback addresses the actual problem.
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