Biofeedback, progressive muscle relaxation, and abdominal breathing are just several of the behavioral medicine techniques proven to reduce headaches and improve the quality of functioning. When employed regularly and combined with preventative medication and optimized acute therapy, quality of life is significantly better than with medication alone.
Headache sufferers are justifiably offended when a doctor or a friend dismisses their pain with an offhand remark such as: “You’re just under too much stress. Try to relax.
“Physical and mental tension can certainly make headaches worse. But simply telling someone to relax doesn’t help deal with deadlines, demanding bosses, crying babies, honking horns, unpaid bills, and missed sleep—to name just a few of life’s daily hassles. Relaxation is a skill and like other skills, it can be mastered with time, practice and a good instructor. There are a variety of mind-body approaches to easing tension and improving pain tolerance. Some have proven track records in preventing headaches or reducing their severity.
Biofeedback and progressive muscles relaxation are the most widely accepted non-drug techniques for headache control and prevention. Their effectiveness has been demonstrated across 25 years of research and well over 100 investigations.
Biofeedback and relaxation training typically yield a 45% to 60% reduction in headache frequency and severity. This is equivalent to the reduction in headache achieved by many headache medications, such as propranolol (Inderal®) and amitriptyline (Elavil®), but without any of the negative side effects. The most common limitation of biofeedback and relaxation training is that it requires time commitment and implementation effort on behalf of the patient. Biofeedback sessions may take one hour and training sessions may include several weekly visits over the course of several months.
For many headache sufferers, the combination of drug and non-drug treatments yields the most significant improvement in headache activity. For example, the average improvement with either biofeedback or propranolol alone is a 55% reduction in migraine. However, when biofeedback is combined with propranolol, the average improvement is a 70% reduction in migraine.
Bringing the body into awareness using biofeedback
Biofeedback (or biological feedback) uses an instrument that monitors a bodily response, such as muscle tension or skin temperature, as the person tries to modify that response. For example, the monitor might give feedback with a tone that goes higher if the muscles in the forehead tighten and lower if the muscles relax. Another type of monitor uses a visual display such as a light that changes color as you increase or decrease the temperature in your hands (or feet).
Increased muscle tension and changed body temperature are two of the body’s responses to stress and strain. By providing you with instant and continuous information on these involuntary and unconscious processes in the body, you can observe and modify your body’s reaction to stress.
After you have used biofeedback to develop your ability to recognize and reduce tension in your body, you will be able to do so anywhere and anytime without the help of the equipment. These skills aid in preventing, reducing, or stopping a headache. Biofeedback, like progressive muscle relaxation, works best when you learn the skills from a qualified professional—typically a psychologist or psychiatrist who is trained in this procedure.
Typically, Electromyogram (EMG) biofeedback is used as a prevention approach for tension-type headaches. With EMG biofeedback, an EMG machine monitors skeletal muscle tension.
Just about any muscle can be monitored, but three muscles most commonly used are:
Frontalis: the muscle in your forehead that is involved with frowning and tightens up when you are worried or under pressure.
Masseter: this muscle tightens your jaw and often stays clenched when you are tense, frustrated, or angry.
Trapezius: this muscle hunches your shoulders and tightens when you are alarmed or anxious or in response to environmental stressors, such as sitting too long at a computer.
These muscles are used in EMG biofeedback because they typically respond to stress and can be easily measured. EMG training is done by placing two sensors (electrodes) at a specified distance from each other on the skin over the identified muscle. A third sensor is placed on a neutral spot to serve as an electrical reference point. These sensors do not cause any discomfort whatsoever; they simply record your body’s responses.
Thermal or hand-warming biofeedback was first used at the famous Menninger Clinic in Kansas. Researchers there discovered that headache patients who learned to raise the temperature of their hands using biofeedback had fewer and less severe headaches when they practiced this skill regularly.
Hand-warming works in the following way: When a person is anxious or under stress, the blood vessels in the fingers narrow and the hands become cooler. That’s why we tend to get “cold and clammy hands” when we’re frightened or nervous. On the other hand, when you are relaxed, the blood vessels in your hands expand, and your hands get warmer. You can get an idea of how stressed you are by taking your hand or finger temperature with a thermometer or biofeedback instrument. You can learn to reduce your level of arousal through the process of temperature biofeedback training. Then, whenever your hands are cool or you are experiencing stress, you use your hand-warming skills to produce a more relaxed state.
Although it’s often assumed that “tension-type” headache responds better to techniques to control muscle tension, it has been found that migraine patients improve as much with EMG biofeedback as they do with thermal biofeedback. Thus, the mechanism of action for biofeedback and relaxation training may be more complex than meets the eye. We know that headache sufferers who regularly practice these techniques report a decreased sense of helplessness and an increased sense of self-control. These changes in mental outlook and behavior may increase your ability to prevent headaches as well as your ability to reduce pain, especially if used as soon as you notice a headache developing.
Relaxation training involves learning how to achieve a physical and mental state of calm and relaxation within a few minutes. It is a systematic set of procedures, rather than simply trying to relax on your own with activities like gardening, reading, or watching TV. Relation training is recommended for headache management because headaches are often related to the body’s reaction to everyday stresses like deadlines, demanding bosses, crying babies, honking horns, unpaid bills, and missed sleep, to name a few of life’s daily hassles. For headache-prone people, stress does not need to be excessive Unpredictability or change in life is all that is needed. Even normal everyday levels of stress can trigger a headache.
Relaxation training slows down the sympathetic nervous system, which is responsible for the stress response. The sympathetic nervous system is involved in regulating heart rate, blood vessel expansion and contraction, blood pressure, sweat production, sleep, and alertness.During stress, heart rate and blood pressure increase, sweat production increases, breathing becomes shallow, and adrenaline and other hormones are released, causing blood vessels to constrict and muscles to contract. You may have noticed that your shoulders are hunched up, and your jaws are clenched during stress. You can see then how slowing the stress response might be beneficial.
Deep relaxation reverses many of the physical responses that can trigger headaches. Additionally, during deep relaxation, the relaxed person takes fewer breaths per minute, yet breathes more deeply. This results in “bathing” the blood cells in oxygen, which means more oxygen gets to the muscles and to the brain. Increasing oxygen supply to the brain seems to help prevent headaches. With practice, deep relaxation changes your body’s response to adrenaline and other stress hormones so that it takes a greater disruption from life stresses (and the stress response) to trigger a headache. Becoming deeply relaxed not only helps reduce headache frequency, but it can give a greater sense of self-control as well as decrease irritability, anxiety, depression, insomnia, and blood pressure.
Learning to relax
Relaxation training is typically provided “live” in a clinic office by an experienced therapist (usually a psychologist). Learning to become deeply relaxed may take several sessions, so you may be scheduled for 4 to 10 visits. Visits may be scheduled a couple of weeks apart or once weekly. During your clinic visits, you will be given instructions and in-office practice sessions for a variety of relaxation techniques. Most likely you will be provided audiotapes and written materials to help you practice at home between your office visits. Then you will learn how to use these skills in your daily life. Relaxation training typically begins with two primary techniques: abdominal or deep breathing and progressive muscle relaxation.
To teach you deep breathing, your therapist will ask you to place one hand on your chest and one hand on your abdomen, just under your ribs, so that you are more aware of your breathing. Next, you will be asked to breathe in slowly through your nose, pulling your breath down towards your stomach, pushing your abdomen outwards, allowing yourself to fill your lungs completely.Your hand on your abdomen should rise slightly more than your hand on your chest when you are breathing deeply. Breathe out slowly, pulling your stomach in towards your spine, and think the word “relax.” With each slow, deep breath you likely will feel yourself becoming progressively more relaxed.
After you have learned to breathe deeply, you will be asked to focus on slowing your breathing. For the first one to two weeks, you will probably be asked to practice this breathing exercise for five to ten minutes, two to three times daily as well as during progressive muscle relaxation (PMR) training. After you have mastered the technique, you should check in with yourself throughout the day to remember to breathe deeply.
Progressive muscle relaxation
Next, you will be instructed in PMR—the most commonly used muscle relaxation technique for the management of headaches. With PMR, you physically tense and then relax your muscles. It might sound like a contradiction, but for a muscle to become relaxed it is helpful for it to be tightened first. Tightening muscles also makes you more aware of what tense muscles feel like. This will help you to identify tension in those muscles early on, so you can apply relaxation skills to prevent increased muscle tension and to reserve the stress response.
Your therapist will demonstrate how to tense and relax each muscle gently. You will learn to tense and then relax muscles in your hands, forearms, upper arms, feet, calves, thighs, stomach, chest, shoulders, neck, face, and head. Next, your therapist will take you through an in-office practice of slowly tensing and relaxing these muscles, while asking you to focus on each muscle, comparing sensations of relaxation with sensations of tension. Between muscle groups, you will be asked to focus also on your breathing.
After tensing and relaxing all of the muscle groups, your therapist may ask you to focus on a relaxing scene that you have discussed before beginning the PMR practice. For example, many patients describe a beach scene, waterfalls, or walking through the woods. For many patients, this helps to further deepen their relaxation, and the imagery can be used alone as a quick relaxation skill. The entire practice session takes about 25 to 30 minutes.
During your in-office practice of PMR, the room may be dimly lit, and you may be offered the comfort of a recliner. You also will be asked to remove your eyeglasses, and you might be asked to remove your shoes, loosen your tie, belt, or any other restrictive closing (suit jacket, for example) in order to be as comfortable as possible.
Your therapist will probably ask you to rate your tension levels before and after your in-office practice. And you will probably be asked to keep track of your practice in relaxation logs so that you can discuss with your therapist any problems you might have with practicing the techniques.
The Relaxation Routine
Some people become very relaxed after their first practice session, but the vast majority of people do not notice substantial reductions in muscle tension, stress levels, or headache activity until they have practiced for some time. So, do not become discouraged if you do not get immediate results. Also, not everyone can imagine the pleasant relaxing scene as vividly as they’d like.
This will likely come with practice although some people find it difficult to learn this skill. If it doesn’t get easier with practice, don’t use it as a relaxation strategy. It is important that you use what works best for you rather than to get discouraged. You don’t have to master all of the techniques your therapist teaches you to improve.
For relaxation training to be effective at reducing your headaches, initially you need to practice daily for about 25 minutes at a time. Ideally, you will practice twice daily. You need to practice enough that deep relaxation becomes a habit, so that when you say “relax” to yourself, your body knows how to respond. The amount of time it takes to get deeply relaxed gets shorter with practice and as you learn briefer methods of relaxation in your follow-up office visits.
The goal is for relaxation training to be a portable skill that you can use at a moment’s notice. Initially, you might want to consider that your body is in training, and accept that you must train your body to know what it is to be completely relaxed.
Deep relaxation is a skill that teaches you how to recognize signs of stress in your body and how to reduce them before they reach the level of painful muscles and headache. These techniques work best to prevent headaches. However, they can be helpful if you use them as soon as you notice a headache starting, rather than during a full-blown attack.
Biofeedback and relaxation techniques are most effective in preventing headaches, rather than treating a headache in progress. Nonetheless, many headache sufferers do report that these techniques often lessen the severity and duration of headache if used during a headache attack. Many patients find these techniques to be effective alternatives to medication. Research also shows that typically headaches are best controlled over time by combining these techniques with some use of preventive and acute medication.
Gay L. Lipchik, PhD Ohio University Headache Treatment & Research Project. Westerville, OH
Updated May 2008 fromHeadache, volume 9, issue 2. Summer 1998.
Biofeedback and relaxation training typically yield a 45% to 60% reduction in headache frequency and severity. This is equivalent to the reduction in headache achieved by many headache medications, such as propranolol (Inderal®) and amitriptyline (Elavil®), but without any of the negative side effects.Does biofeedback really work? ›
But eventually you will be able to achieve success without a monitor or electrodes. Biofeedback is an effective therapy for many conditions, although it is primarily used to treat high blood pressure, tension headache, migraine headache, chronic pain, and urinary incontinence. Are there different types of biofeedback?How does biofeedback treat migraines? ›
Biofeedback is effective in treating migraines. It is believed to have a beneficial effect on autonomous nervous system activity and render individuals resilient to stressors that may trigger a migraine.What is an example of biofeedback training? ›
Another type of biofeedback treatment involves wearing a headband that tracks your brain activity while you meditate. It uses sounds to let you know when your mind is calm and when it's active. This may help you learn to control your stress.What is the most effective psychological treatment for headaches? ›
Mindfulness-based stress reduction for migraine (MBSR-M), cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), biofeedback, and relaxation training are all methods used to “retrain” the brain to manage stress differently.What are the negatives of biofeedback? ›
Disadvantages of biofeedback may include: scientific research is limited on its effectiveness. readings might be inaccurate for those who have health conditions such as a heart arrhythmia or certain skin conditions. sessions can be time-consuming.What is the success rate of biofeedback? ›
Biofeedback therapy is a non-invasive and easily feasible option which has been used for fecal incontinence over several decades. Numerous published studies support it as the first choice of treatment for fecal incontinence. These studies have reported a success rate of about 70% (between 40 to 100%).What are the three stages of biofeedback training? ›
Biofeedback training is conceptualized as including three phases: initial conceptualization, skills-acquisition and -rehearsal, and transfer of treatment.What types of pain can biofeedback relieve? ›
By helping you identify tight muscles and then learn to relax those muscles, biofeedback may help relieve the discomfort of conditions like low back pain, abdominal pain, temporomandibular joint disorders (TMJ), and fibromyalgia.How to get rid of a headache fast? ›
- Try a Cold Pack.
- Use a Heating Pad or Hot Compress.
- Ease Pressure on Your Scalp or Head.
- Dim the Lights.
- Try Not to Chew.
- Get Some Caffeine.
- Practice Relaxation.
The carrier frequency used is 160Hz, the frequency used to quickly eliminate headaches.What is the main goal of biofeedback training? ›
By promoting a more effective mental and physical response to stress, biofeedback aims to help you control body processes like your heart rate and blood pressure. These body processes were once thought to be completely involuntary.How much does a biofeedback machine cost? ›
While an at-home biofeedback device can range from $20 to $1,000, some of the best devices are in the $200 range, making them far more accessible. Plus, it is a one-time purchase that you can use for many years, giving you more value for money in the long term.Can you do biofeedback without equipment? ›
Can I do Respiration Biofeedback without a screen or Software? Yes! Use diaphragmatic breathing techniques to begin to move your breathing closer to a normal range. Diaphragmatic breathing means breathing in and out of your nose, which slows down the rate of your breath.What do neurologists prescribe for headaches? ›
Prescription drugs such as sumatriptan (Imitrex, Tosymra) and rizatriptan (Maxalt, Maxalt-MLT) are used to treat migraine because they block pain pathways in the brain. Taken as pills, shots or nasal sprays, they can relieve many symptoms of migraine.How do you get rid of psychological headaches? ›
If you're dealing with anxiety headaches, the best way to treat them may be to get help for anxiety. Therapy for anxiety can not only improve mental health symptoms, but it can also help reduce physical symptoms such as headache. Cognitive behavioral therapy (CBT) is a common type of therapy used to treat anxiety.What is the psychological reason for headaches? ›
Psychological stress, including both major stressful events and daily hassles, can trigger headache and also increase the intensity of headache (128).What tools are used in biofeedback? ›
- Electromyogram (EMG). This is used to measure muscle tension.
- Electrodermal activity (EDA). This is used to measure changes in perspiration rate.
- Finger pulse measurements. These measure blood pressure and heartbeat.
- Electroencephalogram (EEG).
The Ultium EMG Biofeedback Package includes 2 Ultium EMG Sensors, Ultium EMG Charging Station, Disposables, Android Tablet, and the EMG Biofeedback App.Why is biofeedback controversial? ›
Neurofeedback, also called EEG feedback, is the most controversial form of biofeedback therapy, largely because so few controlled clinical trials have been able to assess its efficacy. Neurofeedback is the retraining of brainwave patterns.
Neurofeedback, or EEG biofeedback, is a type of brain training that's used to address injury or imbalances that occur in the brain. Through a positive reward system, the brain learns how to create new pathways and improve overall functioning.Can biofeedback control brain waves? ›
Types of Biofeedback
EEG Biofeedback can be used to help patients gain control over abnormal brainwave patterns, which can help reduce symptoms of anxiety disorders, panic attacks, depression, and insomnia.
This is completely painless. Usually the sensors are just sticky patches which the therapist will put on specific points on your skin. The type of monitor and sensors used will depend upon your specific needs and the goals of the therapy. Biofeedback is an active rather than passive treatment.Can biofeedback help with nerve damage? ›
Electromyographic biofeedback (EMG-BF) has been applied to treat different types of peripheral nerve injuries (PNI).What happens during a biofeedback session? ›
During a biofeedback session, a practitioner uses monitoring equipment and instruments to measure your body's functions. Based on feedback from the instruments, the practitioner suggests how you can create physiologic changes. With education and practice, you can learn to make those bodily changes without equipment.Which relaxation technique works best for all people? ›
1. Breath focus. In this simple, powerful technique, you take long, slow, deep breaths (also known as abdominal or belly breathing). As you breathe, you gently disengage your mind from distracting thoughts and sensations.What is the basic principle of biofeedback? ›
Biofeedback is based on a principle known as “operant conditioning,” specifically positive reinforcement. Research has shown positive reinforcement increases the likelihood of a behavior and when a behavior is reinforced repeatedly and consistently over time, the behavior can be learned and retained.How do you reverse chronic pain? ›
“Exercise is the key to undoing ingrained chronic pain pathways. Exercise creates new brain cells and neural pathways. It also stimulates blood flow, and has an anti-inflammatory effect on discs in the spine,” says Dr. Isaac.What is biofeedback for neck pain? ›
In people with neck pain, pressure biofeedback involves the use of an inflatable cushion that is connected to a pressure gauge (pressure biofeedback unit). The inflatable cushion is typically placed behind the neck while the person is in supine.What helps the worst headache? ›
The extreme head pain usually settles in a few minutes, but moderate to severe headache can persist for several hours. Common pain relievers such as acetaminophen (Tylenol) and ibuprofen (Advil) may help.
A number of sleep or health disorders, as well as personal habits, can trigger a headache when you wake up. Sleep apnea, migraine, and lack of sleep are common culprits. However, teeth grinding, alcohol use, and certain medications can also cause you to wake up with a headache.Why do I have pressure in my head everyday? ›
The most common causes are headache, migraine, or infection. Most conditions that cause pressure in the head go away on their own or respond to over-the-counter pain medication. However, intense or persistent pressure in the head may indicate a severe underlying medical condition.What is the number one trigger for migraines? ›
Stress. Stress is the most common trigger of headaches and migraines. More than 70 percent of patients experience a high level of stress leading up to a migraine. During stressful times, people can experience tightening of the neck and shoulder muscles, and this pain can be felt in the head.Is there a sound that helps headaches? ›
White noise is essentially background noise. So, while the white noise in your office or on the street will probably increase your stress levels, soothing noise such as the sound of a fan or the sound of rain can help distract you from the pain you're experiencing. Melodic music is another helpful option.What sounds help get rid of headaches? ›
What binaural beat frequency helps with migraines? Most researchers recommend listening to binaural beats at the theta brain wave frequency (4–8 hertz). This frequency is associated with meditation and relaxation.How long is a biofeedback session? ›
A typical biofeedback session lasts between 30 and 60 minutes. The number of required sessions depends on individual needs and goals as well as response to the treatment. At the end of each session, the practitioner typically provides the individual with practice exercises to complete at home.Who benefits from biofeedback? ›
Biofeedback has been proven to:
Help those with ADHD find a greater ability to focus. Improve benefits of other treatment methods. Aid those not being helped by medication. Encourage empowerment and autonomy.
- Electromyography (EMG), which measures muscle tension.
- Thermal biofeedback, which measures skin temperature.
- Neurofeedback or electroencephalography (EEG), which measures brain wave activity.
When starting neurofeedback training, it is optimal that sessions be regular and frequent at two or three (or more) sessions per week. It is possible to do more than one sessions in a day or to have sessions on two or three consecutive days.Is biofeedback therapy legit? ›
Although biofeedback has been used to treat a variety of health problems, there is little scientific evidence that it works for most of them.
How does biofeedback help tension headaches? Biofeedback devices record tension that generates pain in the muscles and shows those levels to the patient. The patient learns to associate actual levels of tension with sensations from the muscles, so muscles are kept appropriately relaxed.What is biofeedback for migraines? ›
To treat migraine, typically an electromyogram (EMG) biofeedback device is used to observe and monitor skeletal and muscle tension. The electrodes are usually used around three specific upper-body muscles that tend to tense up before you get a migraine attack.Can biofeedback reduce blood pressure? ›
How effective is biofeedback for hypertension? Biofeedback instructions can help patients achieve impressive reductions in blood pressure using biofeedback equipment. One review found that the most effective treatments were stress management training, EMG biofeedback, and temperature biofeedback, respectively.Does neurofeedback help with headaches? ›
Neurofeedback training is very helpful for reducing both the frequency and the intensity of migraines. By balancing the brain so it operates better, headaches go away, occur less frequently or are less intense.How do you stop psychosomatic headaches? ›
- Cognitive behavioral therapy.
- Medications, such as antidepressants.
- Mindfulness-based therapy.
- Referral to a specialist in mental health (for example, a psychiatrist or psychologist).
- Regular contact with your primary care provider.
The most researched methods of psychological/behavioural treatment for primary headaches are: biofeedback training (particularly electromyographic [EMG] feedback and thermal feedback), relaxation training, and cognitive behaviour therapy (CBT).What is the downside of neurofeedback? ›
While a majority of patients do not experience side effects. Rare reactions may include: Anxiety or depression. Headaches or dizziness.What frequency helps headaches? ›
What binaural beat frequency helps with migraines? Most researchers recommend listening to binaural beats at the theta brain wave frequency (4–8 hertz). This frequency is associated with meditation and relaxation.How quickly does neurofeedback work? ›
Most people find the neurofeedback process and training relaxing – some feel relief and results immediately, but every patient is different. Most of our patients begin to feel the benefits of neurofeedback in 3-4 weeks, or 6-8 sessions.What mental disorder causes headaches? ›
Headaches can be a common symptom — and sometimes a good indicator — of an anxiety disorder, particularly generalized anxiety disorder, or GAD. And chronic co-occurring headaches can make functioning even more difficult for someone with an anxiety disorder.
Sometimes tension-type headaches may be a sign of an underlying disorder such as thyroid disease or an underlying tumor or a primary headache disorder, such as chronic migraine or new daily persistent headache. Anyone over age 50 with a new onset headache should see their doctor for an evaluation .How do I know if my headache is from stress? ›
Tension headaches are the most common type of headache. Stress and muscle tension are often factors in these headaches. Tension headaches typically don't cause nausea, vomiting, or sensitivity to light. They do cause a steady ache, rather than a throbbing one, and tend to affect both sides of the head.What do headaches mean emotionally? ›
It's not a coincidence — headaches are more likely to occur when you're stressed. Stress is a common trigger of tension-type headaches and migraine. It can also trigger other types of headaches or make them worse. Stress is a particularly common headache trigger in children and young adults.Are headaches caused by emotional stress? ›
Our bodies react to stressful events with a 'fight or flight' response. This involves the release of certain chemicals that can cause physical changes – such as in the blood vessels. This, in turn, can bring on tension headaches. Physical stress can also cause tension headaches.