Psychophysiologic response patterns in migraine before and after temperature biofeedback. Prediction of treatment outcome

Behavioural treatment programme contributes to normalization of contingent negative variation in children with migraine

BACKGROUND

Migraine is a disorder of central information processing which may be characterized by increased amplitudes and reduced habituation of evoked and event-related potentials. In this pilot study, special behavioural training of habituation to aversive stimuli (MIPAS-Family = Migraine Patient Seminar for Families) was developed and proven effective in children suffering from migraine without aura.

METHODS

13 children with migraine participated in the MIPAS-Family programme and 13 other children with migraine were treated with biofeedback. The influence of both treatments on abnormal cortical information processing in migraine was assessed using recordings of the contingent negative variation (CNV), an event-related slow cortical potential.

RESULTS

Both MIPAS training and biofeedback caused an equal reduction of migraine frequency and severity. However, MIPAS treatment was associated with a significant increase in iCNV habituation. Changes in the clinical course of migraine correlated positively with normalization of habituation: the greater the reduction in headache frequency, the greater the increase in CNV habituation was. These effects were not observed in the biofeedback group.

CONCLUSIONS

This study demonstrates that the specific treatment programme which was evolved from knowledge of pathogenetic mechanisms of migraine influences central information processing and leads to a clinical effect.

Psychophysiological response patterns of migraine patients in two habituation tests

OBJECTIVE

To investigate the habituation response pattern of patients with migraine to a simple standard stressor and to a more complex performance-dependent (achievement) stressor in three peripheral systems (electrodermal, vasomotor, and cardiovascular). We hypothesized that the migraine patients would show abnormal habituation in these peripheral systems, especially in response to achievement stimuli.

BACKGROUND

Abnormal central habituation to repetitive stimuli has been reported frequently in patients with migraine. But little is known about habituation of the peripheral autonomic nervous system to stressors in these patients.

METHODS

A total of 30 female migraineurs and 30 physically and mentally healthy women matched for age and social status participated in a simple habituation test (auditory stimuli) and an achievement habituation test (mental arithmetic).

RESULTS

Habituation was impaired in the electrodermal (skin conductance response), vasomotor (pulse volume amplitude), and cardiovascular (heart rate response) systems during the mental arithmetic test (achievement stimuli) in the migraineurs as compared to the healthy controls. With the simple stressor (auditory stimuli), however, habituation was impaired in the vasomotor system only. Consistent with these findings were the participants' verbal reports, which indicated significantly more subjective tension in the migraine group than in the control group during the calculation test.

CONCLUSION

Our results suggest that the mental arithmetic (achievement) habituation paradigm is an important tool for demonstrating reduced habituation in several specific components of the autonomic nervous system. Further research is needed to target the covariance of central and autonomic nervous system habituation phenomena in migraine.

Traitement physique antalgique chez les personnes âgées

A FREQUENT AND DISABLING AFFECTION: Headaches in elderly patients are far more frequent that what is generally presumed; their prevalence is estimated of between 25 and 54% after the age of 70. They must be treated because of the potential impact on the patients' mental, functional and social status. NON-MEDICINAL ANALGESIC TREATMENTS: Various treatments have demonstrated their efficacy on different types of headache and are recommended in the international consensuses. This is notably the case with electrotherapy, cryotherapy, massage and biofeedback the correct use by physiotherapists of which leads to a decrease in the pain, duration and frequency of the attacks, and improves the quality of life of these patients. OTHER PHYSICAL TREATMENTS: Techniques such as acupuncture, relaxation, manual therapy or postural training are less documented but can be proposed. Most of them, alone or in supplement to medicinal treatment, are particularly adapted to elderly patients and limit the need for drugs, the side effects and interactions of which may have severe consequences in fragile patients and those suffering from multiple diseases.