Behavioral Approaches for Migraine Headaches

Rusty Lozano M.ED, LPC, BCBDirector: Center for Biofeedback & Behavior Therapy

15028 Beltway DrAddison, TX 75001

469-358-1309www.onlinebiofeedback.com

Underlying Psychological Factors

• Anxiety and Headache• Chicken or the egg syndrome • Triggers in the body• Symptoms reinforce negative thought and vice

versa (the vicious cycle)

Underlying Psychological Factors

• Pain Behavior• “I can’t because I’m in pain” versus “I can’t

because I will experience pain”• “Human-imprinting” in pain cycle• Classical conditioning • “Conditioned vs. unconditioned response”,

“conditioned vs. unconditioned stimulus”, “positive punishment vs. negative punishment” “positive association vs. negative association”

Underlying Psychological Factors

• School Related Stress• School environment (ex. AP courses,

absenteeism, social) • Performance• Homework load• Parent pressure

Underlying Psychological Factors

• Environmental Association• Negative association and the “branching”

anxiety effect • Avoidant behavior• Inadvertent parental reinforcement

Tension vs. Vascular

• Behavioral Detection Methods• Diagnostic interview of symptoms• Symptom checklist• Peripheral biofeedback assessment• Cranium vs. myofacial muscle regions

Treatment Intervention Types: Adjuncts to Medication

Management

• Peripheral Biofeedback• Adjunct to medication management• Peripheral biofeedback modalities (ex. temp

training, muscle training) • Peripheral nervous system- sympathetic vs.

parasympathetic nervous system• Rehearsal/Generalization (ex. CBBT’s

Pendulum Obstacle Course)

Treatment Intervention Types:Adjuncts to Medication Management

• Progressive Muscle Training• Tense/relax training• Localized muscle relaxation • Strategic stretching

Treatment Intervention Types:Adjuncts to Medication Management

• Relaxation Training• Breathing techniques • Deep relaxation• Autogenic phrases• Yoga

Treatment Intervention Types:Adjuncts to Medication Management

• Cognitive Behavioral Therapy• Identifying triggers• Building a coping strategy database• Thought restructuring

Biofeedback Demo

*CBBT’s Pendulum Gym

*Live Demo

CBBT’s Pendulum

Footage Courtesy of:Alex Lozano

References

Allen, K. D. (2006). Recurrent pediatric headaches: Behavioral concepts and interventions. Journal of Early and Intensive Behavioral Intervention, 3, 211–

219. doi:10.1037/h0100333

Fall, K. A., Holden, J. M., & Marquis, A. (Eds.). (2010). Theoretical models of counseling and psychotherapy (2nd ed.). New York, NY: Rutledge Taylor &

Francis Group.

Khazan, I. Z. (2013). The clinical handbook of biofeedback: A step-by-step guide for training and practice with mindfulness. Malden, MA: Wiley-Blackwell.

Miller, L. (1994). Biofeedback and behavioral medicine: Treating the symptom, the syndrome, or the person. Psychotherapy, 31, 161–169.

doi:10.1037/0033-3204.31.1.161

Peper, E., & Shaffer, F. (2010). Biofeedback history: an alternative view. Biofeedback, 38, 142–147, doi:10.5298/1081-5937-38.4.03

Riva, D., Usilla, A., Aggio, F., Vago, C., Treccani, C., & Bulgheroni, S. (2012). Attention in children and adolescents with headache. Headache, 52, 374–384.

doi:

10.1111/j.1526-4610.2011.02033.x

Schwartz, M. S., & Andrasik, F. (2005). Biofeedback: A practitioner’s guide (3rd ed.). New York, NY: Guilford Press.

Skinner, B. F. (1963). Operant behavior. American Psychologist, 18, 503–515. doi:10.1037/h0045185

Rusty Lozano M.ED, LPC, BCB469-358-1309

www.onlinebiofeedback.com

• Pediatric & Adolescent Biofeedback

• Counseling & Behavior Therapy

• Group Therapy