Is Volitional Manipulation of Hemodynamics a Valid Rationale for Biofeedback Therapy of Migraine?

Abstract

SYNOPSIS Responses of supraorbital (SA), superficial temporal (TA), and digital (F) arterial beds and the heart rate were studied in 5 normal subjects and 10 migraineurs, when their hand temperature was increased by volition and/or by heat. In normal subjects, volitional digital arterial dilation coincided with vasoconstriction in SA and TA. In migraineurs the response varied. Bradycardia resulted in most subjects except in unimproved migraineurs. Heat induced hand vasodilation led to dilation in SA and TA and to tachycardia. In those 8 migraineurs who improved clinically the finger temperature feedback training apparently did not result in conditioning of a single autonomic response (i.e. digital vasodilation), but in a general decrease of the sympathetic tonic outflow.

Classical Conditioning of Digital Pulse Volume in Migraineurs and Normal Controls

“…They seem to respond to most stimuli with the same sympathetic over-reactivity, almost as if they have never encountered the stimuli before. This may underlie the variability that has been attributed to migraineurs' vasomotor activity, 1,7,15 We are confident in the reliability of our results. Very similar results have been found independently by Elmore and Tursky in another laboratory with a different population.…”

“…Morley 4 has argued that the only study that is sound methodologically does not support the notion that migraineurs have abnormal vasomotor reflexes.Several more recent psychophysiological studies have provided support for the hypothesized abnormality of ANS function in migraine headache sufferers. 2,3,6,7 Differences between migraineurs and non-headache controls in response to learning control of an autonomic response 3,7 supports the hypothesis of a deficit in central autoregulatory control. Additional support comes from the finding of ANS response stereotypy in migraineurs to a wide variety of stimuli.…”

Mechanism of the Biofeedback Therapy of Migraine: Volitional Manipulation of the Psychophysiological Background

“…We have previously found that vasodilation in the hands, volitionally induced by normal subjects and migraineurs, and correlating with clinical improvement, also correlated with the capability of the subjects to decrease their sympathetic tonic outflow. 2 Migraineurs often have intermittent periods of increased sympathetic activity. 3 A defect of autonomic central regulation in migraineurs has previously been postulated on the basis of pharmacological and clinical observations.…”

A Comparison of Two Psychophysiological Approaches to the Treatment of Migraine

“…This discrepancy was addressed directly by a recent investigation by Sovak, Kunzel, Sternbach and Dalessio. 7 Concerned with the general hemodynamics accompanying volitionally produced hand temperature increases as a result of biofeedback training, these authors found that large increases in blood flow to the periphery, clearly indicative of a reduction in sympathetic outflow, were paralleled by decreases in pulse amplitude over the superficial temporal and supraorbital arterial beds:…”