1. NRBS, 04/21/2012
BIOFEEDBACK WITH
PREGNANT WOMEN WHO HAVE
MIGRAINES

2. BIOFEEDBACK AND
MIGRAINES
• Most physicians have heard about the connection
between biofeedback and migraine headaches.
Thermal biofeedback is generally considered the
“gold standard” for migraine headaches, among
people who are only peripherally acquainted with
the actual procedures.
• It is generally confusing to discuss details of
different varieties of biofeedback. The term and
the individual practitioner’s track record are all
that count.

3. WHY DO WE HAVE
MIGRAINES?
• They are wonderful storm warning devices.
• May be responsible for survival of large.
groups of humans from 50,000 years ago.
• Now they are inconveneint.
• Also, probably bad for a fetus.
• Medications are almost certainly bad for a
fetus.

4. HOW COMMON ARE
MIGRAINES?
• Extremely varied statistics, but probably
occurs in 20% of the population.
• Migraines may get better, worse, or stay the
same during pregnancy. The target
population includes all of these.

5. What does a migraine look like?

6. What does a migraine look like?

7. DIAGNOSIS
• A patient coming with a diagnosis of migraine
does not mean that it is migraine. Misdiagnoses is
common.
• “contaminated” migraines are much more difficult
to treat than “uncontaminated” migraines.
• Starting to work with someone before pregnancy
occurs is a much better scenario that meeting for
the first time when pregnant.

8. MIGRAINES
• Can mimic any other mental disorder, especially if
there is an aura.
• Aura: progresses in a wave at 2mm to 6mm per
minute, usually from back of the brain to front,
ending in a headache (tsunami effect).
• Called CSD (cortical spreading depression).
Wherever this wave passes, the brain
malfunctions.

9. TYPICAL AND LESS
TYPICAL MIGRAINE AURA
• “GHOSTS”
• AUDITORY HALLUCINATIONS
• PANIC
• PSYCHOTIC EPISODE
• SMELLS
• APHASIA (receptive / expressive)
• PARALYSIS

10. What do women do during
pregnancy to control migraines?
• They suffer.
• They take prophylactic medications.
• They take “abortive medications” like
triptans.

11. FETAL EFFECTS of “suffering”
• Pain might be inconvenient, but the
migraine mechanism itself may contribute
to fetal distress..
• The migraine may affect fetal blood supply
during the migraine event.

12. FETAL EFFECTS of
“prophylactic” medications
• Drugs for depression during pregnancy are
becoming a big issue.
• SSRI’s linked to fetal cardiac problems.
• SSRI’s are considered among the most gentle
drugs and have been until recently considered safe
for pregnancy.
• All drugs during pregnancy represent a potential
fetal risk.

13. FETAL EFFECTS of “abortive”
medications
• The most powerful and predictable drugs to abort
a migraine are the “triptan” class of drugs
(Imitrex, etc.).
• These drugs have powerful vasoconstriction
effects (recall the warnings on television for
cardiac history).
• They probably shut down the fetal blood supply.
• This is not a good thing.
• No solid research – yet, but OB and Neurologist
physicians are very concerned.

14. PHYSICIAN VARIABLES
• They really are concerned about health of mother
and fetus.
• But…
• Migraine patients are time consuming to
physicians.
• And…
• They are very concerned about the potential
ramifications of prescribing these medications to
pregnant women because it may come back to
them via lawsuits re fetal effects.

15. REASONS THAT PHYSICIANS
APPRECIATE HELP WITH
THESE PATIENTS
• Reduction of time load on physician.
• Reduction of need to prescribe migraine drugs
during pregnancy.
• Improved mental stability which also results in
fewer phone calls.

16. WHO SEEKS OUT THIS TYPE
OF TREATMENT
• These tend to be intelligent women who
have read widely about managing
pregnancy, are careful what they eat, don’t
drink during pregnancy, etc. They widely
network with each other and often arrive as
self referrals based on friends who have had
nice experiences.

17. QUESTIONS???