Headaches
Research
Alternative
& Complementary Therapies
Aromatherapy
& Headache
Research at the Neurological
Clinic, University of Kiel, in Germany has demonstrated that essential
oils of peppermint and eucalypus can have significant benefits for
headache sufferers.
Peppermint oil and eucalyptus oil
preparations were found to have beneficial neurophysiological and
psychological effects on 32 healthy subjects in a double-blind,
placebo-controlled, randomized cross-over design study.
Four different preparations were applied to
large areas of the forehead and temples using a small sponge and their
effect was then evaluated. The combination of peppermint oil, eucalyptus
oil and ethanol increased cognitive performance and had a muscle-relaxing
and mentally relaxing effect, but had little influence on pain
sensitivity. However, peppermint oil and ethanol combined produced a
significant analgesic effect with a reduction in sensitivity to headache.
The researchers concluded that the essential oil preparations can be shown
by laboratory tests to exert significant effects on the body’s
mechanisms associated with headaches.
Gobel H; Schmidt G; Soyka D. Effect of
peppermint and eucalyptus oil preparations on neurophysiological and
experimental algesimetric headache parameters. Cephalalgia (NORWAY) Jun
1994, 14 (3) p228-34
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Biofeedback
& Headache
Researchers at Ohio University, Athens Georgia
have demonstrated that biofeedback is an effective treatment for tension
headaches.
Forty four patients (young adults)
suffering from chronic tension-type headaches were randomly assigned to
receive either 6 relaxation sessions with electromyographic (EMG)
biofeedback or to a control group. All of the patients were then monitored
using electromyographic (EMG) activity in the frontal and trapezius muscle
groups.
The results revealed that the biofeedback
training was effective in alleviating headaches. 51.7 per cent of the
patients in the biofeedback group experienced a significant drop of at
least 50% in headache activity whereas those patients in the control group
did not experience any improvements.
Rokicki LA et al. Change mechanisms
associated with combined relaxation/EMG biofeedback training for chronic
tension headache. Appl Psychophysiol Biofeedback. Mar 1997 22(1) pp.21 -
41.
Biofeedback and autogenic
relaxation is effective in treating fainting, and headaches
according to a report from researchers at the Medical College of
Ohio, USA.
Ten patients with histories of
recurrent fainting or near fainting of unknown cause(s) , headaches
and a poor response to or tolerance for drugs, were treated with
biofeedback, autogenic relaxation exercises.
Biofeedback-assisted
relaxation treatment appeared to be most effective in younger
patients whose fainting was associated with a strong
psychophysiological factors and whose headaches were intermittent.
McGrady AV et al.
Outcome of biofeedback-assisted relaxation for neurocardiogenic
syncope and headache: a clinical replication series. Appl
Psychophsyio Biofeedback March 1997. 22(1) pp63-72.
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Chiropractic
spinal manipulation
& Headache
A controlled clinical
study was carried out at the Nordic Institute for Chiropractic to
determine whether the isolated intervention of high-velocity,
low-amplitude spinal manipulation in the cervical spine has any effect on
headaches caused by tension in the neck.
The study took place at an ambulatory
outpatient facility in an independent NHS- funded chiropractic research
institution. Thirty-nine people who were suffering from frequent tension
headaches emanating from the neck were recruited from 400 headache
sufferers who responded to newspaper advertisements to take part in the
study. Half of the group received high-velocity, low- amplitude cervical
manipulation twice every week for three weeks, whereas the other half of
the group received low level laser in the upper cervical region and deep
friction massage (including trigger points) in the lower cervical/upper
thoracic region, also twice a week for three weeks.
The efficacy of the treatment was recorded
by the change in the daily requirement by the patients for analgesics, the
headache intensity per episode and number of headache hours per day.
The results revealed that that both groups
experienced a significant reduction on all three outcome measures, and
there was no statistically significant difference between the two
treatment groups. Both treatments were found to be effective although
because no control group was used, it is difficult to assess how effective
these modes of treatment are in relation to other forms of treatment.
A randomized controlled trial of the effect
of spinal manipulation in the treatment of cervicogenic headache. Nilsson
N. Nordic, Institute for Chiropractic, Forskerparken 10, 5230 Odense M.
Denmark. Journal of Manipulative and Physiological Therapeutics (USA) ,
1995, 18/7
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Hypnosis
& Headache
Researchers in the Netherlands have
established that hypnosis and autogenic training may offer hope for
patients who regularly suffer from tension headaches.
Back in 1992, a carefully designed study(1)
compared an abbreviated form of autogenic training to a form of
hypnotherapy known as ‘future oriented hypnotic imagery’ which was not
presented to the patients as hypnosis, and then they compared both
treatments to the same future oriented hypnotic imagery, but this time
explicitly presented as hypnosis.
Fifty six patients diagnosed by a
neurologists as having chronic tension headaches took part in the study.
The results revealed that all three treatments were equally effective ;
during the treatment the headaches was greatly alleviated in all treatment
groups in significant contrast to the control group; immediately after the
treatment was given , the patients also experienced a reduction in both
the severity of the headache and the associated psychological stress, and
after a 6-month follow-up period, the therapeutic improvement was
maintained.
Short-term and long-term pain reduction
were observed in all treatment groups but the researchers found that those
patients who attributed the pain reduction obtained during therapy to
their own efforts manifested greater long-term pain reduction than those
patients who attributed their improvement to the efforts of the therapist.
Furthermore, patients who received the ‘future oriented hypnotic
imagery’ (which had been explicitly presented as hypnosis) were found to
experience greater benefits than those who received autogenic training.
One other interesting finding of the study
was that the therapists were shown to be as effective with the treatment
modality they preferred as with the treatment modality they felt to be
less remedial suggesting that the therapist’s personal beliefs about the
efficacy of a treatment does not affect the outcome of the treatment.
The researchers were so impressed with the
results of the study that they pursued their line of research by
investigating the efficacy of autogenic training (AT) and cognitive
self-hypnosis training (CSH) for the treatment of chronic headaches in
comparison with a waiting-list control (WLC) condition. In this study 146
patients patients ( 58 of whom were referred by a neurological outpatient
clinic), 48 of whom responded to a n advertisement in a local newspaper,
and a further 40 who were students who had responded to an advert in a
university newspaper. All of the patients were randomly assigned to
receive autogenic training, self-hypnosis or put on a waiting list and
used as controls.
During the treatments, there was a
significant reduction in the Headache Index scores of the subjects in
contrast with the controls. Follow-up assessments indicated that
therapeutic improvement was maintained. Interestingly, the patients in
both treatment groups who were considered to be highly-hypnotizable were
found to achieve a greater reduction in headache pain at post-treatment
and follow-up than did those who were considered to be low-hypnotizable
subjects.
These studies indicate that these
relatively simple and highly structured relaxation techniques of
hypnotherapy and autogenic training may be of considerable help in the
treatment of chronic headaches. It also appears that a high level of
hypnotic susceptibility is associated with a a better therapeutic outcome.
(1) Zitman FG; Van Dyck R; Spinhoven P;
Linssen AC. Hypnosis and autogenic training in the treatment of tension
headaches: a two-phase constructive design study with follow-up.
Department of Psychiatry, Catholic University, Nymegen, The Netherlands. J
Psychosom Res (ENGLAND) Apr 1992, 36 (3) p219-28
(2) Kuile MM; Spinhoven P; Linssen AC; Zitman FG; Van Dyck R; Rooijmans HG
Autogenic training and cognitive self-hypnosis for the treatment of
recurrent headaches in three different subject groups. Department of
Psychiatry, University of Leiden, The Netherlands. Pain (NETHERLANDS) Sep
1994, 58 (3) p331-40
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Acupuncture
& Music Therapy & Headache
An interesting new randomised, controlled study conducted at the Faculty
of Medicine, Department of Physical Therapy and Rehabilitation
investigated a new form of treatment which combines music therapy with
electroacupuncture. The potential analgesic effects of acupuncture is well
documented and music therapy is becoming an increasingly popular means of
enhancing pain relief and alleviating anxiety in stressful situations
including dental treatment, childbirth, coronary care units and
post-surgery. It was for this reason that the researchers decided to
experiment with both therapies to treat patients suffering from migraine
or cervical tension headaches.
A device was developed which delivers an electrical stimulation to
acupuncture needles (electroacupuncture) and this has its frequency
modulated by the sound of classical music being played to the patient (ie.
the frequency of the electrical stimulation altered with the change in the
sound of the music).
Fifty patients (14 male and 36 female), all with a history of migraine
or cervical tension headaches for at least one year, participated in the
study. The patients were randomly assigned to one of two groups; one group
received standard electroacupuncture at 100Hz while the other group had
electroacupuncture stimulation. Pain levels were scored by the patients on
a five point scale ranging from 0 (= no pain) to 5 (=intractable pain).
The analgesic effects observed in the acupuncture group was
statistically significant, but the effects in the music
therapy/acupuncture group were significantly greater. 23 out of the 25
(92%) patients in the music sound electroacupuncture group reported that
they found the music very beneficial and reliable, and all stated that
they would be happy to use it again.
Whilst there was no placebo control group in this study, this may be
because the analgesic effects of acupuncture are well documented and
supported by literally hundreds of studies. The study concludes that music
sound electroacupuncture provides a ‘safe, reliable and effective method
for the management of pain and anxiety in migraine and cervical tension
headache’ and is , ‘on the basis of this trial more effective in pain
relief than standard acupuncture’. However, the report goes on to
acknowledge that this was a ‘preliminary study’ and that ‘additional
investigations are warranted’.
It is clearly too small a study to draw firm conclusions, especially as
there was no placebo control group, but as a pilot study, this research
was a fascinating investigation into a innovative approach to
complementary therapies in which two therapies with a proven track record
in an area of medicine can be combined and tested to see whether they are
more effective when used together.
I. Tekeoglu. Introduction of a new therapy method: Music sound
electroacupuncture stimulation. Acupuncture in Medicine. Nov 1995;
13:2,71-72.
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Spinal
Manipulation & Headaches
A study has been done to study whether the isolated intervention of
high-speed, low-amplitude spinal manipulation in the cervical spine has
any effect on cervicogenic headache.
DESIGN: Prospective randomized controlled trial
with a blinded observer.
SETTING: Ambulatory outpatient facility in an independent research
institution.
PARTICIPANTS: Fifty-three subjects suffering from frequent headaches who
fulfilled the International Headache Society criteria for cervicogenic
headache (excluding radiological criteria). These subjects were recruited
from 450 headache sufferers who responded to newspaper advertisements.
INTERVENTION: After randomization, 28 of the group received high-velocity,
low-amplitude cervical manipulation twice a week for 3 wk. The remaining
25 received low-level laser in the upper cervical region and deep friction
massage (including trigger points) in the lower cervical/upper thoracic
region, also twice a week for 3 wk.
MAIN OUTCOME MEASURES: The change from week 1 to week 5 in analgesic use
per day, in headache intensity per episode and in number of headache hours
per day, as registered in a headache diary.
RESULTS: The use of analgesics decreased by 36% in the manipulation group,
but was unchanged in the soft-tissue group; this difference was
statistically significant (p = .04, chi 2 for trend). The number of
headache hours per day decreased by 69% in the manipulation group,
compared with 37% in the soft-tissue group; this was significant at p =
.03 (Mann-Whitney). Finally, headache intensity per episode decreased by
36% in the manipulation group, compared with 17% in the soft-tissue group;
this was significant at p = .04 (Mann-Whitney).
CONCLUSION: Spinal manipulation has a significant positive effect in cases
of cervicogenic headache.
J Manipulative
Physiol Ther 1997 Jun;20(5):326-30 Nilsson N,
Christensen HW, Hartvigsen J Institute of
Medical Biology (Biomechanics), Faculty of Health Science, University
of Odense, Denmark.
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