A headache must be treated with a multidimensional approach: not just drugs, but also behavioral and cognitive strategies, such as biofeedback.
A headache, especially the chronic one, must be treated with a multidimensional approach: not just drugs, but also behavioral and cognitive strategies for dealing with pain. One example is biofeedback. Let's see with the neurologist what it is.
A headache, there are several types, due to many different disorders, all of which manifest as headaches. About 90% of the population presents a cephalalgic episode at least once a year. A headache has been classified by the World Health Organization (WHO) as one of the top 20 causes of disability and loss of quality of life worldwide.
Regardless of the cause of pain, one of the main characteristics that unite people during a "headache" attack is the gradual limitation in the ability to perform the usual daily occupations, until their complete suspension. Often, the quality of long-term life is also affected by the establishment of behaviors implemented for fear of the emergence of a subsequent crisis, sometimes to the point of encouraging the establishment of real anxiety-depressive states.
The overwhelming majority of empirical and theoretical efforts to elucidate the development and consequences of single headache attacks use a biomedical model that focuses exclusively on biological processes. However, for a doctor who treats headaches regularly, it is common to come into contact with the experiences of many patients who do not meet expectations from a purely biological model, so that sometimes pharmacological interventions show only moderate efficacy, failing to address the underlying psychological and social factors that influence headaches.
By definition, pain is a psychological construct that refers to the perception of unpleasant sensations developed by a complex system of neuronal network in different brain regions. Many of the regions associated with pain processing are also involved with other psychological phenomena (eg, emotions, attention, stress): therefore, the modulation of pain through psychological factors can occur through these shared circuits, altering the pain signal inside the brain.
There are many psychological and social factors that can promote a headache attack. Among them, mainly stress, excessive daily rhythms and an anxious management of events: the latter, once the headache arises, contributes to the deterioration of the same rereading it in turn with a further concern. Personal problems, sudden and drastic changes in life, or unforeseen environmental challenges also play a significant role.
In the scientific world, therefore, an approach that focuses attention on the interaction between biological and psychological factors (mainly composed of cognitive and affective processes) and social/environmental processes in the genesis of headaches.
Cognitive processes include the thoughts, beliefs, attributions, and attitudes that people use when they are in a certain environment. Regarding a headache, the cognitions influence how much a patient engages in behaviors that reduce the probability of having a headache attack, how much it adheres to the pharmacological regimen, and how a patient deals with the headache attack thus affecting the related disability.
Pain also involves an effective component, through a construct consisting of a "triumvirate" of negative emotions: anxiety, depression, and anger.
L ' anxiety is a state of worry, fear, unease or apprehension "resulting from the feeling of not being able to foresee, to control or to obtain the desired results" regarding a specific situation, but sometimes may be more nebulous no having an immediate triggering cause. Patients often use the term "anxiety" and “stress " interchangeably, as these concepts are highly correlated by feeding each other. The depression as a clinical syndrome it is commonly described by feelings of sadness, despair, emptiness, or loss of interest or pleasure in daily activities. The anger is a state of sorrow, intensity ranging from mild irritation to intense anger in response to a perceived wrong that threatens the well-being of an individual. Those suffering from headaches usually tend to repress their anger, expressing it internally.
For these reasons a headache, especially the chronic one must be treated with a multidimensional approach that can support patients not only pharmacologically, but also by providing them with behavioral and cognitive strategies to deal with their pain. One of the non-pharmacological treatments that have shown greater positive results in reducing the symptoms of headaches, in particular, chronic tension headache and in some cases of a migraine, is biofeedback. This method is based on the conditioning mechanism whereby through practice it is possible to acquire awareness and manage through visual and/or acoustic stimuli, some physiological indices (muscle tension, peripheral skin temperature, heart rate, etc.) that are modified during the various situations psycho-emotional and social and that are involved in the different mechanisms of a headache. The end result of biofeedback training, combined with adequate drug therapy, allows reducing or stopping the pain in a tension headache and migraine attacks in the long term, limiting the risk of drug abuse.
The best candidates for this type of approach are people who prefer a non-pharmacological approach or have an intolerance to drug therapies, patients with poor pharmacological treatment, women who are pregnant or during lactation, individuals who suffer life events that are particularly stressful and/or subject to anxious states.