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Treatment of migraine headache by conditioned relaxation: A case study
BEHAVIOn THEBAPY (1971) 2, 592-593
Treatment of Migraine Headache by Conditioned Relaxation: A Case Study~ ERIc R. LUTKER Colorado State University A l t h o u g h t h e e t i o l o g y of t h e m i g r a i n e h e a d a c h e is n o t k n o w n w i t h a n y surety, it is a clearly defined clinical e n t i t y ( A l e x a n d e r & F l a g g , 1965). M i g r a i n e attacks are p e r i o d i c in n a t u r e a n d are c h a r a c t e r i z e d b y p r o d r o m a l d i s t u r b a n c e s , such as i r r i t a b i l i t y a n d visual d i s t u r b a n c e s , a n d f o l l o w e d b y severe h e a d a c h e a s s o c i a t e d w i t h n a u s e a a n d sometimes vomiting. T h e p h y s i o l o g i c a l m e c h a n i s m of t h e p a i n is often a s s u m e d to involve "vascular s t r e t c h i n g of t h e c e r e b r a l a n d c r a n i a l arteries as a result of v a s o d i l a t i o n " ( A l e x a n d e r & F l a g g , 1965)~ This m a y e x p l a i n w h y m i g r a i n e sufferers most often h a v e a feeling of p r e s s u r e or t e n s i o n p r i o r to t h e a c t u a l onset of severe pain. CASE STUDY The client was a 22-year-old female college student who suffered from severe migraine attacks for a period of approximately 8 years. The frequency of her symptoms was about 6-8 times per week without any apparent relationship between time of day and the onset of the attack. In I963 the client was treated for her headaches with eyeglasses on the assumption that they were related to a problem of refraction. However, the headaches continued. The client was treated on at least four occasions by various physicians, and Fiorinal, Dilantin, Equagesie, and Chlor-Trimeton were prescribed. All of these medications helped to some extent, but none completely alleviated the symptoms. Immediately prior to the present treatment, she was contemplating a complete series of allergy tests in order to find out if the symptmns were allergic in nature. The client described her symptoms as follows: First there is a "pressure build-up" on the back of the neck. This symptom stays constant for a period of from 10 rain to 1 hr, when severe pain starts in the back of the neck. The pain gradually moves toward tile top of the head and ends up behind the eyes. This pain continues for periods ranging from 1 hr to the whole day. The pain is accompanied by increased sensitivity to light (photophobia) and nausea. The cessation of pain brings with it a feeling of light-headedness. Treatment Stage I. The client was trained in muscular relaxation via audiotaped instructions (Wo]pe, 1969). These instructions (Suinn, 1969) are similar to those described by ~Requests for reprints should be addressed to Erie R. Lutker, Department of Psychology, Colorado State University, Fort Collins, Colorado 80521. The author thanks John Hinkle for referring the patient in this case study. 592
TREATMENT
OF MIGRAINE HEADACHE
593
Jacobson (1938) and involve the tensing and subsequent relaxation of various muscle groups in order to attain a general state of nmscular relaxation. This relaxation procedure was administered three times per hour in four 1 hr sessions spaced over 2 ~ . She was also instructe'(]"[5""p'~ertd~'i?elaxinghersei( each night before retiring, without the aid of the taped instructions. During this stage the symptoms continued as they had in the past although the client was at this time taking medication. Stage II. The client was instructed to relax herself whenever she felt .tJ~.~'p,r,.~s~ure build-up." This stage of treatment lasted for a period ~ . The client reported t ~ f u l part of her symptom was completely allevTated although she still experienced the "pressure build-up" with unchanged frequency. It should be noted that on the second day of Stage II she stopped all medication. Stage III. The client was next instructed that when she felt the "pressure build-up," she should think about the relaxed-feeling state briefly and continue her normal behavior. This instruction replaced the rigorous relaxation procedure. The client reported that the pain did not reoccur and that the "pressure build-up'" became less apparent and eventually disappeared. In the 2-month follow-up, the client reported that her previous symptoms were entirely gone. Discussion
During Stage I I the pain was being effectively countered by the induced relaxation. It is hypothesized that, during Stage III, the process was extended to where the relaxation response became conditioned to even the slightest feeling of symptom onset. This process may he based on the proved ability of the individual to be "aware" of physiological processes which are not usually considered part of the individual's awareness pool (Kamiya, 1969). The relaxation became so automatic that it substituted itself for the previous symptom in the client's repertoire of responses. The substitution may prove to have far-reaching effects in the treatment of a number of psychophysiological disorders. The attachment of a nonharmful and socially acceptable psychophysiological response to a stimulus which previously elicited a maladaptive response would seem to be a relatively simple and possibly quite effective procedure. REFERENCES ALEXANDER, F., & FLaCc, G. W. The psychosomatic approach. In B. G. Wolman (Ed.), Handbook o[ clinical p~'ychology. New York: McGraw-Hill, 1965. Pp. 855-947. JACOBSON, E. Progressive relaxation. Chicago: Univ. of Chicago Press, 1938. KAMIYA, J. Operant control of the EEG alpha rhythm and some of its reported effects on consciousness. In C. T. Tart (Ed.), Altered states of consciousness: A book o'[ readings. New York: Wiley, 1969. Pp. 507-517. StrinN, R. M. Personal comnmnication, 1969, WOLFE, J. The practice of behavior therapy. New York: Pergamon, 1969.
Treatment of Migraine Headache by Conditioned Relaxation: A Case Study~ ERIc R. LUTKER Colorado State University A l t h o u g h t h e e t i o l o g y of t h e m i g r a i n e h e a d a c h e is n o t k n o w n w i t h a n y surety, it is a clearly defined clinical e n t i t y ( A l e x a n d e r & F l a g g , 1965). M i g r a i n e attacks are p e r i o d i c in n a t u r e a n d are c h a r a c t e r i z e d b y p r o d r o m a l d i s t u r b a n c e s , such as i r r i t a b i l i t y a n d visual d i s t u r b a n c e s , a n d f o l l o w e d b y severe h e a d a c h e a s s o c i a t e d w i t h n a u s e a a n d sometimes vomiting. T h e p h y s i o l o g i c a l m e c h a n i s m of t h e p a i n is often a s s u m e d to involve "vascular s t r e t c h i n g of t h e c e r e b r a l a n d c r a n i a l arteries as a result of v a s o d i l a t i o n " ( A l e x a n d e r & F l a g g , 1965)~ This m a y e x p l a i n w h y m i g r a i n e sufferers most often h a v e a feeling of p r e s s u r e or t e n s i o n p r i o r to t h e a c t u a l onset of severe pain. CASE STUDY The client was a 22-year-old female college student who suffered from severe migraine attacks for a period of approximately 8 years. The frequency of her symptoms was about 6-8 times per week without any apparent relationship between time of day and the onset of the attack. In I963 the client was treated for her headaches with eyeglasses on the assumption that they were related to a problem of refraction. However, the headaches continued. The client was treated on at least four occasions by various physicians, and Fiorinal, Dilantin, Equagesie, and Chlor-Trimeton were prescribed. All of these medications helped to some extent, but none completely alleviated the symptoms. Immediately prior to the present treatment, she was contemplating a complete series of allergy tests in order to find out if the symptmns were allergic in nature. The client described her symptoms as follows: First there is a "pressure build-up" on the back of the neck. This symptom stays constant for a period of from 10 rain to 1 hr, when severe pain starts in the back of the neck. The pain gradually moves toward tile top of the head and ends up behind the eyes. This pain continues for periods ranging from 1 hr to the whole day. The pain is accompanied by increased sensitivity to light (photophobia) and nausea. The cessation of pain brings with it a feeling of light-headedness. Treatment Stage I. The client was trained in muscular relaxation via audiotaped instructions (Wo]pe, 1969). These instructions (Suinn, 1969) are similar to those described by ~Requests for reprints should be addressed to Erie R. Lutker, Department of Psychology, Colorado State University, Fort Collins, Colorado 80521. The author thanks John Hinkle for referring the patient in this case study. 592
TREATMENT
OF MIGRAINE HEADACHE
593
Jacobson (1938) and involve the tensing and subsequent relaxation of various muscle groups in order to attain a general state of nmscular relaxation. This relaxation procedure was administered three times per hour in four 1 hr sessions spaced over 2 ~ . She was also instructe'(]"[5""p'~ertd~'i?elaxinghersei( each night before retiring, without the aid of the taped instructions. During this stage the symptoms continued as they had in the past although the client was at this time taking medication. Stage II. The client was instructed to relax herself whenever she felt .tJ~.~'p,r,.~s~ure build-up." This stage of treatment lasted for a period ~ . The client reported t ~ f u l part of her symptom was completely allevTated although she still experienced the "pressure build-up" with unchanged frequency. It should be noted that on the second day of Stage II she stopped all medication. Stage III. The client was next instructed that when she felt the "pressure build-up," she should think about the relaxed-feeling state briefly and continue her normal behavior. This instruction replaced the rigorous relaxation procedure. The client reported that the pain did not reoccur and that the "pressure build-up'" became less apparent and eventually disappeared. In the 2-month follow-up, the client reported that her previous symptoms were entirely gone. Discussion
During Stage I I the pain was being effectively countered by the induced relaxation. It is hypothesized that, during Stage III, the process was extended to where the relaxation response became conditioned to even the slightest feeling of symptom onset. This process may he based on the proved ability of the individual to be "aware" of physiological processes which are not usually considered part of the individual's awareness pool (Kamiya, 1969). The relaxation became so automatic that it substituted itself for the previous symptom in the client's repertoire of responses. The substitution may prove to have far-reaching effects in the treatment of a number of psychophysiological disorders. The attachment of a nonharmful and socially acceptable psychophysiological response to a stimulus which previously elicited a maladaptive response would seem to be a relatively simple and possibly quite effective procedure. REFERENCES ALEXANDER, F., & FLaCc, G. W. The psychosomatic approach. In B. G. Wolman (Ed.), Handbook o[ clinical p~'ychology. New York: McGraw-Hill, 1965. Pp. 855-947. JACOBSON, E. Progressive relaxation. Chicago: Univ. of Chicago Press, 1938. KAMIYA, J. Operant control of the EEG alpha rhythm and some of its reported effects on consciousness. In C. T. Tart (Ed.), Altered states of consciousness: A book o'[ readings. New York: Wiley, 1969. Pp. 507-517. StrinN, R. M. Personal comnmnication, 1969, WOLFE, J. The practice of behavior therapy. New York: Pergamon, 1969.