Relaxation, hypnosis, feedback and manual therapies

In addition to basic crisis medications, all natural techniques that help to relax during the crisis help to alleviate pain. These therapies also help to better manage stress and potentially reduce the frequency of crises (Fauconnier et al. 2015). Relaxation techniques are numerous and include meditation, yoga or sophrology breathing exercises. Sport is also one of the calming activities and a recent study showed that regular sports practice reduced the frequency of crises (Amin et al. 2018). Regularity seems to be the key point, because isolated intense physical activity can also be a triggering factor.

Relaxation and biofeedback

Biofeedback is increasingly used and is based on the measurement of organic functions. The goal is to teach the patient to identify physiological variations in their body, such as pulse, skin temperature, muscle activity, and then to control them to soothe them. Many publications conclude that biofeedback is effective in relieving migraines (Nestoriuc et al. 2007). Whether accompanied by relaxation or combined with behavioral treatment, the results indicate greater effectiveness than the placebo group.

The meta-analysis of the US Headache Consortium published in 2000 (Campbell and Penzien 2000) shows that relaxation, feedback control combined with relaxation, cognitive and behavioral therapies have a significant effectiveness in preventing attacks compared to placebo, with a reduction of 30 to 50% in their intensity. In addition, these effects seem to be maintained over several years and increase as long as the patient exercises. Many authors question the reliability of these studies, mainly due to the fact that the placebo group is easily identifiable in patients. In any case, calming the mind through these therapies has a beneficial effect on a daily basis in the management of stress and pain. Moreover, its effectiveness was described in the second century by Galen (Sacks 1999) and continues to be used today in almost all chronic pain management services.

Medical hypnosis: a therapy

Medical hypnosis has often been studied in chronic pain and migraine (Michaux 2004). It intervenes on two axes: allowing the migraine sufferer to control his emotions, which are powerful triggers for attacks, and when they set in, to allow him to modulate his pain to reduce its intensity. Several studies have shown the effectiveness of hypnosis in the management of chronic pain. Its effectiveness is essentially linked to the significant production of endorphins which act as natural analgesics. After a more or less lengthy learning process, the patient can use self-hypnosis. By practicing regularly, he is able to relax his body and modulate his pain on his own.

Osteopathy: another therapy

Osteopathy is a manual therapy that patients most often use to manage their migraines. There are very few studies that have evaluated the effectiveness of osteopathy in their prevention. On the one hand, it is difficult to conduct studies using an adequate methodology or to compare them with each other. Indeed, the placebo group often consists of pseudo massage sessions and the evaluation criteria differ from one study to another (Cerritelli et al. 2017). The action of osteopathy would essentially be to modulate parasympathetic activity by cranial and craniosacral techniques. Some osteopaths also claim to have an effect on the drainage of venous sinuses and the tensions of the falx and tents of the brain and cerebellum. Blockages of the first cervicals, and the temporomandibular joints, would also have an impact on the basic treatment of migraine patients in osteopathy (Pérot and Buch 2013).