Relaxation, hypnosis, feedback and manual therapies

In addition to basic crisis medications, all the natural techniques that help to relax during the crisis make it possible to reduce the pain. These therapies also make it possible to better manage stress and potentially reduce the frequency of seizures (Fauconnier et al. 2015). Relaxation techniques are multiple and include meditation, yoga or sophrology breathing exercises. Sports are also part of soothing activities and a recent study has shown that regular sports practice reduces the frequency of seizures (Amin et al. 2018). Regularity seems to be the essential point, because isolated intense physical activity can also be a triggering factor.

Relaxation and biofeedback

Retrocontrol (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 his body, such as pulse, skin temperature, muscle activity, then to control them to soothe them. Numerous 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 superior efficacy to the placebo group.

The US Headache Consortium meta-analysis published in 2000 (Campbell and Penzien 2000) show that relaxation, feedback combined with relaxation, cognitive and behavioral therapies have significant efficacy in preventing seizures compared to placebo, with a reduction of 30 to 50% in their intensity. Moreover, these effects seem to be maintained over several years and are accentuated 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. Be that as it may, the appeasement of the mind, by these therapies, has a beneficial effect on a daily basis in the management of stress and pain. Moreover, its effectiveness was described as early as 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: to allow the migraineur to control his emotions, which constitute powerful triggers of the crises, and when these settle, 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 high production of endorphins which act as natural analgesics. After a more or less long apprenticeship, the patient can use self-hypnosis. By exercising regularly, he is able to relax his body and modulate his pain on his own.

Osteopathy: another therapy

Osteopathy is a manual therapy to which patients have recourse the most in the management of 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 carry out studies according to an adequate methodology or to compare them with each other. Indeed, the placebo group is often made up of pseudo massage sessions and the evaluation criteria differ from one study to another (Cerritelli et al. 2017). The action of osteopathy would be essentially to modulate parasympathetic activity by cranial and craniosacral techniques. Some osteopaths also claim to have an action on the drainage of the venous sinuses and the tensions of the falx and tents of the brain and cerebellum. Blockages of the first cervical and temporomandibular joints would also have an impact in the basic treatment of migraine patients in osteopathy (Pérot and Buch 2013).