1. Behavioral Approaches for Migraine Headaches Rusty Lozano M.ED, LPC, BCB Director: Center for Biofeedback & Behavior Therapy 15028 Beltway Dr Addison, TX 75001 469-358-1309 www.onlinebiofeedback.com

2. Underlying Psychological Factors Anxiety and Headache Chicken or the egg syndrome Triggers in the body Symptoms reinforce negative thought and vice versa (the vicious cycle)

3. Underlying Psychological Factors Pain Behavior “I can’t because I’m in pain” versus “I can’t because I will experience pain” “Human-imprinting” in pain cycle Classical conditioning “Conditioned vs. unconditioned response”, “conditioned vs. unconditioned stimulus”, “positive punishment vs. negative punishment” “positive association vs. negative association”

4. Underlying Psychological Factors School Related Stress School environment (ex. AP courses, absenteeism, social) Performance Homework load Parent pressure

5. Underlying Psychological Factors Environmental Association Negative association and the “branching” anxiety effect Avoidant behavior Inadvertent parental reinforcement

6. Tension vs. Vascular Behavioral Detection Methods Diagnostic interview of symptoms Symptom checklist Peripheral biofeedback assessment Cranium vs. myofacial muscle regions

7. Treatment Intervention Types: Adjuncts to Medication Management Peripheral Biofeedback Adjunct to medication management Peripheral biofeedback modalities (ex. temp training, muscle training) Peripheral nervous system- sympathetic vs. parasympathetic nervous system Rehearsal/Generalization (ex. CBBT’s Pendulum Obstacle Course)

8. Treatment Intervention Types: Adjuncts to Medication Management Progressive Muscle Training Tense/relax training Localized muscle relaxation Strategic stretching

9. Treatment Intervention Types: Adjuncts to Medication Management Relaxation Training Breathing techniques Deep relaxation Autogenic phrases Yoga

10. Treatment Intervention Types: Adjuncts to Medication Management Cognitive Behavioral Therapy Identifying triggers Building a coping strategy database Thought restructuring

11. Biofeedback Demo *CBBT’s Pendulum Gym *Live Demo

12. CBBT’s Pendulum Footage Courtesy of: Alex Lozano

13. References Allen, K. D. (2006). Recurrent pediatric headaches: Behavioral concepts and interventions. Journal of Early and Intensive Behavioral Intervention, 3, 211–219. doi:10.1037/h0100333 Fall, K. A., Holden, J. M., & Marquis, A. (Eds.). (2010). Theoretical models of counseling and psychotherapy (2nd ed.). New York, NY: Rutledge Taylor & Francis Group. Khazan, I. Z. (2013). The clinical handbook of biofeedback: A step-by-step guide for training and practice with mindfulness. Malden, MA: Wiley-Blackwell. Miller, L. (1994). Biofeedback and behavioral medicine: Treating the symptom, the syndrome, or the person. Psychotherapy, 31, 161–169. doi:10.1037/0033-3204.31.1.161 Peper, E., & Shaffer, F. (2010). Biofeedback history: an alternative view. Biofeedback, 38, 142–147, doi:10.5298/1081-5937-38.4.03 Riva, D., Usilla, A., Aggio, F., Vago, C., Treccani, C., & Bulgheroni, S. (2012). Attention in children and adolescents with headache. Headache, 52, 374–384. doi: 10.1111/j.1526-4610.2011.02033.x Schwartz, M. S., & Andrasik, F. (2005). Biofeedback: A practitioner’s guide (3rd ed.). New York, NY: Guilford Press. Skinner, B. F. (1963). Operant behavior. American Psychologist, 18, 503–515. doi:10.1037/h0045185

14. Rusty Lozano M.ED, LPC, BCB 469-358-1309 www.onlinebiofeedback.com Pediatric & Adolescent Biofeedback Counseling & Behavior Therapy Group Therapy