Changing the Script

The Biofeedback Clinic helps adolescents with chronic pain take back their lives. Using a variety of mind-body techniques — including guided visualization, progressive muscle relaxation and deep breathing — adolescents learn to control their pain.

For 9-year-old Connor Wytko, the experience was sickeningly familiar: profound nausea followed by vomiting, a debilitating headache and extreme sensitivity to light and noise. It was another migraine, likely to last hours.

Frequent migraines have ruled Connor's life since he was 3 1/2 years old, sometimes hitting three or four times a week. At times, he needed a trip to the emergency room to get medication strong enough to make any difference. His parents, Michelle and Elvin Wytko of Woodinville, Washington, tried neurologists, allergists, naturopaths, prescription medicines, diet modification and physical therapy. Eliminating corn from Connor's diet and a daily prescription medication helped some. But the medication caused side effects, such as exhaustion and weight gain — 20 pounds in two months. Connor was out of school so much he started falling behind, and he missed out on normal, fun kid stuff like spending the night at a friend's house. The possibility of a migraine hitting while he was away from home was just too scary.

"We were all prisoners of Connor's migraines," says his mom. "If we were at a Mariners game and Connor felt a migraine coming, we'd all just get up and go home, because we knew we needed to get him to a dark, quiet room as soon as possible. When we planned a family vacation to Disneyland, we knew we'd spend at least one day in the hotel while Connor suffered a migraine. I never went anywhere without a Ziploc bag in my purse, in case Connor needed to throw up." Finally, the Wytko's neurologist recommended Connor try something new: biofeedback.

Rewriting the Script

At their first meeting with Dr. Cora Collette Breuner, head of Children's Biofeedback Clinic, Breuner said, "We're going to change this, Connor. Right now, the migraines are dictating your life, and I want you to dictate your migraine." Breuner led Connor — and his mother, little brother and the two cousins who came with him — in a guided visualization. After spending 15 minutes immersed in an imaginary trip to the beach, Connor realized his headache, which had registered about a nine on the 10-point scale at the start of the session, had been reduced to a three. He wanted to know what Dr. Breuner had done. "I didn't do anything, Connor — you did," she replied.

For Breuner, what's revolutionary about biofeedback is the way it rewrites the script. "By the time some kids come to us, they've had umpteen diagnostic tests and been told there's nothing medically wrong with them. Sometimes it's implied that if they didn't stress out so much, they wouldn't have these headaches or other symptoms. When I tell kids that stress may not cause their symptoms but it may make them worse, they're relieved because it changes the script and removes the stigma."

Developing the Mind-Body Connection

When people experience chronic stress, like recurrent migraines, the heightened "fight or flight" state becomes the norm. Biofeedback helps patients consciously reduce the physical manifestations of the fight-or-flight response and reset the body's baseline to a more relaxed state.

Biofeedback involves teaching the patient to develop awareness and control over the mind-body connection. Techniques include guided visualization (like Connor's "trip" to the beach), learning to breathe slowly from the belly and relaxing the face, jaw, neck and shoulders.

Turning the Pain Dial Down

In a typical session, biofeedback therapist Janna Kent, RN, uses a device to measure and "feed back" Connor's biologic rhythms to him. She tapes sensors to his finger, wrists, forehead and shoulders. She fastens an elastic belt around his torso. Throughout the 50-minute session, the sensors gather information about Connor's hand temperature and level of moisture (clamminess), heart and breathing rate and muscle tension. The data displays on a computer screen in front of him.

Kent coaches Connor to slow his breathing and redirect blood flow toward his hands. As he consciously regulates his breathing from deep in his abdomen, his heart rate slows and he is rewarded by the visual metaphor of leaves "growing" on a tree on the computer screen. "Kids respond to the visual connection," says Kent. "Seeing the data on the computer screen helps them make the connection between controlling their body's stress response (heart rate, muscle tension, hand temperature) and what they are feeling. Eventually they learn to control the stress response without the computer feedback."

Every patient responds differently, so the sessions are individualized. At another session, Connor might practice progressive muscle relaxation (learning to tighten and then relax one muscle group after another), or follow a signal on the screen to learn to breathe more slowly and fully.

"Mom, I Can Do This"

For Connor, the turning point came halfway through the standard series of eight sessions. He'd been off his daily migraine medication for a week, and as he was trying to sleep one night, he felt the familiar signs of a migraine. His mother coached him through the belly breathing and meditation techniques he'd been learning. He was able to fall asleep. But when he woke a short time later, the pain felt unbearable. He asked his mother to take him to the ER. "I told him that if we went to the ER, he probably wouldn't be seen right away. I encouraged him to try the biofeedback techniques again," recalls Wytko.

Connor took a deep breath and told his mother, "I don't want to take any more medicine. Mom, I can do this on my own." Using a combination of the techniques he'd been practicing, Connor "turned down" his severe migraine and slept restfully. It was a major victory.

"It was a real turning point for me, too," says Wytko. "I understood that this is something he can do on his own, and that gives him — and us — a tremendous amount of freedom."

Connor still gets migraines, but the frequency has been reduced from three or four a week to just four in the last three months. That has spurred other changes: Instead of dreading school — a former migraine trigger — he now loves it. He's more independent, more confident. He even spent the night at a friend's house recently.

Beyond Headaches

The majority of patients who come to the Biofeedback Clinic are seeking relief from headaches. But since assuming leadership of the clinic in June 2006, Breuner has worked to make biofeedback available to patients with a wide range of symptoms. "What we're seeing is that for patients with diseases where the medical treatment has devastating side effects — like cancer, lupus or Raynaud — biofeedback helps them cope with the stress, pain, nausea and other side effects of treatment," says Breuner.

"I tell patients that I see biofeedback as a gift, something that could change your life if you let it. But it takes daily practice," says Breuner. "The really cool thing is that it's focused on empowering the child, and helps the child take control of their own experience."