Current investigations in headache.

The responses of supraorbital (SA), superficial temporal (TA), and digital (F) arterial beds and heart rate were studied in 5 normal subjects and 10 migraineurs when hand temperature was increased by volition and/or by heat. In normal subjects, volitional digital arterial dilation coincided with vasoconstriction in SA and TA. In migraineurs, the response varied. Bradycardia resulted in most subjects except in unimproved migraineurs. Heat-induced hand vasodilation led to dilation in SA and TA and to tachycardia. In the 8 migraineurs who improved clinically, the finger temperature feedback training apparently did not result in conditioning of a single autonomic response (i.e. digital vasocilation), but in a general decrease of the sympathetic tonic outflow. Improvement in migraine could also be correlated with improvement in psychological tests, with MMPI scores indicative of neurosis, significantly improving in those patients who learned and practiced the BF technique. A pilot study aimed at detection of serum complement alterations in migraine does not suggest a diminished level of the inhibitor of the first component and further inquiry into the possible serum complement abnormalities in migraineurs is in process. The possible relationships between the vasomotor changes in migraine, the reduction in sympathetic tonic outflow evoked by biofeedback, and their psycho-physiological significance have been discussed. An integrated, interpretative fusion of these data is proposed. A new conditioned vasomotor reflex, which we have termed the relaxation reflex, has been described. It should be explored whether BF has more wide applications in the treatment of other "psychosomatic" disorders characterized by vasomotor abnormalities and increased sympathetic tone.