Patient seminar

Biofeedback

The Migraine Patient Seminar (MIPAS), developed by Prof. Gerber and myself, aims to provide comprehensive neurological and behavioral medicine care for pain patients by physicians. This care encompasses both non-pharmacological prevention and treatment of headaches, as well as specific pharmacological prophylaxis and therapy based on a scientifically holistic approach. Through comprehensive training and continuing education, we also intend to enable physicians to conduct group consultations within the framework of a patient seminar.

The patient seminar for chronic headaches is based on models of similar group consultations. The basic principles are to provide information to those affected in a concise format, to initiate self-help groups, and to facilitate effective, interactive treatment through the mutual exchange of information among group members. Ideally, the patient seminar is a patient event led by a physician and a psychologist, typically held on a weekday for 60 to 90 minutes in a small group of patients (approximately 5 to 10 participants) with similar conditions. The patient seminar should be implemented as follows:

• Group formation: In individual consultations, the doctor should select suitable patients, inform them about the patient seminar, and motivate them to participate. Self-monitoring measures will be explained. A headache diary will be provided.
• The first sessions involve group-specific initial consultations. During these sessions, the symptoms of the individual headache disorders are discussed with the patients, and the level of suffering, as well as the developmental history and factors contributing to chronicity, are explored. In particular, the aim is to identify and analyze factors contributing to chronicity, various behaviors that hinder headache treatment, and everyday behavioral patterns.
• Explanation of the diagnosis by the doctor and information about the underlying causes: In this session, patients receive an explanation of the underlying mechanisms of their headache disorder. Based on this, they are taught appropriate, structured steps for treating their headaches. Patients are made aware of not only biological but also psychological and behavioral processes. This includes, in particular, stress, negative thoughts, behavioral patterns, and other factors.
• Consultation and group discussion: In this section of the patient seminar, further information is presented interactively within the group. In addition to individual triggers, lifestyle factors such as irregular sleep, daily planning, stress, workplace design, etc., will be discussed. The basis of the discussion is a specific stress analysis questionnaire, which, in conjunction with a headache checklist, helps to identify the various conditions contributing to headache attacks. During this session, patients will be introduced to a combined treatment strategy – the integration of non-pharmacological and pharmacological approaches.
• Medication review: This session includes a detailed discussion of the patient's medication history, how medications have been taken so far, their effects and side effects, as well as their attitudes towards medication. At the same time, the particular importance of self-regulatory mechanisms such as pain control, stress management, etc., will be emphasized.
• Stress Analysis I: At the beginning of the session, the particular importance of stressors and unfavorable attitudes and behavioral patterns is emphasized. Patients complete specific stress analysis questionnaires, hierarchically ranking the stressors. Stress and strain are also explained in terms of psychobiological concepts. For example, it is shown that certain techniques, such as relaxation techniques, can improve and accelerate the breakdown of neurotransmitters. Based on this, patients are told that a specific awareness of their bodies is necessary. In this context, progressive muscle relaxation according to Jacobson is explained. The effects of stressors on the body are demonstrated through targeted stress inductions, such as watching a stressful film, creating a more visceral experience. It is then shown that patients perceive bodily signals under extreme stress, such as pressure in the forehead, which they can counteract with appropriate relaxation techniques. The subsequent relaxation exercises are also provided to each patient on a CD for home practice. In addition to the CD, patients receive an exercise log in which they are to record their exercise times.
• Stress Analysis II: In this session, patients are first guided through a comprehensive relaxation exercise to achieve deep relaxation. As in previous sessions, the headache diaries are discussed. Any difficulties encountered with medication or with Jacobson's progressive muscle relaxation are first explained to the group. This session focuses on enabling patients to use relaxation techniques in a differentiated way. This means that patients learn to initiate relaxation responses in everyday situations, such as sitting, walking, standing, or speaking, by briefly tensing their muscles. A stress induction, such as a ringing telephone, is then introduced to test possible counter-reactions. Various stressful everyday situations are then role-played, such as discussions, arguments, and assertiveness situations. Patients learn to respond to emerging physical sensations with relaxation exercises.
• Pain Management and Conclusion: This session focuses on pain management (pain management training). First, patients describe their recent attacks or their most recent attack. Then, they are asked to rehearse their attacks. Using specific techniques (e.g., visualization), patients collaboratively develop strategies for ending an attack, with or without medication. The patient seminar concludes with a summary and an agreement to meet again for follow-up sessions if needed. Patients are also encouraged to attend a support group on their own initiative or, if none are available, to start one themselves.