Introduction to pIR HEG.
The term Hemoencephalography was first used by Hershel Toomim in 1997
(Toomim, 2002) to describe his process of Near Infrared
Spectrophotometry (NIRS HEG) system. The Passive Infrared
Hemoencephalography (pIR HEG) system evolved from Carmen’s application
of infrared technology to peripheral thermal biofeedback (Carmen, 2002).
The evolution was in part, based on the psychophysiological concepts
developed by Toomim (Toomim & Carmen, 1999) with his NIRS HEG
Both systems (pIR HEG and NIRS HEG) respond to blood flow dynamics as
a source of data. They also share a total freedom from eye roll and
surface EMG artifacts. This makes both systems well suited for
exercising brain activity in the prefrontal cortex, without any concern
for the effects of these artifacts on the integrity of the acquired
The pIR HEG system was specifically developed as a potential
intervention technique for migraine headaches. As such, most of the
developing data regarding efficacy relates to migraine headaches. The
conceptualization for training cerebrovascular control to produce
migraine control was based on the tentative assumption that if a person
could learn to control cerebrovascular activity, especially control over
excessive vasodilation, control over migraine activity would follow.
Unfortunately, training a person to directly constrict excessively
dilated cerebrovascular structures did not work, regardless of whether a
person had a migraine headache at the time or not. Most people could
easily learn to increase the pIR HEG signal, but few could reduce it at
The hypothesis that reducing excessive vasodilation in the
cerebrovascular system would reduce migraine pain was based on the
vascular theory of migraine pathophysiology that was popular at that
time (Diamond, 1994). Migraine researchers have since rejected that
theory in favor of a more comprehensive theory of migraine
pathophysiology involving the trigeminal nerve and its interactions with
the brainstem and cerebrovascular system (Goadsby, 2001). This may be
an interesting example of an intervention process that failed to work as
anticipated because it was conceptually based on a theory that was
Based on Toomim’s pioneering application of NIRS HEG to the
prefrontal cortex (Toomim & Carmen, 1999) to increase brain
activity, the pIR HEG process was modified to train increases instead of
decreases. This turned out to be a very good idea. When the pIR HEG
sensor assembly was placed at Fpz, and the training process was directed
towards increasing prefrontal cortical brain activity, the effects were
direct and positive on both migraine prophylaxis and actual abortion of
migraine headaches. This effect on migraine activity may have more to
do with training control over the inhibitory effects of the prefrontal
cortex than training direct vascular control. The effects are also more
consistent with current thinking regarding the pathophysiology of
migraine (Goadsby, 2001).
The nature of migraine.
The true nature of migraine headaches remains elusive. Migraines
represent a complex paroxysmal neurovascular phenomenon. They occur in
two major stages, although some researchers have postulated three and
The first stage represents a steady state of readiness to have the
headache and is sometimes associated with unusual neurological and
neuropsychological phenomenon, but no headache. Some of the best
descriptions of this stage of migraine activity can be found throughout
Oliver Sacks’ book “Migraine” (Sacks, 1992).
The second stage is the headache. This often occurs on sudden relief
from a prolonged period of psychological or physiological stress
(Diamond, 1994). The fact that the second stage of a migraine correlates
with excessive dilation of cerebrovascular structures was one of the
pieces of data that caused migraine researchers to erroneously
hypothesize a cerebrovascular pathophysiological mechanism. The
excessive vasodilation appears to be a migraine effect rather than
cause. It probably participates in pain generation rather than
originates the pain (Goadsby, 2001).
Within the field of headache research, the standard for headache
classification is still the International Headache Society (IHS) manual
(Headache Classification Committee of the International Headache
Society, 1988). The classification categories set forth in this manual
represented an attempt to stabilize headache categories for the purpose
of communicating research findings.
These classification categories were set forth at a time when the
understanding of the pathophysiology of migraine was less clear than it
is currently. Now that migraines have been subjected to sophisticated
imaging techniques such as fMRI and PET, the precise pathophysiology is
still unclear, although it is more clear now than when the IHS
classification system was developed.
The theory of migraine pathophysiology that currently has the most
support among migraine researchers is that migraine is involved with and
possibly caused by paroxysmal activity of the trigeminovascular system
(Goadsby, 2001). This system includes all branches of the trigeminal
nerve, the entire cerebrovascular system, as well as the brainstem.
is even unclear as to whether or not primary migraine (that which is
not caused by head trauma or disease) represents pathology at all. Most
physiologically based behaviors and internal mechanisms that permeate
the entire human race probably have their origins in evolutionary
variables (Pinker, 1997). Loader (2002) suggested that the
migraine-prone nervous system might have had a variety of reproductive
survival advantages such as causing a reactive compensation to
environmental conditions that produced global brain hypoperfusion, or
alternatively producing a learned avoidance of external environmental
conditions such as ingestion of toxic plants that would trigger migraine
headaches. In a similar manner Carmen (2002) hypothesized that the
tendency of migraine sufferers to trigger a headache as a direct
correlate of the sudden drop in barometric pressure of an approaching
storm may once have correlated with a reproductive survival advantage by
serving as an early warning system to seek shelter.
Hypothesized mechanisms for the effects of pIR HEG on migraine.
The positive effects on migraine management after exposure to the pIR
HEG system when the sensor assembly is placed in the center of the
forehead, behave in a manner consistent with a global increase in the
amount of control generated by the inhibitory and regulatory functions
of the prefrontal cortex (Goldberg, 2001). Using an electronic circuit
analogy, this would be equivalent to increasing the gain of the negative
feedback loop in which a portion of an output signal is fed back to the
input to reduce the output. Negative feedback circuits are inherently
stable. (Madhu, 1985)
This inhibitory hypothesis is based in part on the following observations:
1. Patients being treated for migraine
headaches using pIR HEG consistently report spontaneous changes in
attending behavior in the direction of easier and smoother sustained
attention to tasks. Correlated with this is a reduced distractibility to
both internal and external stimuli.
2. Patients being treated for migraine
headaches using pIR HEG consistently report spontaneous changes in
emotional reactivity in the direction of emotional responses that are
less rapid and less strong in response to stimuli that don’t call for a
rapid and strong emotional response.
3. pIR HEG requires a significant
amount cognitive “effort”; a concept first clearly defined by Pribram
& McGuinness (1975). Sometimes during the first session or two this
sustained effort appears to produce the functional equivalent of
prefrontal cortical fatigue. When this happens, the behavioral effects
appear to be those of disinhibition (difficulty attending to task, rage
reactions, severe migraine activity) for the rest of the day. Typically
on the following day after a good night’s sleep, inhibitory functions
are normal or better than normal for that person, suggesting some sort
of an exercise/ rest/recovery mechanism.
This is a collection of cases not a controlled study. The results
must be viewed within that context. The setting was a clinical setting
rather than a research setting. Also, pIR HEG was not the only
intervention variable. At each session, attempts were made to maximize
migraine management effects beyond just using the pIR HEG system. These
additional variables included but were not limited to the following:
1. Discussion of eating patterns and food triggers.
2. Discussion of stress response patterns.
3. Discussion of less obvious potential
triggers such as the driving effects of visual flicker sources.
4. Behavioral methods of migraine management.
5. Behavioral and insight oriented psychotherapy as needed.
These additional interventions represent a potential source of
contamination in terms of isolating effects to the application of pIR
HEG. However, there is one built-in control over the effects of these
additional interventions. They are the same additional interventions
that were used with the biofeedback based migraine intervention
techniques previously used by Carmen that were considerably less
effective than pIR HEG (Carmen, 2002).
This population represents a heterogeneous group of 100 patients who
participated in migraine treatment using the pIR HEG system. There was
only one selection criteria applied. All patients met the criteria for
at least one of the migraine categories set forth in the IHS
classification criteria for headache disorders for primary migraine
headaches (IHS, 1988). Patients whose migraines were secondary to head
injury or an active disease process were excluded.
Typically patients were referred by a neurologist or primary care physician, due to one of three reasons:
1. Poor response to medication.
2. Concerns about the potential
negative effects of medication, including the risk of fetal effects
during pregnancy as well as potential health risks directly to the
3. Concerns about addiction to migraine medications.
In most cases migraine medications represent an acceptable
risk/benefit ratio. However, there is one uniquely serious risk
category. The “triptans” that represent the current standard of
care for aborting migraines have been documented to constrict coronary
arteries and occasionally produce death through this mechanism (Tepper,
2001). Anyone who has coronary risk factors or active coronary disease
is generally prohibited from using these drugs. For these people,
behavioral treatments may represent a medical necessity rather than
Real world environments are not as well controlled as research
environments. For these 100 patients, length of active work with the pIR
HEG system was generally limited to 30 minutes within each office
visit, but was sometimes less than 30 minutes if fatigue, increase in
headache, or fading attention made continuing difficult. Sessions were
usually scheduled once per week, although sometimes sessions were less
frequent due to scheduling conflicts. Sessions were eventually spread
out to weeks and months between sessions, based on how long the patient
was maintaining migraine management. Morning was given preference for
time of day, but the actual time of the sessions was also determined by
personal variables such as school and work schedules. The total number
of sessions was determined by patient preference. Often the response of
the headache to the pIR HEG sessions was rapid but not complete, and
patients would elect to continue sessions, progressively increasing the
number of days between sessions, to fine tune the migraine management.
Other times, significant improvement was considered sufficient, leaving
the remaining headaches to be managed with medication or simply
tolerated. Sometimes more sessions were scheduled to work on other
aspects of self management, even though the migraines were under stable
Basic descriptive data.
Table #1 provides a breakdown of the sex and age of 100 subjects. This
reflects the relatively higher ratio of females to males in the general
population who suffer from migraines (Marcus, 1999). The female to male
ratio in this study is approximately 2:1, which is similar to the ratio
of 3:1 reported by Lipton et. al. (2001). The ages of the 100 subjects
are somewhat younger than the general population suffering from
migraines (Lipton et. al. 2001). The slight differences in age and sex
between these 100 subjects and the general population probably reflect
the age and reason people in this geographical region seek treatment (or
are referred for treatment).
NUMBER OF SUBJECTS
The pIR HEG system began to be used clinically in September, 1998
(Carmen, 2002). The system captures infrared radiation, within the 7 to
14 micron band, with a center weighted circular field of view of 32mm.
The thermal resolution is .01 represented in the equivalent of degrees
Fahrenheit. Based on the physics of thermal transmission (Fraden, 1996),
the best estimate of the area of the brain to which the system is most
sensitive would approximate the size and shape of a golf ball, directly
under the center of the field of view of the sensor assembly. The sensor
assembly for the pIR HEG system is mounted on the forehead, recording
infrared light waves emitted from the forehead in much the same way that
a camera records visible light waves reflected from objects.
The thermal activity picked up by the pIR HEG system reflects excess
thermal energy generated by the brain as a function of brain activity.
Increases in the pIR HEG signal reflect a composite of thermal energy
generated by brain cells, vascular supply and vascular return, although
there is disagreement among researchers as to which source represents
the largest thermal contribution to the increase. Some researchers have
hypothesized that the major contribution of the thermal increase comes
from brain cells (Kiyaikin, 2002). Others have hypothesized that it
comes mostly from the vascular system, (Swerdlow and Dieter, 1991).
Shevelev (1992) is more supportive of the composite hypothesis.
Regardless of the source, it seems reasonable to view the pIR HEG
signal as a thermal waste product of increased brain activity (Carmen,
2002). Whereas the relative magnitude of source contributions to the pIR
HEG signal remains an unresolved issue, the only thing that is of
immediate importance to treatment issues is that increases in the pIR
HEG signal are localized and follow increases in localized brain
second type of equipment was also used, but for data collection only
rather than as a feedback source. This equipment was not used with all
patients because it was only available for the last two of the fours
years. This additional equipment is not part of the pIR HEG system, but
is used as a means of monitoring the effects of training. It is an
infrared video capture system that captures changes in infrared patterns
as thermal energy is emitted from the forehead as a function of focal
changes in brain activity.
Infrared image capture systems.
The initial system was a STARSIGHT model 80 camera manufactured by
Insight Vision Systems (Malvern, England). This camera failed after one
year of use, and since it is no longer being manufactured, repair parts
were not available. It used older technology and had relatively poor
image quality. The thermal resolving power was too unstable to
The STARSIGHT was replaced with a Raytheon 4000b digital core
(Raytheon Corporation, Dallas, Texas), modified for the capture of
infrared images of the head. The thermal resolution of this system is
.04 degrees Fahrenheit equivalent.
Both systems are similar in some respects. They both match the 7
to 14 micron spectral range of the pIR HEG system. What they “see”
corresponds to the data captured by the pIR HEG system. They both use a
50mm, f1.0 lens, and have a pixel resolution of 240x320. However the
electronic processing of the signal is so different between the
STARSIGHT and the Raytheon camera systems that the images captured are
not directly comparable.
For both systems, image capture from the camera to the Windows 2000
based computer was carried out using an Integral Technologies FP3D
industrial frame grabber using the Integral Technologies software
designed for that particular hardware (Integral Technologies,
Part of the pIR HEG process involves watching a video, the operation
of which is regulated by a threshold setting on the pIR HEG system. The
VCR used was a Hitachi FX6404, displayed on a standard 20 inch JVC
television, viewed at a distance of 8 feet.
The sensor assembly for the pIR HEG system has a response speed of 80
milliseconds. Response speed is defined by the industry standard
definition of the time required to reach 67% of the full value of the
object being measured (Fraden, 1996). The sensor assembly picks up the
infrared radiation from the surface of the forehead as blackbody
radiation and then converts the infrared signal into a dc signal that is
fed to the input of the pIR HEG computer. The signal is then processed
and converted to a green digital LED display. Each LED is .56 inch in
height. The data sampling rate is 60 times per second. The display
update rate is 3.5 times per second. The display presents the data as a
temperature equivalent in degrees Fahrenheit with a resolution of .01
degree. There are no electrodes used, so there is no direct electrical
contact with the patient. The system also interfaces with a universal
remote control that provides threshold based control over external
audiovisual sources such as a VCR or DVD. A threshold is set on the
internal computer, above which a movie will turn on, and below which the
same movie will turn off.
of the 100 subjects were also monitored with one of two of the infrared
image capture systems previously described.
For those subjects who began treatment after the installation of the
infrared video system, an image capture was carried out before and after
each session. A baseline image was captured and stored in digital tiff
format. At the end of the session a second image was captured. Images
were captured using the 50 mm lens set at f1.0, at a distance of 3 feet
from the subject. With the Raytheon system, the maximum thermal capture
range was set in software at a 10 degree Fahrenheit equivalent.
In the next step, the sensor assembly was placed on the forehead so
that the center of the field of view was in the center of the forehead,
roughly at Fpz. (See figure 1). It was held in place with soft hook and
loop straps just tightly enough to prevent slippage. Since the sensor
assembly acquires light wave infrared data, direct physical contact with
the forehead is only necessary to the extent that it prevents movement
of the sensor assembly.
Image #1 is an infrared image of the author wearing the sensor
assembly on his forehead, captured with the Raytheon camera. Please note
two significant things. First, infrared by definition has no color. All
of the infrared images in this article have been digitally converted
from grayscale images (the native format for infrared cameras) to
something called “false color” (Kaplan, 1999). In this case the colors
assigned to intensity changes range from black (lowest intensity) to red
to yellow to white (highest intensity). This color code was selected
for its intuitive value, since it is the pattern seen on stove burners
and other heated objects and is easy for people to comprehend the
meaning of these colors. Second, all images (except the one of the
author) have been captured with eye glasses removed. Both glass and
plastic eyeglasses are opaque to this part of the infrared spectrum,
resulting in a total loss of infrared data from that portion of the face
covered by the glasses. Glasses were left in place in this picture to
demonstrate that mechanism.
Typically for migraine, the center of the forehead is the only location
used. With humans this is a unique location. The human forehead
is devoid of hair, making it an ideal location for the radiation of
excess thermal energy from the brain. It also makes it an ideal location
for recording thermal activity from the prefrontal cortex.
After the baseline infrared image was captured, the sensor assembly was
placed on the forehead and the pIR HEG display turned on. At the same
time, a movie (selected by the subject) was started. After several
minutes a threshold was set above the current display reading, causing
the VCR to place the movie on “pause”. This required the subject to
increase the pIR HEG signal to a point in excess of the threshold
setting in order to turn the movie back on.
The mental state that produces the maximum output of infrared radiation
from the forehead is a simultaneous combination of the following:
1. Very low levels of discomfort such as anxiety, anger, or frustration.
2. Very intense levels of sustained concentration.
This is an affective/cognitive combination that usually does not feel
familiar or intuitive. However most were able to learn the concept
within a minute or two.
Most, if not all headache research also includes some sort of pain
index. A review of the last 5 years of the IHS journal, Cephalalgia
revealed various pain scales from 0 to 3, all the way up to 0 to 100.
Some researchers also used faces that smile or frown as a correlated
measure of pain. The commonality of these measures among all the studies
is that the lowest number or face represents no pain and the highest
number or face represents the worst pain the person can imagine. There
is however a problem with all of these measures. When headaches start to
improve, people forget how bad the headaches used to be. Without
realizing it, they start to assign higher numbers to headaches of pain
levels to which they used to assign lower numbers.
All of the subjects included in this study rated their headaches on a
0 to 10 scale. However, the only consistently reliable number was “0”.
Regardless of the rating system used, total lack of pain is a stable,
An additional, and probably more stable migraine change measure is
the point at which the person reports having a headache, but is no
longer able to tell whether it was a migraine or not. That was the
primary head pain change measure used in this study to measure
It is a concept that at face value appears vague, but has turned out
to be one of the more robust measures, at least for the people in this
study. For people who are still getting some headaches, this is a more
useful measure than “no pain” because it reflects the point at which the
headaches are discernable but not troublesome. Although it does not
have a numeric intensity equivalent, it appears to be a more reliable
and valid measure. It also allows a frequency measure to continue as an
added headache variable.
For the purpose of this study, “significant improvement” has been
functionally defined as that point at which the subject was still
getting some headaches but was unable to clearly identify them as
migraine because the pain level was so much less.
Infrared imaging provided a different type of measure. Although it
reliably displayed patterns of thermal energy emitted through the
forehead, for many of the subjects the migraine itself was visible.
During a migraine headache, the painful areas of the head were often
visible as high output areas on the infrared image. Although the meaning
of this is not entirely clear in terms of the underlying
pathophysiological mechanisms, the correlation with pain and location is
very high. Typically subjects who viewed the image would spontaneously
say something like “that’s exactly where it hurts”. The intensity of
this image reliably decreased by the end of the session, even though the
output of the forehead region increased. In addition, the amount of the
reduction of the intensity of the headache area correlated with the
pain reduction by the end of the session.
Color code. The following cases were drawn from those for whom
infrared images were available. The images follow a color code of
thermal output ranging from black (least thermal output) to red to
yellow to white (most thermal output). Migraine activity is generally
correlated with yellow, and sometimes white. The reference color bar is
inserted below as image #2. Each bar in this image reflects a 1.0 degree
Fahrenheit equivalent. Actual captured images display a minimum
resolvable temperature difference (MRTD) (Kaplan, 1999) that is much
more sensitive, by blending colors and intensities.
This was a 15 year old male, referred for 4 years of headache
activity that had evolved into chronic migraine activity of variable
pain level for the previous 6 months. There was no identified disease
process associated with the headache activity. He had a strong family
history for migraines. That combined with the family history suggested a
familial/genetic etiology. He had been on a variety of prophylactic
medications but they were having minimal to no effect. Abortive
prescription and over the counter (OTC) medications had been taken as
often as daily. There were no identifiable environmental triggers. He
was an excellent student but not attending school when first entered
treatment due to the headache activity. He would wake with a mild to
moderate headache daily, 7 days per week, including vacations. Migraines
that are active 7 days a week and on vacations tend to be especially
stubborn. His headaches would usually become gradually worse by
afternoon and get somewhat better after abortive medication. The
location of the headaches was unstable, sometimes focal and sometimes
generalized throughout the whole head. Appointments were scheduled for
mornings when headache activity was at the lowest level, because high
pain levels made concentration difficult. Parts of his face are “grayed
out” in these images to help preserve anonymity.
Even after the first session, the low level headache that he came in
with was gone by the end of the session. Initially, the relief obtained
was temporary and did not last more than one day. As the sessions
progressed, the headache control lasted progressively longer.
session #5 he came in with a severe left sided posterior migraine that
he rated as a “10” on a 0 to 10 pain scale. The baseline infrared image
(IMAGE #3) is inserted here.
After a 30 minute session of pIR HEG, the pain level dropped to “3 or 4” pain level. That image (IMAGE #4) is inserted here.
IMAGE 4 shows a post session lower intensity of thermal output in the
left posterior region of his head, corresponding to a reduced level of
pain. Both pre and post images delineated almost exactly the area of his
On session #10 he came in with the same headache in the same location
but the pain level was so low that the actual level was very difficult
to determine. This is an example of the type of change that is
considered “significant improvement”. He could feel it, but not
strongly. He rated it as a “1”. That image is inserted here as IMAGE #5.
Note, hair interferes with infrared transmission in these frequencies.
The yellow mark in the back of his head is where the hair is parted and
does not represent pathological signal intensity.
session #12 the headache activity was no longer chronic, all
medications were discontinued, and he was back in school. Sessions were
stretched to one every 3 weeks. By session #17 he was still getting
occasional mild headaches, lasting an average of 30 minutes. He was no
longer using abortive or prophylactic medication, and headaches were no
longer interfering with his life.
Comments: This case used more sessions than most, but may have had
elements of rebounding from excessive medication use. It is not typical
to be able to image migraines as precisely as these, which is one reason
for the inclusion of this particular case.
This was an 11 year old pre-pubescent female who had been getting
focal and generalized migraines for the previous two years. They varied
from daily to weekly, usually towards the end of the day. There was no
identified disease process associated with the headache activity.
Everyone in the immediate family had migraines, making a
familial/genetic etiology a high probability. The only medications used
were OTC analgesics and then only for the very severe headaches. She
responded very rapidly. By the 6th session she was under complete control with no headaches. At a two month follow-up there were no further headaches.
Comments: Migraines often start up in girls as adolescent hormones start
to kick in, and it is not unusual for the migraines to begin prior to
the onset of first menstruation. One to two years prior is somewhat
typical. Often as adolescence progresses, the migraines get worse. In
this case it is too early to tell whether they are just completely gone,
or if she will be back in another year or two with another bout of
severe headaches. In any case, based on experience with others, if she
does have a recurrence, it will probably take less work than the first
time to bring them back under control.
Image #6 is her first session baseline without headache present. The
relatively dark frontal image suggests relatively low overall prefrontal
brain activity. Experience suggests that this can be either part of the
problem in terms of allowing the brainstem migraine generator to be too
active, or it could be a product of being in pain much of the time.
Image #7 is the baseline image from the second session. She came in with
a left frontal migraine, which imaged nicely in yellow around the area
of the left temporal artery, which is the area to which the migraine was
localized. This does not mean that the migraine was being generated by
the left temporal artery, although it might have been. That still
represents a theoretical issue.
Image #8 is the post session image from the same session. The migraine
is not completely gone, but down from severe to mild (“8” down to “3” by
her rating). Note that the right and left sides of the forehead
are reasonably balanced in terms of thermal output, and that the dark
areas of the forehead are less dark. In many patients, the dark areas
appear to take on meaning in terms of focal brain activity deficits and
tend to correlate with emotions and attentional patterns. However as a
general guideline, when the dark areas become lighter, people feel
better physically and mentally.
Image #9 is the baseline image from the final (6th)
session. This is significantly lighter in the forehead region,
indicating greater prefrontal brain activity. There was no headache
present and no further headaches were reported on 1 and 2 month
is not unusual for these forehead infrared images to become
progressively lighter over time. This generally correlates with symptom
reduction and may indicate a general increase in normal prefrontal
This 24 year old woman started and finished treatment prior to the
installation of either of the infrared imaging systems, but is worth
mentioning because of the urgency of the situation. She had a long
standing history of severe migraines since early adolescence. The
migraines were debilitating when they occurred but tended to be
infrequent. They sometimes hit once a week, sometimes once a month,
sometimes months between migraines. These were managed reasonably well
with various abortive medications. Most recently she had been very
successfully managing her migraines using oral Imitrex. Imitrex is the
first of the new breed of drugs called “triptans”, and for many people
has allowed them to live much more normal lives.
The problem is that this young woman found herself pregnant, and
although sometimes migraines get better during pregnancy (Marcus, 1999),
hers got worse. The triptan drugs are powerful vasoconstrictors, and
have been shown in animal studies to have teratogenic effects (Tepper,
2001). She needed an alternate way to manage her migraines during
pregnancy, that did not carry potential risks to the health of the
The migraines came under rapid control, reducing first in intensity and
then frequency. (As previously noted, reduction in frequency is a
difficult thing to measure because if the intensity is reduced
sufficiently it is difficult to tell if a migraine actually happened or
not). In any case, after 3 sessions over a period of 3 weeks, her
migraines seemed to be greatly diminished or completely gone, depending
on the criteria used for defining the headaches. 5 more sessions were
completed just because it seemed like a good idea. There was some
continued headache activity through the balance of her pregnancy but it
was unclear whether or not they were migraines or just general pregnancy
related mild to moderate headaches. They did not require medication for
This 41 year old woman had been suffering from severe migraines for
the previous 6 years. They were severe enough to require occasional
trips to the local emergency room for injected narcotics. Prophylactic
and abortive medications had been only somewhat useful. Frequency varied
from 1 per month to almost daily.
This case is less clear than the others in terms of etiology. Her mother
also had occasional migraines, but not with such a severe frequency or
intensity. Correlated with the onset of her migraines was severe chronic
psychological stress from both work and home. She slept very poorly in
that she would toss and turn all night and wake exhausted. The sleep
patterns would rise and fall with the amount of psychological stress she
was experiencing, although it was not clear as to whether the sinusitis
played a role as well. In addition, there were a variety of comorbid
physical disorders that fall into the category of “migraine aggravators”
rather than migraine causes. These included temporomandibular joint
problems, chronic bilateral maxillary sinus infections, and some ill
defined generalized health problems. The headaches correlated positively
with her menstrual cycle in that one severe migraine was predictable
premenstrually. Others could come at any time. Usually she woke with a
mild dull headache that was qualitatively different from the migraine.
The migraine was usually left sided and throbbing. The morning headache
was more generalized and dull. In terms of etiology, this is a difficult
diagnostic judgment call. While there was probably a genetic component,
there were enough physical problems to possibly account for the
headaches. Also, the relatively late onset of the migraines is a little
suspicious for secondary rather than primary migraine.
Surprisingly, her response to pIR HEG was very rapid, although the rapid
response did not hold for extended periods of time. The other physical
and psychological stressors remained relatively constant, but her
migraines got better between sessions. This suggested that these
migraines were in fact primary rather than being caused by some other
physical disorder, although the physical problems were clearly making
She completed 11 pIR HEG sessions over a period of 6 months. The first 5
sessions were 1 per week. After that the sessions were spread farther
apart. Each session had what appeared to be both abortive and
prophylactic effects. If she came in with a migraine, she left either
without it, or greatly diminished. Any migraine activity between
sessions was greatly diminished in terms of intensity. After the first 5
visits, her life became too complex to continue except on an
intermittent basis. She would still get approximately 7 days of improved
migraine control from each session, but the headaches would still creep
back to previous levels by the end of the 2nd or 3rd week. She still comes in for an occasional session, but on an irregular basis.
This case represents a very complex set of circumstances. It has been
included here as an example of the potential complexity of working with
migraine headaches, since they usually seem to be affected if not
actually driven by life stressors. The pIR HEG sessions clearly helped
her a great deal. However she also had been living under unbelievable
levels of psychological and physical stress, so it is not likely that
the migraines were going to disappear altogether. In cases like this,
sometimes it seems worthwhile to continue weekly sessions for a long
period of time, or switch to home training. However in her particular
life situation, neither was a viable option.
is likely that when her life circumstances straighten out and her
physical problems start to become less intense, her migraines will also
become less troublesome. When that happens, further pIR HEG sessions may
bring her migraines under exceptionally smooth control.
Image #10 is a baseline from a recent scheduled session. She came in
with a very bad migraine, localized to the right temporal region. In the
image, that region can be seen to be relatively brighter and covering a
relatively larger area than the left side. The “wings” on either side
of her head are her hands holding her hair out of the picture. This was
also unusual for her in that most of her migraines have been left sided.
Image #11 was captured immediately after the session was completed. The
headache was completely gone.
The thermal output from the forehead on this image shows less of a
right/left difference, and the forehead is generally lighter in color,
indicating increased overall prefrontal cortical activity. The same
caveats apply in this situation as the previous two sets of images.
These images correlate with migraine pain or lack of it. They may or may
not represent the underlying physiological mechanism generating the
pain. Regardless, the reliability of these images is very high. The
utility of these images becomes greater when studied as specific
patterns that are unique to each individual. Under those conditions,
they become predictable and useful, especially as part of an ongoing
differential diagnostic process.
The typical response pattern for all those who improved was to have the
intensity level of the migraines change before anything else changed.
The headaches, when they occurred were less intense. The point of
“significant improvement” was defined as the point at which it had
become difficult to identify headaches as “migraine”. From the
standpoint of headache patterns, the focal location of the pain usually
remained the same as the “migraines”, but the pain level was much less,
sometimes becoming almost indiscernible.
Reduction in headache frequency typically came weeks or months after
reduction in pain levels. This is an even more complex and unreliable
measure than pain level because as pain levels drop it becomes more and
more difficult to determine if a headache (migraine) actually happened.
Detailed questioning has revealed that many people will continue to have
very low intensity “events” that are probably actual migraines but have
an intensity so low that it requires very careful data collection for
identification as a migraine. Often they are not even identified as
headaches. Sometimes the only way to identify them is by patterns of
events. For example, if the person’s migraines typically triggered on a
Friday after a long hard week, that person might continue to have very
low intensity “events” at the time and day that they used to get a
migraine headache. These are probably still migraine headaches, but they
lack intensity. These “events” can be non pain events that present only
as altered sensations. This observation may lend support to the
hypothesis that the mechanism of action of the pIR HEG system on
migraine headaches is through inhibition of the migraine generator.
Functionally the migraines appear to become weaker. It may be that the
frequency actually remains constant. Self reports are inadequate for
this level of discrimination, and the infrared images are so sensitive
to intensity that they don’t help much either.
The decision to terminate treatment was typically based on a variety of
variables, most of them personal. Given the option of continuing
sessions as long as needed, they were continued weekly until the
headaches had stabilized to a comfortable point. Then the sessions were
spread out progressively farther apart until a mutual agreement was
reached to completely terminate. Personal preferences varied as to the
degree of migraine management desired. Most were satisfied with relative
freedom from debilitating headaches, relying to some extent on
medication for the occasional very bad headache.
For those 61 individuals for whom pre/post infrared images were
recorded, the following observations also apply:
1. The strongest correlate of the
impact of the session was a decrease in dark areas in the image rather
than the total increase in lightness of the image. This is somewhat
consistent with the “cold patch” observed by Swerdlow & Dieter
(1991). However because of the age and technology of their infrared
camera, their images are not directly comparable with either of the
image data sets in this study.
PATTERNS OF HEADACHE IMPROVEMENT
NUMBER OF SUBJECTS
“SIGNIFICANT IMPROVEMENT” IN 6 SESSIONS OR LESS
ADDITIONAL SUBJECTS WITH “SIGNIFICANT IMPROVEMENT” IN 7 SESSIONS OR MORE
REGARDED THEMSELVES AS “COMPLETELY CURED”
DID NOT IMPROVE AT ALL
DROPPED OUT BEFORE 6 SESSIONS
TOTAL IMPROVED (OF THOSE SUBJECTS WHO DID NOT DROP OUT BEFORE 6 SESSIONS)
VARIABLES ASSOCIATED WITH DROPPING OUT BEFORE 6 SESSIONS
DRUG ADDICTION (MIGRAINE MEDICATION)
For both males and females, the majority started to see signs of
improvement in 6 sessions or less. Of the 36 males in this study, 23
improved enough in 6 sessions to consider themselves significantly
improved. Of the 64 females, 38 improved enough in 6 sessions to
consider themselves significantly improved. Most continued on for more
sessions, terminating when it felt comfortable or when the financial or
time inconvenience of coming to an appointment was greater than the
inconvenience caused by the relatively minor headaches. The number of
sessions does appear to have some predictive importance in that most who
eventually achieved “significant improvement” showed signs of
improvement by session #6.
A relatively smaller number of males (5) and females (6) took more
than 6 sessions before they saw signs of improvement. The cutoff point
of 6 sessions appears to have considerable predictive value in that if
someone has not seen signs of improvement by session number 6, it is
only somewhat likely that more sessions will help. For those who needed
more sessions to see improvement, typically they needed much more. Some
went as high as 20 or 30 sessions.
4 people regarded themselves as completely cured. Followup suggests that this may in fact be the case.
Not everyone improved. 8 of the males and 20 of the females did not
improve at all. However, all of the males who did not improve, and 16 of
the females who did not improve, had dropped out prior to 6 sessions.
It is unknown if these would have converted into “significantly
improved” had they continued.
An analysis of the patterns of reasons for dropping out, showed great
variability and the reasons given may not have always been the real
reasons. 1 male and 10 females dropped out for financial reasons. The
reason for the extreme female/male ratio on this variable is unclear.
The psychological reasons for dropping out were also quite variable and
idiosyncratic. Some people were addicted to the migraine medications and
did not or could not stop taking them. These drugs would often produce a
once or twice daily rebound headache. Breaking the cycle required a
total withdrawal from abortive medication, that these people were either
unwilling or unable to accomplish.
The infrared images added a very useful measure for those for whom it
was available. If a person came into the session with a headache,
painful areas could usually be identified as high intensity areas on the
images. Not everyone came to a session with a headache, but it happened
often enough to gather some data. Typically the high intensity painful
areas would reduce to a lower intensity by the end of the session,
correlated with a reduced pain level. This was a very consistent
Observations and impressions.
These are general subjective impressions from working directly with
all of these patients using the pIR HEG process. Most people like the
process, and learn it quickly, in spite of the fact that the high
intensity cognitive “effort” combined with a very relaxed emotional
state is an unfamiliar concept to almost everyone.
The reasons for change in migraine status remain unclear. It is likely
that the mechanisms involve the inhibitory functions that are closely
associated with the prefrontal cortex, but at this point that is
hypothesis rather than proven fact.
The results of this study support the observations of other clinicians
using the pIR HEG system with migraine patients. Migraine patients
appear to improve strongly, and quickly, usually seeing positive effects
within the first 6 sessions. In addition, the effects appear to be both
prophylactic and abortive. Because the system is so new, long term data
is not yet available. It must still be considered an experimental
More precise pre/post psychophysiological measures such as fMRI, QEEG
and related imaging processes may eventually help to clarify the
specific brain mechanisms activated by this process. As more data is
gathered, it may even contribute meaningful information to ongoing
attempts to clarify the basic pathophysiological mechanisms associated
with migraine headaches.
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Accepted 4/03 for publication in the Journal of Neurotherapy