S3:Ep34 – Therapeutic Laser Treatment for Migraine
Voice-over: Welcome to Spotlight on Migraine, hosted by the Association of Migraine Disorders. Join us for fresh perspectives by medical experts and advocates as we explore the spectrum of migraine and dig deeper into this complex disease.
This episode is brought to you by our generous sponsor, Biohaven Pharmaceuticals.
Molly O’Brien: Hello, and welcome to Spotlight on Migraine. I’m your host, Molly O’Brien. Today we’re talking about laser therapy treatment for migraine and headache. I’m really excited to learn about this topic, and I’d like to introduce our guest today, who knows a lot about it. Our guest is Phil Harrington. Dr. Harrington has a degree in physics from Iowa State University and graduated from the Palmer College of Chiropractic. He has more than 14 years’ experience in the therapeutic-laser industry and currently serves as medical director, clinical manager, and laser safety officer for Summus Medical Laser.
Dr. Harrington, thanks so much for joining us today.
Dr. Phil Harrington: Well, thank you, Molly. It’s wonderful to be with you today. I appreciate the opportunity to share some information about laser therapy with your listeners.
Molly: Well, this is a really exciting topic. I think we’re just starting to see this grow more and more. And so I know our followers are very interested — and I know I am as well — to find out how it all works. So let’s start off with the basics. What is laser therapy, and how does it work?
Dr. Harrington: Laser therapy is the use of red and infrared laser light that will have effects both on the skin surface, but then also on structures deeper inside of the body. And so just a brief history is that the laser devices were invented in the 1960s. And shortly after that, there was an accidental discovery during some experiments where they found that hair grew back more quickly on small animals that were shaved for various experiments. And that chance observation that the application of red and infrared light would help to stimulate processes inside of the body is where it all started.
So then in the last few decades, we have seen the science behind laser therapy grow exponentially, especially just in the last few years. And a big part of that is the understanding of the mechanisms, the understanding of what exactly happens when we shine light on tissues.
Now, one analogy that we will make — if someone is skeptical about the influence of light on biological tissue, first, we will remind them that we all know that plants use a process called photosynthesis to produce energy for the plants. And then also there are other biological processes in human bodies that are influenced by light. One of those would be our special sense of vision. The simple fact that I can see you means that there are photons of light being absorbed by the different rods and cones in the retina of my eye. That light energy is being converted into chemical energy, and then I have a brain signal of vision.
Another application of light would be for newborn babies that are born jaundiced. We would use ultraviolet light to have a positive influence on them.
So, in the last few years, as I said, we’ve gained a better understanding of the mechanisms of laser. And, just briefly, there are things that happen inside of the cell, and the things that we talk about most often, there is various enzymes inside of the mitochondria inside of the cells of our body. Now, you can think of the mitochondria inside of a cell as the engine of the cell. We are a living and breathing organism, and our body continually needs to produce energy from the food we eat and the water that we drink and the air that we breathe. So one effect of laser is to influence enzymes in the mitochondria to help our cells produce more energy.
A second effect is going to be on the cell membrane. At the cell membrane, we will talk about the ion channels. For our cells to be working optimally and normally, there are different — they’re called ion channels, where we have exchange of sodium-potassium across the cell membrane. We get exchange of calcium across the cell membrane. All of those things are helping the cell to work at an optimal level.
And then outside of the cell, there are things is called cell signaling from one cell to another. This cell has to tell another cell on down the line what to do, how to perform its job most efficiently.
So I know I’ve said a lot there, but, just in general, the way we summarize it is that therapeutic lasers, when that light gets absorbed by components inside of the body, it is helping to increase circulation in the tissues, increase delivery of oxygen from the blood to the tissues, and then increase the processing of that oxygen to produce cellular energy so the cell can work more efficiently.
Molly: OK. So now that we have a better understanding of how it works and probably a deeper understanding of the science behind it — hopefully, we can follow along there — can you tell us how laser therapy might be able to help a migraine patient?
Dr. Harrington: Right. And I do have friends and family members who are migraine sufferers, and then I also, in my role as clinical manager for Summus Medical Laser, I get to interact with our hundreds and maybe even thousands now of laser practitioners around the country and around the world. And so there are ways that laser therapy treatments can help migraine sufferers with their associated symptoms.
Now, the first question that we have to ask is, Is safe? And that’s my approach as a healthcare provider. When I look at any sort of treatment, I think the first thing we need to look at is, Is it safe? If we deliver this treatment, whether it is laser therapy or something else, are we following our oath to first do no harm.
And we can rest assured there. With therapeutic laser light, we are using red and infrared laser light. By definition, on the electromagnetic spectrum, red and infrared is nonionizing. So nonionizing means that, yes, it is very safe, and one argument we could make is that a therapeutic laser treatment is actually safer than walking outside in sunlight. When you walk outside, you get exposed to UV rays, and we all know that UV rays can cause various problems in the body because ultraviolet, UV, is ionizing. It can cause various problems in the skin. So, first, I want to emphasize the safety of therapeutic laser treatments.
The second I want to emphasize is when we are lasering in the skin, in the tissues, and then also when we are lasering over the brain, are we getting light into the body? And so we have answered that question there by doing what’s called depth-of-penetration studies. And with a depth-of-penetration study, we will shine the laser at the skin surface or over the skull over the brain, and then at different depths inside of the tissue, we will measure, first, are we getting light there, and then, second, how much light is getting in?
So the first thing we did is depth-of-penetration studies on the body, so where we were going into soft tissues for various musculoskeletal complaints. And there we found that, yes, at a depth of several centimeters, we are delivering a sufficient amount of light so that we can get the beneficial of therapeutic laser deep inside of the body.
And measurements show us, when we shine infrared laser light directly on the skull, we are getting about 10 percent of the light through the skull. And then beyond that, the brain and the other structures inside of the brain are relatively transparent to laser light. So once we get past that barrier of the skull and get laser inside of the brain, then we can have those positive physiological effects.
Molly: Great. Can you walk us through what a treatment for someone living with migraine might look like? Can you tell us, do you go into a room and lie down? Is it a half-hour? Is it five minutes? Walk us through. Where do they put the laser?
Dr. Harrington: So, first off, there are some laser devices that are set up to be what’s called unattended laser therapy, where it’s basically like a light bulb or a tanning bed or something like that where the patient would just sit in a chair. They would turn the laser device on, point it at whatever tissues they want to affect, and then set it up as an unattended device.
I’m not a big fan of those for a number of reasons, one of them being is that from a laser safety standpoint, if by chance someone gets curious about that laser treatment and they turn and look at that laser device, there is a potential for causing problems with the eye and with vision. So safety is number one. The second is going to be a clinical-effectiveness standpoint in the sense that if the patient moves at all during the treatment, then that laser light is not being shined on the intended tissues.
So I like to describe therapeutic laser treatments, and that’s what we do with our devices, is it’s an active procedure. The laser therapist, the laser technician, with our devices, would choose an appropriate setting for whatever body part they’re treating, and then it is an active procedure, where they are actively shining the light on the tissues. So that’s a very good thing there.
But the other thing is that even though laser may sound like a very complicated procedure, it is really not difficult. We simply are turning the laser device on and then shining the light on the tissues that we want to treat.
Now, during a treatment for a migraine sufferer, most commonly, they would just be comfortably seated in a chair. We want the patient to be comfortable and relaxed during the treatment. And then when the laser device is turned on, the beauty of it is, is that treatments are — I’ve already emphasized the safety — they are also very comfortable. They induce a soothing and relaxing sensation. With some of the treatments, the patient may feel a mild warming sensation in the treatment area so that as the laser technician is shining the laser light on the tissues, it really induces a sense of relaxation.
We will typically start the laser treatment in the cervical spine, and the reason for that — there’s a few of them. One of them is going to be if there are tight and tense muscles in the cervical spine, that’s either going to be causing or contributing to the problem of the migraine. So by treating in the cervical spine and then during the laser treatment, the patient would just flex and extend their neck. They may rotate, turn their head from left to right. That is going to help loosen up the cervical musculature.
But, more importantly, treating in the cervical spine is going to help with blood flow to the brain, OK. There are two sets of arteries that send blood to the brain. You have the vertebral arteries that are in the back of your neck, and you have the carotid arteries in the front. So, by treating over the vertebral arteries in the cervical spine, and if we do a little bit of anterolateral approach on the neck, we’re also going directly over the carotid. We are helping to have that influence on normalizing blood supply to the brain.
I know that there are a lot of theories about the development and the genesis and the neuropathophysiology of migraine, but part of it is if we can influence normal blood flow to the brain, we can have a positive effect.
So the first part of the treatment is going to be over the cervical spine. The second part of the treatment would just be delivered over the area where the patient is experiencing their migraine symptoms. So, once again, it’s a soothing, relaxing treatment, and treatment times, it’s going to be fairly short. It is only going to be five, six, seven minutes. It’s not going to take a long time for the treatment.
Molly: It’s fascinating to hear how it works and what an actual treatment might look like. I know a lot of people aren’t super familiar with this, so I’m glad we’re able to get the information out.
Any side effects from treatment? Are people able to drive right after? Do you wait 15 minutes? Sometimes it’s after a massage, and you get all that blood going, and you want to wait about 10, 15 minutes or so. But we’re not talking about drugs here, so you’re not getting administered with anything. Are you able to function normally throughout the day? Anything that pops up for after someone receives treatment?
Dr. Harrington: That’s a very, very good question. And so one thing to help to — I emphasize it during the treatment — we’re helping to relax. And if someone is familiar with — it’s called our autonomic nervous system, the part of our nervous system that we do not have control over: our respiration rate, our heart rate, the various processes in our body that our autonomic nervous system is in control of.
You have two divisions there: sympathetic and parasympathetic. The sympathetic is the fight or flight. That is what’s activated when you’re under stress, when you’re driving in traffic, when you have stress from your job, when you’re watching TV news and hearing all of these horrible stories. That activates your sympathetics.
The very cool thing is that when we treat with the laser, we’re actually having an effect to balance those divisions of the autonomic nervous system out, and we are helping the parasympathetics to balance out. And the parasympathetic are the healing response. That’s what helps you to relax. That’s when your body heals. That’s what helps with blood flow throughout your body.
So I would highly encourage — if someone is going to get a therapeutic laser treatment for migraine headache, I would highly encourage you to get the treatment and then be able to put yourself into a relaxed environment. If you can have someone drive you, that would be fantastic. If the office where you get your laser treatment has an area where you can sit and relax, that would be great.
As far as direct side effects after the treatment, there really are none. And some of the things that can happen after a laser treatment, it is really not a side effect; it is actually a beneficial effect of the laser. And one of the most common things that can happen is post-treatment soreness. And post-treatment soreness is going to happen, or it can happen a small percentage of the time, after that first treatment. So if we are doing that treatment on the cervical spine, one thing that we are doing with that increase in blood flow in the tissues, we are also helping to cause the release of what are called kinins and various tissue irritants.
So someone possibly may feel a mild elevation of soreness or discomfort a couple of hours after the laser treatment, but, please, do not ever take that as a bad sign. One way to mitigate that, the most efficient and the easiest way to mitigate that, is going to be with your hydration status. Before you getting your laser treatment, make sure you drink a nice glass of clean water, filtered water, whatever your source of hydration, and then also afterwards.
Molly: Fascinating. And, yeah, I mean, that doesn’t seem too uncommon to have a little bit of soreness after multiple different kinds of treatments like a massage, like getting adjusted, or possibly acupuncture. It just kind of depends. So sometimes it’s nice to know that it’s working.
Dr. Harrington: Right. Right. Yeah, absolutely. Right. Right.
Molly: Yeah, yeah. So everyone is different in life, and all migraine patients are different in experience. Everyone’s experience is different. But I’m curious if you have a ballpark. When you’re using laser therapy, is there a treatment regimen? Is there a certain amount of times you need to go? Is it a one-and-done, you feel a little bit better? Or is it usually you set up a treatment plan?
Dr. Harrington: Right. So you can compare it to a physical-therapy modality. So if someone has gotten, let’s say, a therapeutic ultrasound or any other type of physical-therapy type of treatment or chiropractic treatment, it is not a one-and-done. If we try to do a one-and-done, it really is just — it’s honestly just a waste of time. It is something that we will need subsequent treatments for.
What I like to recommend at the very minimum is an initiation of three times a week for two weeks, and after that time period — and that’s the very minimum. What I would ideally like to see is three times a week for four weeks. That way we have gone through a full month of time, and if the migraine sufferer has a way that they monitor their symptoms — I think that some migraine sufferers will keep a headache journal or monitoring of their pain levels or however they self-monitor their symptoms of the migraine. What we typically will see is reduction in the symptoms over time.
And so what the migraine sufferer will experience during the laser treatment — and this is based on my own experience and then also the feedback that I get from our clinicians — is that first off, if the patient is having an active attack during the time of the laser treatment, it helps to lessen the severity of it and it also helps to shorten the duration. So we go through the three times a week for four weeks, and we should notice both of those. We should notice reduction in severity and reduction in the frequency of the migraine headaches.
And then beyond that initial treatment period of three times a week for four weeks, we can handle it two different ways. I know that some clinicians and some patients will like to come in once a week or every other week for a treatment just to help with normalizing and maintaining the blood flow and the function of the neural tissues. Other people will like to wait until they start to experience migraine.
But in my opinion and my experience, getting a laser treatment — if you want call it prophylactic or preventative — in my opinion, and this is just my opinion, that is going to be better than relying on prescription medication or having to deal with the migraine episode. And, of course, any medication that we take is going to have certain side effects associated with it. And then, why wait until you have an episode if you have a treatment than can help to serve as a preventative.
Molly: And it’s good to know that there can be positive effects if you are experiencing a migraine attack at the time of your treatment. Sometimes, depending on the type of therapy, you want to avoid getting any kind of treatment when you’re in the midst of an attack. So, good to know that.
So it sounds like it could be a commitment to start, but you’ve got to invest in yourself. So I know we get a lot of questions, and, again, everybody’s provider, everybody’s insurance is different. But can you give us an estimate on cost of laser therapy treatment, and are you typically seeing insurance cover it?
Dr. Harrington: Right. So, for the most part, there will be cases where insurance will cover. I kind of hesitate to go too far down there because it’s going to be — the individual state, the individual insurance carrier, or the individual office that the patient would go to, so I hesitate to give a blanket answer there. There are some insurances that are covering laser therapy treatments. There are, if a patient does have an HSA set up, the health savings account, those funds can be for laser therapy treatments.
In general, depending on the location where the clinic is and where the patient would seek treatment, typical treatments are going to be in the 50-to-100-dollars-per-treatment range. It’s going to be in that ballpark. Don’t come after me if your treatments are costing more than that, but please look at the big picture here because we’re talking about a treatment that is completely noninvasive and safe. And to me, that alone, finding a treatment that is noninvasive and safe, that carries a certain dollar value in itself.
If possible, hopefully, you would be able to find a practitioner who has some experience in treating migraine sufferers already and has somewhat of a clinical track record that they can share with you for the migraine sufferer.
Molly: Well, and it’s interesting to know. Good to hear that some insurances are providing coverage for this. And like we talked about in the beginning, we’re seeing more and more evidence of this. We’re learning more about the potential. So I think down the road, we could probably start to see more insurance covering it. And also just getting a ballpark on what it might cost. Because it is so new, I think a lot of us were like, “Is it $1,000 a treatment? Is it 50?” So it’s good to be able to pinpoint it a little bit. And, again, every provider will be different.
So let me ask you this as we kind of wrap up here. If someone’s interested in using laser therapy for their migraine treatment, putting it in their toolbox, what’s a good way to find a provider? And what should you look for in a provider?
Dr. Harrington: Right. So on our company website, which is summuslaser.com — S-U-M-M-U-S, S-U-M-M-U-S — so summuslaser.com. And on our website, at the top, we do have a find-a-provider link where people could put in their city and state location or their zip code and they can find Summus providers in the area.
And then, as I said earlier, if they can find a provider that has a track record of treating migraine patients, great. And let me just point out, in our Summus laser devices, we have the protocols built into the machine. So our team of scientists and researchers, and I talked about the depth-of-penetration studies earlier and relevant laser therapy research — we have put all of that information into the laser. And then the end user in the clinic simply will go to the body part that they’re treating, the indication that they’re treating, to pull up the proper protocol for that patient.
So, in our devices, we do have various settings for the head and we do have a specific setting for migraine headache in the device. And then if you do find a provider who does not have experience in treating migraine sufferers, then that’s where I come in. As clinical advisor, I can interact with that doctor and give them advice on here’s the way we should approach therapeutic laser treatments.
Molly: Wonderful. Well, as we kind of wrap up here, is there anything else that you feel like you want to touch on?
Dr. Harrington: Well, I think we did cover the topic of migraine very well, and I know that this is a migraine podcast, but I also have to say that these Summus medical laser treatments are used on conditions literally from head to toe. And the way that we describe this is anywhere that there is pain or inflammation or damaged tissues in the body. And so that could be something such as the migraine headache, but it can also be — and I’m just going to do a quick rundown here — Bell’s palsy, trigeminal neuralgia, cervical pain from a motor vehicle accident, rotator cuff injury, low-back pain, plantar fasciitis. So literally conditions from head to toe can benefit from therapeutic laser treatments.
Molly: Well, and it’s good to know that there are a lot of practical uses for this because usually migraine patients deal with chronic pain in other areas or have — we have a lot of comorbidities. Not everyone, but there’s a lot going on, especially with the migraine brain. So it’s good to know, and it’s really cool that people have one more thing in the toolbox, especially as it’s growing and we’re getting more evidence and more people are becoming interested in it.
What an excellent discussion. I know I learned a ton about laser therapy treatment for migraine and other conditions. So we really appreciate our guest today, Dr. Phil Harrington, for joining us. I learned a ton, and thank you for explaining how this all works. We were so glad to have you here today.
Dr. Harrington: I just really enjoyed this, Molly, and I appreciate the opportunity to share information about class 4 laser therapy because it really is a treatment that has helped tens of thousands of patients. And one phrase that I like to use is “The doctor of the future will use class 4 laser therapy.” And my vision for healthcare is that class 4 laser therapy will be an integral modality in all fields of healthcare.
Molly: That’s incredible, and we really appreciate your time, Dr. Harrington, and thank you to all of our followers out there for watching or listening to this episode of Spotlight on Migraine. I’m Molly O’Brien, with the Association of Migraine Disorders. We’ll see you next time.
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