Wednesday, February 27, 2013

Low Level Laser in the Treatment of Migraine and Traumatic Brain Injury in the Adult population

Pratibha Bansal M.D.,   Romanth Waghmarae M.D. DABA, FIPP. , Louis Banas B.S. , M.S. CLT ; Buffalo, New York,  June 2012

Note: Dr’s Bansal and Waghmarae are Board Certified Pain Management Physicians who have practicing Pain Management in Buffalo, New York for over 20 years.   Louis Banas is a laser specialist who has treated over 2500 hundred patients for chronic pain issues. He has treated over 60 adults for headaches of various types with significant success in most cases.   


Migraine headache due to trauma or otherwise is a major health concern worldwide with massive financial and social impact. Conventional treatments primarily focus on the prevention of further damage to the brain parenchyma, while failing to address the already existent symptoms. Previous clinical studies have shown that Low Level Laser Therapy (LLLT) can significantly reduce pain and induce temporary vasodilation in capillaries.  The authors demonstrate how LLLT can be used to improve the quality of life in patients by treating their current symptoms,. This case report illustrates the use of LLLT in the treatment of several patients with a severe headache and the clinical success achieved in the reduction of pain, as measured by VAS - achievable within 2-8 treatments.

Objective Information and Background.

The following case studies were followed at a Pain Management Clinic in Buffalo New York.  Pain Rehab is staffed with two board certified Pain Management Specialists who will see 300 to 400 patients weekly. Most patients were being seen do to traumatic injuries suffered at work, home or auto accident and in most cases had little or no relief with physical therapy, chiropractic, massage or surgery. Pain Rehab is very progressive in utilizing new and proven technology and reluctantly prescribes opiates and NSAIDS . All patients suffered from moderate to severe, debilitating pain on a daily basis. After a very positive evaluation of laser therapy on patients, a physical therapy clinic was added to the practice, therefore enabling this new modality to be readily available to their patients. Several patients suffering from chronic, debilitating headaches due to trauma or congenital defects were treated during a four month period. (It is important to note that headaches were just part of the overall pain complaints except for two patients noted in cases 4 and 7.) Over twenty patients were treated and only two patients out of twenty did not respond well. The treatments were performed by a laser specialist with four years of laser experience.  Listed below are a few of the significant, more interesting cases.

Case # 1.  A 28 y.o. female suffered severe whiplash in an auto injury and complained of daily, severe headaches with a vas value of 7-8 accompanied by blurred vision for a 12 month period. Laser was applied to bilateral temples and mastoid   for 2 minutes, delivering 15 joules to five sites, which included bilateral temple and mastoid sites and right cervical spine.  Patient was not able tolerate minimal cervical spine treatment. , including 6 joules per site for a 3 minute duration.  Note: Patient is African American and due to nerve damage or skin pigmentation could not tolerate prescribed dosage.   Treatment was given 3 times per week for two weeks at a reduced dosage for a total of six treatments.  Pain levels were substantially reduced and patient now only suffers 2-3 episodes per week with a vas value of 2-3.

Case #2 .  38 y.o. female, auto injury.  Previous physical therapy was unsuccessful. Patient complained of daily headaches 7-8 on the vas scale for two years.  Treatment included bilateral c-spine and right trapezium for 3 minutes time delivering 42.5 joules to each site, for a period of two weeks and levels increase to 72 joules for second week as patient healed and was more able to tolerate the procedure.  Patient received 12 treatments over a three week period and now experiences mild to moderate headaches once or twice per month.

Case 3#.  58 y.o. male was injured on the job and suffered a severe neck and left clavicle injury. Headaches were daily which were debilitating and patient reported a 7-8 level on the vas scale. Treatments of 8 sessions included 76.5 joules applied to left cervical spine and clavicle. 15 joules were applied to left cervical 1 area, after 10 treatments the headaches were entirely eliminated.

Case # 4. A 23 y.o. Female suffered from headaches 3-4 times per week since six years of age.  Patient has a high stress job as customer service representative. One treatment was applied at both temples delivering 15 joules in a two minute session. Patient was headache free for one week. 

Case#5.  A  57 y.o. female, auto injury 17 years ago and had damage to both frontal lobes. 28 Joules was applied to her forehead at two sites. Due to transportation difficulties her treatments are sporadic but after two treatments she now wakes up with minimal or no pain on most mornings.

Case #6.  A 52 y.o. male fell at work and hit back of head. Headaches occur on daily basis since accident 4 months ago.  Two treatments were performed two days apart delivering 25 joules to injured area. Patient states that headaches are significantly reduced and sleep patterns are substantially improved.

Case # 7. A 31 y.o. female former military P.A. presented herself with migraine headaches with a vas value of 7-8 on a daily basis. She has suffered with them since the age of 8.  The patient had seen several specialists including neurologists who were unable to help. The patient had military training as a physician’s assistant and realized she needed detoxing from drug overload which had been prescribed for the problem.   A single laser treatment was administered which included  48 joules at 2 sites on the forehead and 28 joules to four sites which included bilateral temple and mastoid areas.  The patient had significant relief for a 7 day period at which point she felt the change in medications was to blame. She returned for a single visit one day after the relapse and the  procedure was repeated.  The patient reported to be pain free within minutes after the procedure.  She feels she is completely healed.

Technical data:

The system utilized is the Theralase super pulsed Low Level Laser medical system. It  The system is equipped with a multiple probe hand piece (5 x 905 nm wavelength @0-100 mw average power per laser diode and 4 x 660 nm wavelength @25 mw . power per laser diode. (This allows for deep penetration of tissue when necessary with minimal heat transference to the tissue).

Healing pathways- Discussion

The majority of patients seen in this clinic have multiple injuries and headaches are a by-product of some type of trauma. Therefore, it may be safe to assume that vascular insufficiency is the main cause. A recently published a peer review paper concludes that the equipment used utilizes a 905 nm. Wavelength increasing Nitric acid up to 700 percent which expands capillary delivery of oxygenated blood. Currently Dr. Michael Whalen, working at Massachusetts General Hospital, is conducting controlled studies using a low level laser with the hopes of bringing this new technology into the forefront of neuroscience and medicine. These case studies give examples of how LLLT can be used to treat chronic migraines, specifically those that are a result of traumatic brain injuries. LLLT has been shown to reduce pain and inflammation, create a state of vasodilation by activating the nitric oxide pathway and further even promote angiogenesis.

ATP production.  Cold laser has the unique ability to generate the production of ATP Adenosine Tri-phosphate through a process called biostimualtion. Vacuoles (cytochromes and chromaphores) in the mitochondria of the cell absorb specific light wavelengths causing a cascade effect which rejuvenates damaged cells lacking this essential fuel molecule. Although this may be the main pathway for treating the traumatic injures, it is arguable that the nitric oxide production is the primary source of pain reduction.

Summary. LLLT is now becoming a valuable but slowly recognized modality for acute and chronic pain as well as wound care in the United States. It has been used extensively in Canada for over 12 years.

1.            Faul M, X.L., Wald MM, Coronado VG, Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths. 2010.
2.            Finkelstein E, C.P., Miller T and associates, The Incidence and Economic Burden of Injuries in the United States. Oxford University Press, 2006.
3.            Sahni, T., et al., Use of hyperbaric oxygen in traumatic brain injury: retrospective analysis of data of 20 patients treated at a tertiary care centre. Br J Neurosurg, 2012. 26(2): p. 202-7.
4.            Naeser, M.A. and M.R. Hamblin, Potential for transcranial laser or LED therapy to treat stroke, traumatic brain injury, and neurodegenerative disease. Photomed Laser Surg, 2011. 29(7): p. 443-6.
5.            Moriyama, Y., et al., In vivo effects of low level laser therapy on inducible nitric oxide synthase. Lasers Surg Med, 2009. 41(3): p. 227-31.
6.            Wu, Q., et al., Low-level laser therapy for closed-head traumatic brain injury in mice: effect of different wavelengths. Lasers Surg Med, 2012. 44(3): p. 218-26.

7.             Stephan, W. et al . Efficacy of super –pulsed 905 nm Low Level Laser Therapy in the Management of
Traumatic Brain Injury (TBI) World Journal of Neuroscience November 2012

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