Summary of benefits
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Biofeedback and pharmacotherapy had best outcome compared to the ones who received Biofeedback or conventional therapy
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combining biofeedback with medication can enhance outcomes
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significant effects were observed for muscle tension, self-efficacy, symptoms of anxiety, depression, and analgesic medication
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improvement in headaches, wellbeing and reduction anxiety
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it reduces anxiety, improves the quality of life and the behavioral responses to stress
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the thermal biofeedback group had almost complete elimination of migraine attacks by the end of training, and maintained that performance as long as six months after training
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Biofeedback reduced the duration of headaches by 1.9 days, and the frequency of days when headache intensity was ≥50 by 2.4 times
“Efficacy of biofeedback in treatment of migraine”
Patients who received combination of biofeedback and pharmacotherapy had best outcome (74.28%) compared to the ones who received biofeedback (43.3%) or conventional therapy (57.4%) alone.
https://www.researchgate.net/publication/368513659_
February 2023 International Journal of Research in Medical Sciences, Authors: David Rosario Ashwith B. Anitha Sequeira
“Biofeedback treatment for headache disorders: a comprehensive efficacy review”
The aim of the present review was to critically evaluate the documented evidence regarding the efficacy of biofeedback for the two most prevalent headache conditions–migraine and tension-type headache. Drawing upon two recently published meta-analyses, data from 150 outcome studies, including randomized controlled trials as well as uncontrolled quasi-experimental designs, were screened. Of these, 94 studies were selected for inclusion according to predefined criteria. Meta-analytic integrations were carried out separately for the two conditions of interest. The main results were medium-to-large mean effect sizes for biofeedback in adult migraine and tension-type headache patients. Treatment effects remained stable over an average follow-up period of 14 months, both in completer and intention-to-treat analyses. Headache frequency was the primary outcome variable and showed the largest improvements. Further significant effects were shown for perceived self-efficacy, symptoms of anxiety and depression, and medication consumption. Reduced muscle tension in pain related areas was observed in electromyographic feedback for tension-type headache. Biofeedback was more effective than waiting list and headache monitoring conditions in all cases, while electromyographic feedback for tension-type headache showed additional significant effects over placebo and relaxation therapies. Levels of efficacy (migraine: efficacious, level 4; tension-type headache: efficacious and specific, level 5) and recommendations for future research are provided.
https://pubmed.ncbi.nlm.nih.gov/18726688/ Meta-Analysis Appl Psychophysiol Biofeedback 2008 Sep;33(3): Epub 2008 Aug 26. Yvonne Nestoriuc 1, Alexandra Martin, Winfried Rief, Frank Andrasik
“Biofeedback and relaxation therapy for patients with migraine and tension headaches”
The biofeedback literature shows that biofeedback training is most effective when combined with relaxation and visualization techniques. This approach was used to run a pilot study for training 40 people with migraine and tension headache. Our results indicate an improvement in both headache symptomology, general well-being and a reduction in anxiety. In addition, our observations from working with these patients suggests that the training program could be improved by adding physical measures such as the re-education of breathing patterns and posture. We also found that insight, awareness of factors causing stress and an ability to change lifestyle were an essential ingredient to reduction of headache intensity of frequency
https://pubmed.ncbi.nlm.nih.gov/6395157 Psychiatr Neurol Med Psychol (Leipz) . 1984 Nov;36(11):649-54. [Article in German] A Woolley-Hart
“Biofeedback in headache: an overview of approaches and evidence”
The use of general biofeedback-assisted relaxation techniques for headache has been evaluated extensively by expert panels and meta-analyses. Taken together, these reviews indicate that (1) various forms of biofeedback are effective for migraine and tension-type headache; (2) outcomes with biofeedback rival outcomes with medication therapy; (3) combining biofeedback with medication can enhance outcomes.
https://pubmed.ncbi.nlm.nih.gov/20622082/ Review Cleve Clin J Med. 2010 Jul;77 Suppl 3:S72-6 Frank Andrasik
“Appraisal of treatment of the trigger points associated with relaxation to treat chronic headache in the adult. Relationship with anxiety and stress adaptation strategies”
Treatment by relaxation allows for a perceived increase in control of symptoms by the sufferer. Consequently, it reduces anxiety, improves the quality of life and the behavioural responses to stress. In turn, the treatment improves the long-term prognosis for the headaches as well as the health of the sufferer in general. The treatment described here addresses 3 types of people: 1. Sufferers with difficult headaches which do not respond well to medical treatment. 2. People for whom anxiety and coping strategies are very much modified
https://pubmed.ncbi.nlm.nih.gov/14615687/ 2003 Sep-Oct;29(5):377-90. [Article in French] C Goffaux-Dogniez 1, R Vanfraechem-Raway, P Verbanck Encephale. 2004 Jan- Feb;30(1):94
“BVP-biofeedback in the treatment of migraine. The effects of constriction and dilatation during different phases of the migraine attack”
Biofeedback training for self-regulation of blood-volume pulse (“BVP”) amplitude of the temporal arteries has been used previously with good results in treatment of migraine headaches. In the present study, 23 subjects were randomly assigned to one of three groups and given (a) biofeedback training in temporal artery constriction and instructions to apply these skills during headaches; (b) the same training and instructions to apply the skills between headaches, during stress periods, and (c) biofeedback training to dilate the temporal arteries, and instructions to use these skills during stress periods. Clinically meaningful headache reductions were achieved and maintained at follow-up. Furthermore, results indicated that voluntary temporal artery dilatation also leads to headache reductions, and that there is a connection between levels of achieved self-regulation skill and the clinical effects
https://pubmed.ncbi.nlm.nih.gov/2331243/ Clinical trial Behav Modif. 1990 Apr;14(2):200-21. J Lisspers 1, L G Ost
“Modification of combined migraine-muscle contraction headaches using BVP and EMG feedback”
The effect of blood volume pulse (BVP) and frontalis muscle action potential (EMG) feedback on control of vasoconstriction of the temporal artery and frontalis muscle activity in combined migraine-muscle tension subjects was investigated in a multiple baseline design (across subjects and responses). The data indicated: (a) both subjects obtained an ability to control BVP during BVP feedback and EMG during EMG feedback; (b) there were decreases in frequency of migraine headaches during BVP feedback and decreases in muscle contraction headaches during EMG feedback. The results of this study supported the theoretical explanation of two pain mechanisms involved in combined muscle contraction-migraine headaches as well as the effectiveness of bio-feedback procedures that target directly the specific pain mechanism in the elimination of the two types of head pain.
https://pubmed.ncbi.nlm.nih.gov/670111/ J Appl Behav Anal . 1978 Summer;11(2):215-23.1978.11-215. E T Sturgis, C D Tollison, H E Adams
“Biofeedback and relaxation in the treatment of migraine headaches: comparative effectiveness and physiological correlates”
While improvements in headaches were observed in all groups, the best improvements took place in the thermal biofeedback group, which had almost complete elimination of migraine attacks by the end of training, and maintained that performance as long as six months after training. Examination of the patterns of skin temperature and EMG changes in the three groups over the course of training also points to a relationship between skin temperature control and reduction in migraine headache symptomatology, and suggests that this relationship is worthy of further investigation.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1027443/ J M Lacroix, M A Clarke, J C Bock, N Doxey, A Wood, S Lavis
“Temperature biofeedback in the treatment of migraine headaches: a controlled evaluation”
After an initial four-week baseline phase, during which daily records of headache frequency and intensity and daily medication records were kept, 30 patients with frequent (at least one per month) migraine headaches were randomly assigned to three conditions: (1) temperature biofeedback, autogenic training, and regular home practice; (2) progressive relaxation with regular home practice; and (3) a waiting-list control condition. Comparisons of headache data from the four weeks of baseline and last two weeks of treatment showed that both the relaxation and biofeedback groups improved significantly on total headache activity, duration of headaches, and peak headache intensity and reduced consumption of analgesic medication, while the waiting list control group did not. All three groups showed significant decreases in headache frequency.
https://pubmed.ncbi.nlm.nih.gov/365125/ Clinical trial Arch Gen Psychiatry 1978 May;35(5):581-8. E B Blanchard, D E Theobald, D A Williamson, B V Silver, D A Brown
“Biofeedback in the prophylactic treatment of medication overuse headache: a pilot randomized controlled trial”
Our results indicate that at the end of treatment the number of patients that returned episodic in the Biofeedback group was significantly higher than in the Control group. Patients in the Biofeedback group differed from the Control group in headache frequency, amount of drug intake and active coping with pain. These outcomes were confirmed also after 4 months of follow-up.
Biofeedback added to traditional pharmacological therapy in the treatment of medication overuse headache is a promising approach for reducing headache frequency and analgesic intake.
https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-016-0679-9 Research article. Published: 22 September 2016 TheJournal of Headache and Pain volume 17, Article number: 87 (2016)
Real-Time Assessment of the Effect of Biofeedback Therapy with Migraine: A Pilot Study
Biofeedback reduced the duration of headaches by 1.9 days, and the frequency of days when headache intensity was ≥50 by 2.4 times. In addition, headache-related disability, psychological stress, depression, anxiety, and irritation were significantly improved. Biofeedback could improve the symptoms of migraine, including psychological stress and headache-related disability.
https://pubmed.ncbi.nlm.nih.gov/25670026/
Int J Behav Med. 2015 Dec;22(6):748-54. Miyuki Odawara 1, Masahiro Hashizume 2, Kazuhiro Yoshiuchi 3, Koji Tsuboi 2
Meta-analysis of biofeedback for tension-type headache: efficacy, specificity, and treatment moderators
Biofeedback was more effective than headache monitoring, placebo, and relaxation therapies. The strongest improvements resulted for frequency of headache episodes. Further significant effects were observed for muscle tension, self-efficacy, symptoms of anxiety, depression, and analgesic medication. Moderator analyses revealed biofeedback in combination with relaxation to be the most effective treatment modality; effects were particularly large in children and adolescents. In intention-to-treat and publication-bias analyses, the consistency of these findings was demonstrated. It is concluded that biofeedback constitutes an evidence-based treatment option for tension-type headache.
https://pubmed.ncbi.nlm.nih.gov/18540732/
J Consult Clin Psychol. 2008 Jun;76(3):379-96. Yvonne Nestoriuc 1, Winfried Rief, Alexandra Martin