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Headaches / Migraines

Use of Biofeedback for Headaches & Migraines

Headache - Paediatric Migraine
Level 3 Efficacy (Probably Efficacious)

The research support for using biofeedback as an intervention for childhood migraine is more plentiful than for adults. Research support for child and adult migraines in general is stronger than that for mixed and tension-type headache.

A recent review article (Hermann & Blanchard, 2002) summarized headache/biofeedback research in children to date and concluded, "With few exceptions, thermal biofeedback has been proven to be highly successful in alleviating headache activity in children. In fact, in most studies more than two thirds of the children could be classified as treatment successes based on the widely accepted criterion of a 50% symptom reduction." (p. 145). Given that this efficacy rate far exceeds a placebo response, studies using a credible placebo condition for comparison so far have not been done.

A minority of studies used EMG biofeedback from the frontal area instead of or in addition to hand-warming thermal biofeedback. Most protocols use 10 sessions or fewer and included home practice; some involved the parents also. For example, five children with tension-type headaches participated in a multiple-baseline, time-lagged, within subject design using thermal biofeedback (Arndorfer & Allen, 2001). All learned the hand warming technique and showed significant clinical improvement, and six months afterward, 80% were headache- free. Labbe (1995) compared thermal biofeedback-assisted autogenic training to autogenic training only, with a wait-list control group, in 30 migrainous children. Eighty percent of the first group had significant improvement; 50% of the second group, and none in the third group.

Headache - Adult
Level 4 Efficacy (Efficacious)

Adult headaches, tension, migraines, or mixed has been the focus of much research. Arena, Bruno, Hannah, & Meader (1995) compared biofeedback training from the forehead and trapezius muscles, with a non-feedback progressive muscle relaxation control group, in 26 tension-headache patients. Clinical improvement was strongest for the trapezius muscle training group. Silberstein (2000) published a review of migraine treatment concluded thermal and muscle biofeedback, in a general context of relaxation training, was generally effective and recommended as a treatment option on behalf of the American Academy of Neurology U.S. Consortium. McGrady, Wauquier, McNeil, & Gerard (1994) and also Vasudeva, Claggett, Tietjen, & McGrady (2003) found superior clinical results for biofeedback assisted relaxation compared to self-directed relaxation. This conclusion was supported by measurement of cerebral flood flow using trans-cranial Doppler monitoring. Rokicki et al (1997) found a significant drop in headaches following six-sessions EMG biofeedback protocol, compared with a control group that showed no improvement. Improvement correlated most with greater sense of self-efficacy rather than with EMG levels. A meta-analysis of research by McCrory, Penszien, & Rains (1996) determined EMG biofeedback was 'modestly effective' for tension-type headaches compared to wait-list controls, but was not significantly different in effect size from cognitive therapy, relaxation training, or hypnosis. Isolating biofeedback as the active element from factors such as general relaxation, emotional improvement, and enhanced self-efficacy has not been challenging so far, but it may facilitate a synergistic effect.

Technical Papers & Abstracts

Andrasik, F. (May 2007). What does the evidence show? Efficacy of behavioural treatments for recurrent headaches in adults. Neurological Sciences: Official Journal Of The Italian Neurological Society And Of The Italian Society Of Clinical Neurophysiology, 28(2), S70-S77. Retrieved from Medline Database.

Arndorfer, R. E., & Allen, K. D. (2001) . Extending the efficacy of a thermal biofeedback treatment package to the management of tension-type headaches in children. Headache, 41(2), 183-92.

Baumann, R. J. (2002). Behavioral treatment of migraine in children and adolescents. Paediatric Drugs, 4 (9), 555-561. Retrieved from Medline Database.

Blanchard, E. B. & Arena, J. G. (1999). Biofeedback, relaxation training, and other psychological treatments for chronic benign headache. In M. L. Diamond & G. D. Solomon (Eds.), Diamond's and Dalessio's The Practicing Physician's Approach to Headache (6th ed.) (p. 209-224). Philadelphia: W. B. Saunders. (IV)

Blanchard, E. B. & Diamond, S. (1996). Psychological treatment of benig headache disorders. Professional Psychology: Reasearch and Practice, 27, 541-547.

Ciancarelli, I., Tozzi-Ciancarelli, M. G., Spacca, G., Di Massimo, C., & Carolei, A.(Oct. 2007). Relationship between biofeedback and oxidative stress inpatients with chronic migraine. Cephalalgia: An International Journal Of Headache, 27 (10), 1136-1141. Retrieved from Medline Database.

Grazzi, L., Andrasik. F., D'Amico, D., Leone. M., Moschiano, F., & Bussone, G. (Oct. 2001) . Electromyographic biofeedback-assisted relaxation training in juvenile episodic tension-type headache: clinical outcome at three-year follow-up. Cephalalgia: An International Journal Of Headache, 21(8), 798-803. Retrieved from Medline Database.

Holroyd, K. A. & Lipchik, g. L. (1999). Psychological management of recurrent headache disorders: Progress and prospects. In R.J. Gatchel & D.C. Turk (Eds.), Psychosocial Factors in Pain (pp. 193-212). New York: Guilford Press. (IV) (VII)

Holroyd, K. A. & Penzien, D.B. (1990). Pharmachological versus non-pharmacological prophylaxis of recurrent migraine headache: A meta-analytic review of clinical trials. Pain, 42, 1-13. (VII). Retrieved from Medline Database.

Kinart, C. M., Cuppett, M. M., &Berg, K. (Jul. 2002). Prevalence of migraines in NCAA division I male and female basketball players. National Collegiate Athletic Association. Headache, 42 (7), 620-269. Retrieved from Medline Database.

Labbe, E. E. (1995). Treatment of childhood migraine with autogenic training and skin temperature biofeedback: A component analysis. Headache, 35(1), 10-13. Retrieved from Medline Database.

McCrory, D. C., Penszien, D. B., & Rains, J. C. (1996). Efficacy of behavioral treatments for migraine and tension-type headache: Meta-analysis of controlled trials [Abstract]. Headache, 36, 272.

McGrady, A., Wauquier, A., McNeil, A., & Gerard, C. (1994). Effect of biofeedback-assisted relaxation on migraine headache and changes in cerebral blood flow velocity in the middle cerebral artery. Headache, 34(7), 424-428.

Rokicki, L. A., Holroyd, K. A., France, C. R., et al. (1997). Change mechanisms associated with combined relaxation/EMG biofeedback training for chronic tension headache. Journal of Applied Psychophysiology and Biofeedback, 22, 21-41. Retrieved from SpringerLink Database.

Rokicki, L. A., Holroyd, K. A., France, C. R., Lipchik, G. L., France, J. L., & Kvaal, S. A. (1997). Change mechanisms associated with combined relaxation/EMG biofeedback training for chronic tension headache. Applied Psychophysiology & Biofeedback, 22(1), 21-41.

Schwartz, M. S. (1995) . Headache: Selected issues and considerations in evaluation and treatment. Part A: Evaluation. In Schwartz and Associates (2nd ed.), pp. 248-287, 313-353, 354-407.

Silberstein, S. D. (2000). Practice parameter: Evidence-based guidelines for migraine headache (an evidence-based review): Report of the quality standards subcommittee of the American Academy of Neurology. Neurology, 55, 754-762.

Vasudeva, S, Claggett, A. L., Tietjen, G. E., & McGrady, A. V. (2003). Biofeedback-assisted relaxation in migraine headache: relationship to cerebral blood flow velocity in the middle cerebral artery. Headache, 43(3), 245-50.

Vasudeva, S., Claggett, A. L., Tietjen, G. E., & McGrady, A, V. (Mar. 2003). Biofeedback-assisted relaxation in migraine headache: relationship to cerebral blood flow velocity in the middle cerebral artery. Headache, 43 (3), 245-250. Retrieved from Medline Database.

Research Findings
Though there are still many causes and unanswered questions about the causes and mechanisms, evaluation and assessment and the treatment of special populations, extensive research and clinical literature exists with good support for relaxation, biofeedback, and other applied psychophysiological therapies for the treatment of tension-type and migraine headaches.

Biofeedback: A Practitioner's Guide by Schwartz & Andrasik, 2003.