Efficacy of Biofeedback for Migraine: A Meta-Analysis
Yvonne Nestoriuc and Alexandra Martin
Philipps-University of Marburg, Section for Clinical Psychology and Psychotherapy, Gutenbergstr. 18, 35032 Marburg, Germany
Received 16 June 2006; revised 10 August 2006; accepted 5 September 2006. Available online 2 November 2006.
Published in: Pain, November 2006.
Abstract
In this article, we meta-analytically examined the efficacy of biofeedback (BFB) in treating migraine. A computerized literature search of the databases Medline, PsycInfo, Psyndex and the Cochrane library, enhanced by a hand search, identified 86 outcome studies. A total of 55 studies, including randomized controlled trials as well as pre–post trials, met our inclusion criteria and were integrated. A medium effect size ( , 95% CI = 0.52, 0.64) resulted for all BFB interventions and proved stable over an average follow-up phase of 17 months. Also, BFB was more effective than control conditions. Frequency of migraine attacks and perceived self-efficacy demonstrated the strongest improvements. Blood-volume-pulse feedback yielded higher effect sizes than peripheral skin temperature feedback and electromyography feedback. Moderator analyses revealed BFB in combination with home training to be more effective than therapies without home training. The influence of the meta-analytical methods on the effect sizes was systematically explored and the results proved to be robust across different methods of effect size calculation. Furthermore, there was no substantial relation between the validity of the integrated studies and the direct treatment effects. Finally, an intention-to-treat analysis showed that the treatment effects remained stable, even when drop-outs were considered as nonresponders.
Keywords: Migraine; Biofeedback; Behavioral therapy; Meta-analysis
Biofeedback Treatment for Headache Disorders:
A Comprehensive Efficacy Review
Yvonne Nestoric, Alexandra Martin, Winfried Rief, Frank Andrasik
Abstract: 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, 102 studies depicting data from over 3500 headache patients were selected for inclusion according to predefined criteria. The average chronicity of migraine and tension-type headache was over 14 years. Meta-analytic integrations were carried out separately for the two headache conditions of interest. The main results were robust medium-to-large mean effect sizes for biofeedback in adult migraine and tension-type headache patients, both adults and geriatric. 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 (EMG) feedback for tension-type headache. Biofeedback was more effective than waiting list and headache monitoring conditions in all cases, while EMG feedback for tension-type headache showed additional significant effects over placebo and relaxation therapies.
Although effective for both types of headache, biofeedback treatment was somewhat more effective for tension-type headache than for migraine. This is likely because the most common form of biofeedback applied to tension-type headaches (i.e., electromyographic (EMG) biofeedback) was more directly related to the known cause of the headache-- muscle tension. The most commonly used forms of biofeedback to treat migraine headaches was skin temperature (TEMP) and electrodermal response (EDR) and these are related more to a reduction of sympathetic arousal of the autonomic nervous system.
Levels of efficacy (migraine: efficacious, level 4; tension-type headache: efficacious and specific, level 5) and recommendations for future research are provided.
Published in: Applied Psychophysiology & Biofeedback (2008), vol. 33, No. 3, pp.125-140.
Biofeedback Treatments for Headache
Overview Efficacy: Numerous controlled, clinical, comparative, and long term follow-up studies have proven beyond any doubt that biofeedback can reduce and cure tension and migraine headaches among adults and children. Several medical groups strongly recommend using biofeedback before or instead of medications. This therapy is rated as efficacious and specific (level 4 on a scale of 1 to 5 with 5 being the best).
Why biofeedback would help this problem: Tension headaches are usually caused by muscles in the neck, shoulders, jaws and other facial structures being kept too tense for too long. These muscles may become too tense because some people can not recognize the actual level of tension in painful muscles, because of postural problems while working, over-reactions by the muscles to stress, poor habits, etc. Psychophysiological assessments can identify which muscles are not functioning correctly and what circumstances lead to the incorrect patterns of tension. Biofeedback of muscle tension is used to train people to recognize actual levels of tension and to correct these levels in conjunction with relaxation training. Temperature biofeedback for migraine headaches work through a similar chain of logic.
Brief summary of evidence supporting the efficacy of biofeedback for headache: There are simply too many studies to note even a fraction of them. Yucha and Gilbert (2004) and Sherman (2004) reviewed the studies supporting efficacy of this therapy and found a plethora of fine work ranging from double blind controlled studies to clinical studies.
Comparative studies show that biofeedback is as good or better than any medication. Long term follow-up studies show that the treatments last for most people as long as they continue to practice the techniques learned during therapy. People who had biofeedback therapy were more likely to continue to use it than people taking any particular medication were likely to continue taking that medication. Pain from jaw problems is treated effectively if the pain is due to problems in the muscles but not if the problem is in the jaw joint itself.
Studies do not support the efficacy of biofeedback for all kinds of headaches. The evidence supporting its use with migraines brought on by trauma, cluster headaches, and menstrual headaches is much weaker. There is no evidence supporting its effectiveness for trigeminal neuralgia, jaw joint problems, etc.
