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.
Nestoriuc
Yvonne
Y
Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02120, USA. ynestoriuc@partners.org
Martin
Alexandra
A
Rief
Winfried
W
Andrasik
Frank
F
D001676:Biofeedback, Psychology; D004576:Electromyography; D019317:Evidence-Based Medicine; D006801:Humans; D008881:Migraine Disorders / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D018781:Tension-Type Headache / Q000628:therapy*; D016896:Treatment Outcome