title: A virtual reality system combined with biofeedback for treating pediatric chronic headache--a pilot study.
abstract: OBJECTIVE
  Pediatric headache is highly widespread and is associated with distress and reduced quality of life. Pharmacological treatment of chronic headache in children has been only partially effective and, as in medication-overuse headache, can sometimes be counterproductive. Therefore, there is a substantial need to develop other effective methods of treatment. Here we present the rationale, feasibility, and preliminary results of a pilot study applying a novel system, combining virtual reality and biofeedback, aimed as an abortive treatment of pediatric chronic headache.
  
  
  METHODS
  A prospective single-arm open-label, pilot study. Ten children attending an outpatient pediatric neurology clinic were treated by the proposed system. Participants practiced relaxation with biofeedback and learned to associate successful relaxation with positive pain-free virtual images of themselves.
  
  
  RESULTS
  Nine patients completed the 10-session intervention. Ratings of pain, daily functioning, and quality of life improved significantly at 1 and at 3 months posttreatment. Most patients reported applying their newly acquired relaxation and imagery skills to relieve headache outside the lab.
  
  
  CONCLUSIONS
  This novel system, combining biofeedback and virtual reality, is feasible for pediatric use. Randomized controlled studies in larger populations are needed in order to determine the utility of the system in reducing headache, improving daily functioning, and elevating quality of life.
authors: Department of Physical Medicine and Rehabilitation, Hadassah Hebrew University Medical Center, Jerusalem, Israel. shimonshiri@hadassah.org.il
authors: Shimon
authors: S
authors: Shiri
authors: Uri
authors: U
authors: Feintuch
authors: Nilly
authors: N
authors: Weiss
authors: Alex
authors: A
authors: Pustilnik
authors: Tal
authors: T
authors: Geffen
authors: Barrie
authors: B
authors: Kay
authors: Zeev
authors: Z
authors: Meiner
authors: Itai
authors: I
authors: Berger
mesh_terms: D000293:Adolescent; D001676:Biofeedback, Psychology / Q000379:methods*; D002648:Child; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D020773:Headache Disorders / Q000628:therapy*; D006801:Humans; D008297:Male; D010865:Pilot Projects; D012064:Relaxation Therapy / Q000379:methods*; D016896:Treatment Outcome; D063367:Virtual Reality Exposure Therapy / Q000379:methods*