title: Real-Time Assessment of the Effect of Biofeedback Therapy with Migraine: A Pilot Study.
abstract: BACKGROUND
  Biofeedback therapy has been reported to be effective in the treatment of migraine. However, previous studies have assessed its effectiveness using paper-and-pencil diaries, which are not very reliable.
  
  
  OBJECTIVE
  The objective of the present pilot study was to investigate the feasibility of using computerized ecological momentary assessment (EMA) for evaluating the efficacy of BF treatment for migraine in a randomized controlled trial.
  
  
  METHODS
  The subjects comprised one male and 26 female patients with migraine. They were randomly assigned to either biofeedback or wait-list control groups. Patients were asked to carry a palmtop-type computer to record momentary symptoms for 4 weeks before and after biofeedback treatment. The primary outcome measure was headache intensity. The secondary outcome measures included psychological stress, anxiety, irritation, headache-related disability and the frequency (number of days per month) of migraine attack and of headache of at least moderate intensity (pain rating ≥50).
  
  
  RESULTS
  Headache intensity showed significant main effects of period (before vs. after therapy, p = 0.02) and group (biofeedback vs. control groups, p = 0.42) and a significant period × group interaction (p < 0.001). 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.
  
  
  CONCLUSIONS
  The present study used computerized EMA to show that biofeedback could improve the symptoms of migraine, including psychological stress and headache-related disability.
authors: Department of Psychosomatic Medicine, Faculty of Medicine, Toho University, 6-11-1 Omorinishi, Ota-ku, Tokyo, 143-8541, Japan. mykodawara@med.toho-u.ac.jp.
authors: Miyuki
authors: M
authors: Odawara
authors: Department of Psychosomatic Medicine, Faculty of Medicine, Toho University, 6-11-1 Omorinishi, Ota-ku, Tokyo, 143-8541, Japan.
authors: Masahiro
authors: M
authors: Hashizume
authors: Department of Psychosomatic Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
authors: Kazuhiro
authors: K
authors: Yoshiuchi
authors: Department of Psychosomatic Medicine, Faculty of Medicine, Toho University, 6-11-1 Omorinishi, Ota-ku, Tokyo, 143-8541, Japan.
authors: Koji
authors: K
authors: Tsuboi
mesh_terms: D000328:Adult; D001676:Biofeedback, Psychology / Q000379:methods*; D004185:Disability Evaluation; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000523:psychology / Q000628:therapy; D010147:Pain Measurement / Q000379:methods; D010865:Pilot Projects; D013315:Stress, Psychological / Q000175:diagnosis / Q000503:physiopathology; D063189:Symptom Assessment / Q000379:methods
keywords: Biofeedback; Ecological momentary assessment; Headache-related disability; Migraine; Multilevel model; Psychological stress