title: Biofeedback as Prophylaxis for Pediatric Migraine: A Meta-analysis.
abstract: Migraine is a common problem in children and adolescents, but few satisfactory prophylactic treatments exist.
  
  
  
  Our goal was to investigate the pooled evidence for the effectiveness of using biofeedback to reduce childhood migraine.
  
  
  
  A systematic search was conducted across the databases Medline, Embase, CENTRAL, CINAHL, and PsychINFO.
  
  
  
  Prospective, randomized controlled trials of biofeedback for migraine among children and adolescents were located in the search.
  
  
  
  Data on reduction of mean attack frequency and a series of secondary outcomes, including adverse events, were extracted. Risk of bias was also assessed.
  
  
  
  Forest plots were created by using a fixed effects model, and mean differences were reported. Five studies with a total of 137 participants met the inclusion criteria. Biofeedback reduced migraine frequency (mean difference, -1.97 [95% confidence interval (CI), -2.72 to -1.21]; P < .00001), attack duration (mean difference, -3.94 [95% CI, -5.57 to -2.31]; P < .00001), and headache intensity (mean difference, -1.77 [95% CI, -2.42 to -1.11]; P < .00001) compared with a waiting-list control. Biofeedback demonstrated no adjuvant effect when combined with other behavioral treatment; neither did it have significant advantages over active treatment. Only 40% of bias judgments were deemed as "low" risk.
  
  
  
  Methodologic issues hampered the meta-analyses. Only a few studies were possible to include, and they suffered from incomplete reporting of data and risk of bias.
  
  
  
  Biofeedback seems to be an effective intervention for pediatric migraine, but in light of the limitations, further investigation is needed to increase our confidence in the estimate.
authors.affiliation: Department of Neuroscience, NTNU Norwegian University of Science and Technology, Trondheim, Norway;
authors.forename: Anker
authors.initials: A
authors.lastname: Stubberud
authors.affiliation: Department of Health and Rehabilitation/Physiotherapy, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
authors.forename: Emma
authors.initials: E
authors.lastname: Varkey
authors.affiliation: Duke Evidence Synthesis Group, Duke Clinical Research Institute, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina;
authors.forename: Douglas C
authors.initials: DC
authors.lastname: McCrory
authors.affiliation: Section for Medicine, NTNU University Library, NTNU Norwegian University of Science and Technology, Trondheim, Norway; and.
authors.forename: Sindre Andre
authors.initials: SA
authors.lastname: Pedersen
authors.affiliation: Department of Neuroscience, NTNU Norwegian University of Science and Technology, Trondheim, Norway; Norwegian Advisory Unit on Headaches, St Olavs Hospital, Trondheim, Norway.
authors.forename: Mattias
authors.initials: M
authors.lastname: Linde
mesh_terms: D000293:Adolescent; D001676:Biofeedback, Psychology; D002648:Child; D006801:Humans; D008881:Migraine Disorders / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D014850:Waiting Lists