A retrospective,follow-up study of biofeedback-assisted relaxation therapy in patients with posttraumatic headache

Although biofeedback in the treatment of migraine and tension-type headache has been widely researched, there is little research examining biofeedback therapy in posttraumatic headache (PTH). In this retrospective study, 40 subjects with PTH who had received biofeedback-assisted relaxation at our headache clinic were questioned at least 3 months following the completion of therapy. Subjects were queried about improvements in headache, increases in ability to relax and cope with pain, and overall benefits, lasting effectiveness, and continued use of biofeedback in daily life. Results indicate 53% reported at least moderate improvement in headaches; 80% reported at least moderate improvement in ability to relax and cope with pain; 93% found biofeedback helpful to some degree; 85% felt headache relief achieved through biofeedback had continued at least somewhat; and 95% stated they were continuing to use biofeedback skills in daily life. A correlation analysis revealed a negative relationship between response to biofeedback and increased chronicity of the disorder. In other words, the more chronic the disorder, the poorer the response to treatment. A stepwise regression analysis found that chronicity of the disorder and number of treatment sessions significantly affected response to treatment. Data suggest that biofeedback-assisted relaxation should at least be considered when planning treatment strategies for posttraumatic headache.We wish to express our appreciation to Sandra Tomlinson Becky Kinloch, and C. M. Bundrick for their assistance in this project.     

A preliminary analysis of EMG variance as an index of change in EMG biofeedback treatment of tension-type headache

The effectiveness of EMG biofeedback training for tension headache has been well established. Previous studies evaluating changes in an average EMG activity score from pre- to posttreatment have not consistently found a relationship between a reduction in average EMG activity and headache improvement at posttreatment. The current study is a preliminary analysis of the utility of EMG variance as another possible mechanism of change. Frontalis EMG average activity and variances from 6 chronic tension-type headache sufferers who demonstrated significant improvement in headache activity at posttreatment (at least 70%) and 6 chronic tension-type headache sufferers who did not demonstrate improvement (less than 30%) were examined across 6 sessions of biofeedback treatment. The improved group demonstrated larger time-specific EMG variance in relation to mean EMG amplitudes during all treatment sessions. A dramatic decline in time-specific variance was observed during the later treatment sessions for improved participants; this pattern was not observed in the group who demonstrated little or no improvement. Results from the current study suggest that the inclusion of both average EMG activity and EMG variance may provide a more comprehensive measure to evaluate possible physiological changes responsible for improvement in headache activity following EMG biofeedback training.     

Comparison of Biofeedback and Relaxation in the Treatment of Pediatric Headache and the Influence of Parent Involvement on Outcome

The relative efficacy of EMG-frontalis feedback and progressive relaxation was examined in children with tension-type or combined headaches (8–14 yrs. old). Furthermore, the influence of parent involvement, in the form of a three-session educational approach, on training outcome was systematically explored (2 × 2 factor design). Fifty children took part in the study, 40 were randomly assigned to the four different treatment conditions, 10 children participated in the self-monitoring control group. The training comprised 6 sessions of 1 hr each in the relaxation treatment and 12 sessions of 1/2 hr duration in the biofeedback group. Headache diaries were kept by children and parents for 4-week period prior to therapy, and for a similar length of time at post-treatment and follow-up (6 months). Multivariate analyses of variance on the headache diary data yield no significant main or interaction effects of treatment format or of parent involvement, but only a main effect of period, indicating a general efficacy of the four treatment conditions. At follow-up the reduction of headache activity is even more prominent. A different evaluative approach points to the superiority of biofeedback revealing a mean effect size for biofeedback training that reflects a good to excellent improvement rate. Correlations between headache data from children and parents are high.     

Electromyographic biofeedback training for tension headache in the elderly: A prospective study

This study evaluated the effects of a 12-session frontal electromyographic biofeedback training regimen on the headache activity of eight tension headache sufferers aged 62 and older. The biofeedback sessions were slightly modified for a geriatric population, essentially to increase comprehension and retention of rationale and instructions. Post-treatment assessment at three months revealed significant decreases in overall headache activity (50% or greater) in 50% of the subjects, and moderate improvement (35%–45%) in three of the remaining four subjects. Significant clinical and/or statistical prepost differences were also found for the number of headache-free days, peak headache activity, and medication index. This is the first prospective study of biofeedback training for tension headache in an elderly population and, unlike previous retrospective studies, suggests that such therapy may be an effective intervention in the treatment of tension headaches in the elderly.The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the United States Department of Veterans Affairs. This study was supported by a Department of Veterans Affairs MERIT-Review awarded to the first author.     

自适应式与固定式生物反馈训练对出口梗阻型便秘患者肛直肠功能和心理状态的影响

目的:探讨自适应式与固定式生物反馈训练对出口梗阻型便秘(OOC)患者肛直肠功能和心理状态的影响。方法:选取2017年4月～2019年12月期间晋城大医院收治的OOC患者98例,根据随机数字表法将患者分为对照组(n=49,固定式生物反馈训练)和研究组(n=49,自适应式生物反馈训练),比较两组患者疗效、肛直肠功能、排便次数、排便困难评分和心理状态。结果:研究组治疗8周后的临床总有效率93.88%(46/49),高于对照组的77.55%(38/49)(P0.05)。两组治疗8周后排便次数增加,排便困难评分降低(P0.05),研究组治疗8周后排便次数多于对照组,排便困难评分低于对照组(P0.05)。两组治疗8周后直肠肛门抑制反射阈、肛管静息压均较治疗前下降,模拟排便时直肠肛管压力梯度较治疗前升高(P0.05)。两组治疗8周后焦虑自评量表(SAS)、抑郁自评量表(SDS)评分均较治疗前下降,且研究组低于对照组(P0.05)。结论:与固定式生物反馈训练相比,自适应式生物反馈训练可获得与之效果相当的肛直肠功能改善程度,并可进一步减轻患者症状及改善心理状态,疗效显著。     

Temperature biofeedback and relaxation training in the treatment of migraine headaches. One-year follow-up.

In a previous controlled group outcome study, a comparison of temperature biofeedback with progressive relaxation indicated that relaxation training was more effective in reducing migraine headache activity at the end of treatment. However, follow-up data obtained at 1, 2, and 3 months after the completion of treatment showed no difference between the two groups on any dependent measure. In the current study, 18 of 26 subjects who completed treatment in the original investigation collected headache data and completed a headache questionnaire 1 year subsequent to the conclusion of treatment in order to evaluate the long-term effectiveness of the two treatments. The results indicated that gains achieved in the reduction of headaches during both treatments were maintained at a 1-year follow-up. With the exception of medication consumption (for which relaxation training led to better long-term results) the 1-year follow-up data reveal no differential efficacy for temperature biofeedback or progressive relaxation in treating migraine headaches.     

Temperature biofeedback and relaxation training in the treatment of migraine headaches

In a previous controlled group outcome study, a comparison of temperature biofeedback with progressive relaxation indicated that relaxation training was more effective in reducing migraine headache activity at the end of treatment. However, follow-up data obtained at 1, 2, and 3 months after the completion of treatment showed no difference between the two groups on any dependent measure. In the current study, 18 of 26 subjects who completed treatment in the original investigation collected headache data and completed a headache questionnaire I year subsequent to the conclusion of treatment in order to evaluate the long-term effectiveness of the two treatments. The results indicated that gains achieved in the reduction of headaches during both treatments were maintained at a 1-year follow-up. With the exception of medication consumption (for which relaxation training led to better long-term results) the 1-year follow-up data reveal no differential efficacy for temperature biofeedback or progressive relaxation in treating migraine headaches.     

Comparison of Side-effects of Tetracycline and Tetracycline Plus Nystatin

In a multicentre, double-blind, controlled trial of tetracycline plus nystatin (Mysteclin) and tetracycline, 111 patients with respiratory infections received one or other drug for a period of 10 days.The incidence of gastrointestinal symptoms was high in both groups before treatment began, and somewhat higher in the Mysteclin group than in the tetracycline group. After 10 days'' treatment 50% of the patients in the Mysteclin group had symptoms, a mean of 1.44 each, compared with 34% of the patients in the tetracycline group, with a mean of 1.47 symptoms each; the difference between the two groups is not significant (P>0.05). The incidence of Candida albicans in the stools at 10 days in the Mysteclin group (9.1%) was significantly lower than that in the tetracycline group (37.1%), but this was not reflected in any reduction in the frequency of gastrointestinal symptoms.     

A comparison of frontal EMG biofeedback and neck EMG biofeedback in the treatment of muscle-contraction headache

EMG biofeedback from the frontal area (FFB) was compared to EMG biofeedback from the neck (NFB) in the treatment of chronic muscle-contraction headache. Both treatment groups (N=10) evidenced significant decreases in reported headache activity, with the NFB group also significantly reducing medication consumption. An analysis of EMG changes suggested that subjects were able to produce large within-session changes in EMG activity during initial sessions, with the major effect of additional training being an increase in speed with which these changes occurred. In neither group, however, did changes in EMG activity correspond closely to changes in reported headache activity.     

Behavioral management of recurrent headache: three decades of experience and empiricism

In the past three decades, behavioral interventions (chiefly relaxation, biofeedback, and stress-management) have become standard components of the armamentarium for management of migraine and tension-type headaches. Meta-analytic literature reviews of these behavioral interventions have consistently identified clinically significant reductions in recurrent headache. Across studies, behavioral interventions have yielded approximately 35–50% reduction in migraine and tension-type headache activity. Although we have only recently begun to directly compare standard drug and nondrug treatments for headache, the available evidence suggests that the level of headache improvement with behavioral interventions may rival those obtained with widely used pharmacologic therapies in representative patient samples. In recent years, some attempts have been made to increase the availability and cost effectiveness of behavioral interventions through alternative delivery formats and mass communications. Recent developments within diagnosis and classification are summarized, pointing out implications for behavioral researchers. Select future directions are discussed, which include impact of the triptans, cost and cost effectiveness, and integration of behavioral treatments into primary care settings, the place where the great majority of headache sufferers receive treatment.     

Electromyographic biofeedback training for tension headache in the elderly: a prospective study.

This study evaluated the effects of a 12-session frontal electromyographic biofeedback training regimen on the headache activity of eight tension headache sufferers aged 62 and older. The biofeedback sessions were slightly modified for a geriatric population, essentially to increase comprehension and retention of rationale and instructions. Post-treatment assessment at three months revealed significant decreases in overall headache activity (50% or greater) in 50% of the subjects, and moderate improvement (35%-45%) in three of the remaining four subjects. Significant clinical and/or statistical pre-post differences were also found for the number of headache-free days, peak headache activity, and medication index. This is the first prospective study of biofeedback training for tension headache in an elderly population and, unlike previous retrospective studies, suggests that such therapy may be an effective intervention in the treatment of tension headaches in the elderly.     

Muscular response to the therapist and symptomatic improvement during biofeedback for tension headache.

The relationship between muscular response to the therapist's presence and symptomatic improvement was studied during biofeedback. Thirty-two patients suffering from tension headaches received muscular biofeedback training of six sessions plus a follow-up session two months later. Patients' electro-myographic frontal response was measured prior to treatment both with and without the therapist present. A relationship was found between symptomatic improvement at follow-up and muscular response to the therapist's presence before treatment: patients showing a decrease of at least 10% in muscular tension response to the presence of their future therapist improved more regarding headache intensity than the patients showing increase or smaller variation of their EMG. A significant correlation of .59 was found between the frontal EMG response to therapist presence during the evaluation session and headache improvement at follow-up. The results suggest that the decrease of muscular tension during the first contact with the therapist could be an indicator of good prognosis, possibly because of an immediate positive therapeutic relationship and/or favorable expectancies concerning future benefit of treatment.     

The Effects of Respiratory Sinus Arrhythmia Biofeedback on Heart Rate Variability and Posttraumatic Stress Disorder Symptoms: A Pilot Study

Recent studies have found a significant association between PTSD and low heart rate variability (HRV), a biomarker of autonomic dysregulation. Research indicates that respiratory sinus arrhythmia (RSA) biofeedback increases HRV while reducing related pathological symptoms. This controlled pilot study compared RSA biofeedback to progressive muscle relaxation (PMR) as adjunctive interventions for 38 persons with PTSD symptoms in a residential treatment facility for a substance use disorder. Both groups were assessed at pre-intervention and 4-week post-intervention. Group × time interactions revealed significantly greater reductions in depressive symptoms and increases in HRV indices for the RSA group. Both groups significantly reduced PTSD and insomnia symptoms and a statistical trend was observed for reduced substance craving for the RSA group. Increases in HRV were significantly associated with PTSD symptom reduction. Overall, these results provide preliminary support for the efficacy of RSA biofeedback in improving physiological and psychological health for individuals with PTSD.     

Muscular response to the therapist and symptomatic improvement during biofeedback for tension headache

The relationship between muscular response to the therapist's presence and symptomatic improvement was studied during biofeedback. Thirty-two patients suffering from tension headaches received muscular biofeedback training of six sessions plus a follow-up session two months later. Patients' electro-myographic frontal response was measured prior to treatment both with and without the therapist present. A relationship was found between symptomatic improvement at follow-up and muscular response to the therapist's presence before treatment: patients showing a decrease of at least 10% in muscular tension response to the presence of their future therapist improved more regarding headache intensity than the patients showing increase or smaller variation of their EMG. A significant correlation of .59 was found between the frontal EMG response to therapist presence during the evaluation session and headache improvement at follow-up. The results suggest that the decrease of muscular tension during the first contact with the therapist could be an indicator of good prognosis, possibly because of an immediate positive therapeutic relationship and/or favorable expectancies concerning future benefit of treatment.The authors thank Mrs. G. Parisé for her assistance during the experimentation, Ms. M. Newman for her editorial corrections, and Ms. A. Khan for her secretarial work.     

A double blind, placebo-controlled study of Andrographis paniculata fixed combination Kan Jang in the treatment of acute upper respiratory tract infections including sinusitis.

A double blind, placebo-controlled, parallel-group clinical study was carried out to evaluate the effect of an Andrographis paniculata (N.) extract SHA-10 fixed combination, Kan Jang, in the treatment of acute upper respiratory tract infections, including sinusitis. Ninety-five individuals in the treatment group and 90 individuals in the placebo group completed the study according to the protocol. The medication was taken for 5 days. Temperature, headache, muscle aches, throat symptoms, cough, nasal symptoms, general malaise and eye symptoms were taken as outcome measures with given scores. The total score analysis showed a highly significant improvement in the verum group versus the placebo. This result applied to the group as a whole and to the sinusitis subgroups. The individual symptoms of headache and nasal and throat symptoms together with general malaise showed the most significant improvement while cough and eye symptoms did not differ significantly between the groups. Temperature was moderately reduced in the verum group. It can be concluded that Kan Jang has a positive effect in the treatment of acute upper respiratory tract infections and also relieves the inflammatory symptoms of sinusitis. The study drug was well tolerated.     

Relative efficacy of ritalin and biofeedback treatments in the management of hyperactivity

This study examined the efficacy of biofeedback and Ritalin treatments on hyperactivity as reflected by muscular electrical activity and as observed by teachers and parents. Eighteen male subjects between the ages of 10 and 13 were assigned to three groups, matched by age, IQ, and race. One group received 10 biofeedback sessions, another received Ritalin, and the third group controlled for nonspecific treatment effects. EMG readings, the Conners Teacher Rating Scale, the Werry-Weiss-Peters Scale, and the Zukow Parent Rating Scale were used to measure treatment efficacy. Results indicated that biofeedback-assisted relaxation significantly reduced muscle tension levels, whereas neither Ritalin nor personal attention produced significant change. On teacher ratings of hyperactivity, significant improvement was made by all three groups. Parent ratings on the Zukow scale indicated significant improvement by subjects in all groups. On the Werry-Weiss-Peters scale, the biofeedback and control groups made significant improvements in hyperactivity.     

Relative efficacy of Ritalin and biofeedback treatments in the management of hyperactivity

This study examined the efficacy of biofeedback and Ritalin treatments on hyperactivity as reflected by muscular electrical activity and as observed by teachers and parents. Eighteen male subjects between the ages of 10 and 13 were assigned to three groups, matched by age, IQ, and race. One group received 10 biofeedback sessions, another received Ritalin, and the third group controlled for nonspecific treatment effects. EMG readings, the Conners Teacher Rating Scale, the Werry-Weiss-Peters Scale, and the Zukow Parent Rating Scale were used to measure treatment efficacy. Results indicated that biofeedback-assisted relaxation significantly reduced muscle tension levels, whereas neither Ritalin nor personal attention produced significant change. On teacher ratings of hyperactivity, significant improvement was made by all three groups. Parent ratings on the Zukow scale indicated significant improvement by subjects in all groups. On the Werry-Weiss-Peters scale, the biofeedback and control groups made significant improvements in hyperactivity.     

生物反馈联合电刺激在女性盆底功能障碍性疾病治疗中的临床应用

目的:分析生物反馈联合电刺激对女性盆底功能障碍性疾病(PFD)的治疗效果。方法:选择2011年1月至2016年3月我院收治的1000例PFD患者为研究对象,按随机数字表法分为实验组和对照组,每组各500例。实验组给予生物反馈联合电刺激,对照组给予功能性电刺激治疗。比较两组治疗前后盆底肌肉肌力分级的变化,测定盆底功能相关指标的改善及患者治疗前后排尿情况。结果:治疗后2组盆底肌力分级均呈明显上升趋势(Z=52.587,37.581;P0.001),且观察组改善效果优于对照组(Z=27.588,P0.001);治疗后实验组盆底肌肉肌力正常率高于对照组,差异有统计学意义(x~2=68.323,P0.05);治疗后实验组最大收缩压、持续收缩压提升幅度较大,膀胱颈移动度明显减小,与对照组各项指标对比差异有统计学意义(P0.05),且治疗后两组排尿情况均有所好转,实验组效果优于对照组(P0.05)。结论:生物反馈联合电刺激对女性PFD具有较好的效果,能提高患者盆底最大收缩压、持续收缩压,减小膀胱颈移动度,改善患者排尿功能。     

Electroencephalographic Biofeedback in the Treatment of Attention-Deficit/Hyperactivity Disorder

Historically, pharmacological treatments for attention-deficit/hyperactivity disorder (ADHD) have been considered to be the only type of interventions effective for reducing the core symptoms of this condition. However, during the past three decades, a series of case and controlled group studies examining the effects of EEG biofeedback have reported improved attention and behavioral control, increased cortical activation on quantitative electroencephalographic examination, and gains on tests of intelligence and academic achievement in response to this type of treatment. This review paper critically examines the empirical evidence, applying the efficacy guidelines jointly established by the Association for Applied Psychophysiology and Biofeedback (AAPB) and the International Society for Neuronal Regulation (ISNR). On the basis of these scientific principles, EEG biofeedback was determined to be “probably efficacious” for the treatment of ADHD. Although significant clinical improvement was reported in approximately 75% of the patients in each of the published research studies, additional randomized, controlled group studies are needed in order to provide a better estimate of the percentage of patients with ADHD who will demonstrate such gains in clinical practice.     

Evaluation of home-based thermal biofeedback treatment of pediatric migraine headache

Sixteen children and adolescents with migraine headache were treated with thermal biofeedback. Seven were seen individually in the clinic while the other nine participated in a limited-contact, partly home-based regimen. Evaluation of headache diary data from 4-week monitoring periods before and after treatment showed significant (p<.01) reduction in headaches, with no significant difference in efficacy between the two conditions.This research was supported in part by grants from NIMH, MH-41341, and NINCDS, NS-23440.