The role of absorption capacity in thermal biofeedback treatment of vascular headache

The clinical utility of Tellegen's Absorption Scale was examined using a sample of 32 chronic vascular headache patients drawn from a larger treatment study investigating the efficacy of thermal biofeedback with vascular headache. A regression analysis found that acquisition of the hand-warming response was directly related to increase in capacity for absorption. Conversely, a trend was found for absorption capacity to be inversely related to reductions in headache frequency and intensity. Reasons for these differences in process and outcome variables are discussed.     

The role of absorption capacity in thermal biofeedback treatment of vascular headache

The clinical utility of Tellegen's Absorption Scale was examined using a sample of 32 chronic vascular headache patients drawn from a larger treatment study investigating the efficacy of thermal biofeedback with vascular headache. A regression analysis found that acquisition of the hand-warming response was directly related to increase in capacity for absorption. Conversely, a trend was found for absorption capacity to be inversely related to reductions in headache frequency and intensity. Reasons for these differences in process and outcome variables are discussed.This research was supported in part by a grant No. NS23440 from NINDS.     

Biofeedback control of migraine headaches: a comparison of two approaches

In order to assess the relative effectiveness of finger warming and temporal blood volume pulse reduction biofeedback in the treatment of migraine, 22 female migraine patients were assigned to one of three experimental conditions: temporal artery constriction feedback, finger temperature feedback, or waiting list. Biofeedback training consisted of 12 sessions over a 6-week period. All patients completed 5 weeks of daily self-monitoring of headache activity (frequency, duration, and intensity) and medication before and after treatment. Treatment credibility was assessed at the end of Sessions 1, 6, and 12. Results showed that temporal constriction and finger temperature biofeedback were equally effective in controlling migraine headaches and produced greater benefits than the waiting list condition. Power analyses indicated that very large sample sizes would have been required to detect any significant differences between the two treatment groups. No significant relationships were found between levels of therapeutic gains and levels of thermal or blood volume pulse self-regulation skills. Likewise, treatment outcome was not found to be related to treatment credibility. Further analyses revealed that changes in headache activity and medication were associated with changes in vasomotor variability. Because blood volume pulse variability was not significantly affected by biofeedback training, questions about its role in the therapeutic mechanism are raised.     

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.     

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.     

Posttraumatic Headache: An Exploratory Treatment Study

Fourteen patients with posttraumatic headache (PTHA) were treated with a comprehensive treatment package targeting headache symptoms along with associated posttraumatic stress symptoms. Treatment consisted of some or all of the following depending on headache features: thermal biofeedback, electromyography biofeedback targeting the forehead and/or neck muscles, progressive muscle relaxation, education and cognitive–behavioral therapy. Mean improvement for the treatment group was 21%, whereas mean improvement for the wait-list group was –14% indicating a worsening of headache; however, the difference between groups was not statistically significant. There was a significant between groups difference on headache-free days. Within group results were modest with 29% mean improvement by the end of treatment. The reduction in headache index was significant. Minor reductions in psychopathology, most notably anxiety, were found after treatment. This study confirmed the treatment difficulties seen in this understudied population of headache sufferers, but offered hope for symptom relief.     

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.     

Training for voluntarily increasing individual upper α power as a method for cognitive enhancement

In order to estimate the effect of simultaneous α EEG stimulating and electromyogram (EMG) decreasing biofeedback training on the α activity and cognitive functions, fluency, accuracy, and flexibility during cognitive tasks, as well as α-activity characteristics before, during, and after ten training sessions of voluntarily increasing α power in an individual upper α range with the eyes closed were studied in 27 healthy men aged 18–34 years. To isolate the biofeedback effect in training for the α power increase, data on two groups of subjects were compared: an experimental group (14 subjects) with true biofeedback and a control group (13 subjects) with sham biofeedback. Follow-up testing was performed one month after the end of training to estimate the stability of the effect. The results showed that the training for the upper α power increase using biofeedback increased the frequency, width, and power in an individual upper α range at rest and improved cognitive performance only in subjects with a low baseline α frequency. Conversely, sham biofeedback training (without the feedback signal) increased the α power, though less efficiently, only in subjects with a high baseline α frequency, this increase was not accompanied by improved cognitive performance. The biofeedback α training eliminated the decrease in the α amplitude in response to a cognitive task after the biofeedback training course, this effect being preserved within one month. It may be concluded that α EEG-EMG biofeedback training can be used for improving cognitive processes in healthy subjects, as well as for prognostic purposes in clinical practice and in the brain-computer interface technology.     

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.     

Hypnotizability and response to EMG relaxation training

This study examines the relationship between Spiegel's Hypnotic Induction profile (HIP) and ability to perform EMG relaxation under conditions of self-induced and audio-assisted biofeedback training. One hundred women volunteered for screening with Spiegel's test for hypnotizability. Thirty students were then selected from the top, middle, and bottom of the HIP scoring distribution for EMG biofeedback training in relaxation. Three treatment trials included baseline, EMG biofeedback with self-induced relaxation, and EMG biofeedback with audio relaxation instructions. Contrary to predictions, high HIPs were not significantly different from low HIPs on any of the treatment measures, although all students showed a training effect. The middle HIPs demonstrated significantly higher levels of EMG activity than the extreme groups.     

Long-term maintenance of improvements achieved with (abortive) pharmacological and nonpharmacological treatments for migraine: preliminary findings

This report presents the first prospective comparison of the long-term maintenance of reductions in recurrent migraine headaches achieved with (abortive) pharmacological and nonpharmacological (combined relaxation training and thermal biofeedback training) treatments. Nineteen of 21 (90%) successfully treated patients (50% or greater reduction in headache activity) were contacted for follow-up evaluation 3 years later. Migraine sufferers who had been treated with ergotamine were less likely to still be relying on the treatment they had received and more likely to have additional medical treatment for their headaches and to be using prophylactic or narcotic medication than were migraine sufferers who had been treated with relaxation/biofeedback training. However, daily headache recordings revealed that patients in both treatment groups continued to show lower headache activity at 3-year follow-up than prior to treatment. Although preliminary, these findings raise the possibility that improvements achieved with nonpharmacological treatment are more likely to be maintained without additional treatment than are similar improvements achieved with abortive pharmacological treatment.     

Biofeedback and relaxation treatments for headache in the elderly: A caution and a challenge

Results for 11 older (60 years or greater) headache patients treated with combinations of biofeedback and relaxation are presented. Overall, only 18.2% were clinically improved after treatment. None of the 5 tension headache patients were improved. Suggestions for future work with the older headache patient are offered.This research was supported in part by a grant from NINCDS, NS-15235.     

髋部肌锻炼联合盆底电刺激生物反馈对盆底功能障碍性疾病患者盆底功能及应激反应的影响

摘要 目的：探讨髋部肌锻炼联合盆底电刺激生物反馈对盆底功能障碍性疾病（PFD）患者盆底功能及应激反应的影响。方法：选取2021年1月-2022年12月在我院接受治疗的120例PFD患者作为研究对象,按随机数字表法分为对照组和观察组,每组各60例。对照组患者进行髋部肌锻炼,观察组患者在对照组的基础上联合盆底电刺激生物反馈治疗,观察分析两组患者盆底功能以及应激反应的变化。结果：两组治疗后观察组临床总有效率显著高于对照组（P＜0.05）;两组患者治疗后PFDI-20、PISQ-12及PFIQ-7评分显著优于治疗前,且观察组上述指标明显优于对照组（P＜0.05）;治疗后两组患者前盆底肌电位、动态肌张力、静态肌张力及收缩力较治疗前显著改善,且观察组相较于对照组上述指标显著提升（P＜0.05）;治疗后两组患者去甲肾上腺素（NE）、前列腺素（PGE₂）、皮质醇（COR）水平明显提高,且观察组明显优于对照组（P＜0.05）。结论：髋部肌锻炼联合盆底电刺激生物反馈使肌肉功能得到锻炼,提高了盆底肌张力水平,促进盆底功能的恢复和应激反应的提高,明显提高患者的生活质量。     

Biofeedback and relaxation treatments for headache in the elderly: a caution and a challenge

Results for 11 older (60 years or greater) headache patients treated with combinations of biofeedback and relaxation are presented. Overall, only 18.2% were clinically improved after treatment. None of the 5 tension headache patients were improved. Suggestions for future work with the older headache patient are offered.     

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.     

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.     

生物反馈训练辅助治疗梗阻性便秘对粪便性状、排便时间及排便频度的影响

目的:探讨生物反馈训练辅助治疗梗阻性便秘患者对粪便性状、排便时间与排便频度的影响。方法:选取我院收治的90例梗阻性便秘患者,根据随机数字表法分为3组,A组接受常规治疗,B组于常规治疗基础上进行固定式生物反馈训练(FBF),C组于常规治疗基础上进行自适应式生物反馈训练(ABF),比较3组治疗前后肛直肠功能、粪便性状、排便时间、排便频度和临床疗效。结果:治疗后,直肠肛门压力梯度:A组B组C组(P0.05),矛盾性收缩率:A组B组C组(P0.05),B组与C组肛管静息压、直肠肛门抑制反射阈值显著小于A组(P0.05),且肛管松弛率显著大于A组(P0.05);C组粪便性状4～7型占比明显高于其余两组(P0.05),且B组4～7型占比明显高于A组(P0.05);排便时间:A组B组C组(P0.05),排便频度:A组B组C组(P0.05);C组总有效率显著高于A组与B组(P0.05)。结论:生物反馈训练尤其是ABF可有效改善梗阻性便秘患者肛直肠功能,在改善粪便性状、缩短排便时间、增加排便频度上具有明显优势,可获得更好的临床疗效。     

Biofeedback control of migraine headaches: A comparison of two approaches

In order to assess the relative effectiveness of finger warming and temporal blood volume pulse reduction biofeedback in the treatment of migraine, 22 female migraine patients were assigned to one of three experimental conditions: temporal artery constriction feedback, finger temperature feedback, or waiting list. Biofeedback training consisted of 12 sessions over a 6-week period. All patients completed 5 weeks of daily self-monitoring of headache activity (frequency, duration, and intensity) and medication before and after treatment. Treatment credibility was assessed at the end of Sessions 1, 6, and 12. Results showed that temporal constriction and finger temperature biofeedback were equally effective in controlling migraine headaches and produced greater benefits than the waiting list condition. Power analyses indicated that very large sample sizes would have been required to detect any significant differences between the two treatment groups. No significant relationships were found between levels of therapeutic gains and levels of thermal or blood volume pulse self-regulation skills. Likewise, treatment outcome was not found to be related to treatment credibility. Further analyses revealed that changes in headache activity and medication were associated with changes in vasomotor variability. Because blood volume pulse variability was not significantly affected by biofeedback training, questions about its role in the therapeutic mechanism are raised.This research was supported in part by grants from the Quebec Ministry of Education and the Quebec Ministery of Social Affairs to the first author, and an award from the Medical Research Council of Canada to the second author. The authors are indebted to Drs. Frank Andrasik, Howard Barbaree, Edward Blanchard, Martin Ford, and Patrick McGrath, as well as to two anonymous reviewers, for their helpful comments on an earlier draft of this paper.     

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.     

Long-term maintenance of improvements achieved with (abortive) pharmacological and nonpharmacological treatments for migraine: Preliminary findings

This report presents the first prospective comparison of the long-term maintenance of reductions in recurrent migraine headaches achieved with (abortive) pharmacological and nonpharmacological (combined relaxation training and thermal biofeedback training) treatments. Nineteen of 21 (90%) successfully treated patients (50% or greater reduction in headache activity) were contacted for follow-up evaluation 3 years later. Migraine sufferers who had been treated with ergotamine were less likely to still be relying on the treatment they had received and more likely to have additional medical treatment for their headaches and to be using prophylactic or narcotic medication than were migraine sufferers who had been treated with relaxation/biofeedback training. However, daily headache recordings revealed that patients in both treatment groups continued to show lower headache activity at 3-year follow-up than prior to treatment. Although preliminary, these findings raise the possibility that improvements achieved with nonpharmacological treatment are more likely to be maintained without additional treatment than are similar improvements achieved with abortive pharmacological treatment.A Baker Award from Ohio University provided support for the original outcome study.Abgelo Theofanous with R. L. Associates (Ann Arbor).