Biofeedback Treatment for Headache Disorders: A Comprehensive Efficacy Review |
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Authors: | Yvonne Nestoriuc Alexandra Martin Winfried Rief Frank Andrasik |
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Institution: | Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02120, USA. ynestoriuc@partners.org |
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Abstract: | The aim of the present review was to critically evaluate the documented evidence regarding the efficacy of biofeedback for
the two most prevalent headache conditions––migraine and tension-type headache. Drawing upon two recently published meta-analyses,
data from 150 outcome studies, including randomized controlled trials as well as uncontrolled quasi-experimental designs,
were screened. Of these, 94 studies were selected for inclusion according to predefined criteria. Meta-analytic integrations
were carried out separately for the two conditions of interest. The main results were medium-to-large mean effect sizes for
biofeedback in adult migraine and tension-type headache patients. Treatment effects remained stable over an average follow-up
period of 14 months, both in completer and intention-to-treat analyses. Headache frequency was the primary outcome variable
and showed the largest improvements. Further significant effects were shown for perceived self-efficacy, symptoms of anxiety
and depression, and medication consumption. Reduced muscle tension in pain related areas was observed in electromyographic
feedback for tension-type headache. Biofeedback was more effective than waiting list and headache monitoring conditions in
all cases, while electromyographic feedback for tension-type headache showed additional significant effects over placebo and
relaxation therapies. Levels of efficacy (migraine: efficacious, level 4; tension-type headache: efficacious and specific, level 5) and recommendations for future research are provided.
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Keywords: | Migraine Tension-type headache Biofeedback Relaxation Treatment efficacy Meta-analysis White paper |
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