Applied Psychophysiology and Biofeedback

, Volume 33, Issue 3, pp 125–140 | Cite as

Biofeedback Treatment for Headache Disorders: A Comprehensive Efficacy Review

  • Yvonne Nestoriuc
  • Alexandra Martin
  • Winfried Rief
  • Frank Andrasik
Article

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.

Keywords

Migraine Tension-type headache Biofeedback Relaxation Treatment efficacy Meta-analysis White paper 

References

  1. Ad Hoc Committee on the Classification of Headache. (1962). Classification of headache. JAMA, 179, 117–118.Google Scholar
  2. Andrasik, F. (2001). Migraine and quality of life: Psychological considerations. The Journal of Headache and Pain, 2, 1–9. doi:10.1007/s101940170001.CrossRefGoogle Scholar
  3. Andrasik, F., Blanchard, E. B., Neff, D. F., & Rodichok, L. D. (1984). Biofeedback and relaxation training for chronic headache: A controlled comparison of booster treatments and regular contacts for long-term maintenance. Journal of Consulting and Clinical Psychology, 52, 609–615. doi:10.1037/0022-006X.52.4.609.PubMedCrossRefGoogle Scholar
  4. Andrasik, F., Lipchik, G. L., McCrory, D. C., & Wittrock, D. A. (2005). Outcome measurement in behavioral headache research: Headache parameters and psychosocial outcomes. Headache, 45, 429–437. doi:10.1111/j.1526-4610.2005.05094.x.PubMedCrossRefGoogle Scholar
  5. Blanchard, E. B., & Andrasik, F. (1987). Biofeedback treatment of vascular headache. In J. P. Hatch, J. G. Fisher & J. Rugh (Eds.), Biofeedback. Studies in clinical efficacy (pp. 1–49). New York: Plenum Press.Google Scholar
  6. Blanchard, E. B., Andrasik, F., Ahles, T. A., Teders, S. J., & O’Keefe, D. (1980). Migraine and tension headache: A meta-analytic review. Behavior Therapy, 11(5), 613–631. doi:10.1016/S0005-7894(80)80001-3.CrossRefGoogle Scholar
  7. Bogaards, M. C., & ter Kuile, M. M. (1994). Treatment of recurrent tension headache: A meta-analytic review. The Clinical Journal of Pain, 10, 174–190. doi:10.1097/00002508-199409000-00003.PubMedCrossRefGoogle Scholar
  8. Ciancarelli, I., Tozzi Ciancarelli, M. G., Spacca, G., Di Massimo, C., & Carolei, A. (2007). Relationship between biofeedback and oxidative stress in patients with chronic migraine. Cephalalgia, 27(10), 1136–1141. doi:10.1111/j.1468-2982.2007.01398.x.PubMedCrossRefGoogle Scholar
  9. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2ed.). Hillsdale: Erlbaum.Google Scholar
  10. Gibbons, R. D., Hedecker, D. R., & Davis, J. M. (1993). Estimation of effect size from a series of experiments involving paired comparisons. Journal of Educational Statistics, 18, 271–279. doi:10.2307/1165136.CrossRefGoogle Scholar
  11. Goslin, R. E., Gray, R. N., McCrory, D. C., Penzien, D. B., Rains, J. C., & Hasselblad, V. (1999). Behavioral and physical treatments for migraine headache (Technical Review 2.2). Prepared for the Agency for Health Care Policy and Research Under Contract No. 290-94-2025. (NTIS Accession No. 127946).Google Scholar
  12. Haddock, C. K., Rowan, A. B., Andrasik, F., Wilson, P. G., Talcott, G. W., & Stein, R. J. (1997). Home-based behavioral treatments for chronic benign headache: A meta-analysis of controlled trials. Cephalalgia, 17, 113–118. doi:10.1046/j.1468-2982.1997.1702113.x.PubMedCrossRefGoogle Scholar
  13. Headache Classification Committee of the International Headache Society. (1988). Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia, 8, 1–96. doi:10.1046/j.1468-2982.1988.0801001.x.CrossRefGoogle Scholar
  14. Headache Classification Committee of the International Headache Society. (2004). The international classification of headache disorders, 2nd edition. Cephalalgia, 24(Suppl. 1), 1–151.Google Scholar
  15. Hedges, L. V., & Olkin, I. (1985). Statistical methods for meta-analysis. Orlando: Academic Press.Google Scholar
  16. Holroyd, K. A., & Penzien, D. B. (1986). Client variables and the behavioral treatment of recurrent tension headache: A meta-analytic review. Journal of Behavioral Medicine, 9, 515–535. doi:10.1007/BF00845282.PubMedCrossRefGoogle Scholar
  17. Holroyd, K. A., & Penzien, D. B. (1990). Pharmacological versus non-pharmacological prophylaxis of recurrent migraine headache: A meta-analytic review of clinical trials. Pain, 42, 1–13. doi:10.1016/0304-3959(90)91085-W.PubMedCrossRefGoogle Scholar
  18. Houle, T. T., Penzien, D. B., & Houle, C. K. (2005). Statsitical power and sample size estimation for headaceh research: An overview and power calculation tools. Headache, 45, 414–418. doi:10.1111/j.1526-4610.2005.05092.x.PubMedCrossRefGoogle Scholar
  19. International headache society clinical trials subcommittee. (2000). Guidelines for controlled trials of drugs in migraine: Second edition. Cephalalgia, 20, 765–786.Google Scholar
  20. Kroener-Herwig, B., Heinrich, M., & Morris, L. (2007). Headache in german children and adolescents: A population-based epidemiological study. Cephalalgia, 27(6), 519–527. doi:10.1111/j.1468-2982.2007.01319.x.CrossRefGoogle Scholar
  21. LaVaque, T. J., Hammond, D. C., Trudeau, D., Monastra, V., Perry, J., Lehrer, P., et al. (2002). Template for developing guidelines for the evaluation of the clinical efficacy of psychophysiological interventions. Efficacy task force. Applied Psychophysiology and Biofeedback, 27, 273–281. doi:10.1023/A:1021061318355.CrossRefGoogle Scholar
  22. Lipton, R. B., Stewart, W. F., Diamond, S., Diamond, M. L., & Reed, M. (2001). Prevalence and burden of migraine in the United States: Data from the American Migraine Study II. Headache, 41, 646–657. doi:10.1046/j.1526-4610.2001.041007646.x.PubMedCrossRefGoogle Scholar
  23. Martin, P. R., Forsyth, M. R., & Reece, J. (2007). Cognitive-behavioral therapy versus temporal pulse amplitude biofeedback training for recurrent headache. Behavior Therapy, 38(4), 350–363. doi:10.1016/j.beth.2006.10.004.PubMedCrossRefGoogle Scholar
  24. McCrory, D., Penzien, D. B., Hasselblad, V., & Gray, R. (2001). Behavioral and physical treatments for tension-type and cervicogenic headaches. De Moines, IA: Foundation for Chiropractic Education and Research.Google Scholar
  25. Molarius, A., & Tegelberg, A. (2006). Recurrent haedache and migraine as a public health problem—A population-based study in Sweden. Headache, 46, 73–81. doi:10.1111/j.1526-4610.2006.00297.x.PubMedCrossRefGoogle Scholar
  26. Nestoriuc, Y., & Martin, A. (2007). Efficacy of biofeedback for migraine: A meta-analysis. Pain, 128, 111–127. doi:10.1016/j.pain.2006.09.007.PubMedCrossRefGoogle Scholar
  27. Nestoriuc, Y., Rief, W., & Martin, A. (2008). Meta-analysis of biofeedback for tension-type headache: Efficacy, specificity, and treatment moderators. Journal of Consulting and Clinical Psychology, 76(3), 379–396. doi:10.1037/0022-006X.76.3.379.PubMedCrossRefGoogle Scholar
  28. Nicholson, N. L., & Blanchard, E. B. (1993). A controlled evaluation of behavioral treatment of chronic headache in the elderly. Behavior Therapy, 24(3), 395–408. doi:10.1016/S0005-7894(05)80213-8.CrossRefGoogle Scholar
  29. Penzien, D. B., Andrasik, F., Freidenberg, B. M., Houle, T. T., Lake, A. E., I. I. I., Lipchik, G. L., et al. (2005a). Guidelines for trials of behavioral treatments for recurrent headache, first edition: American Headache Society Behavioral Clinical Trials Workgroup. Headache, 45(Suppl 2), S110–S132. doi:10.1111/j.1526-4610.2005.4502004.x.PubMedCrossRefGoogle Scholar
  30. Penzien, D. B., Rains, J. C., Lipchik, G. L., Nicholson, R. A., Lake, A. E., & Hursey, K. G. (2005b). Future directions in behavioral headache research: Applications for an evolving healthcare environment. Headache, 45, 526–534. doi:10.1111/j.1526-4610.2005.05105.x.PubMedCrossRefGoogle Scholar
  31. Rains, J. C., Penzien, D. B., McCrory, D. C., & Gray, R. N. (2005). Behavioral headache treatment: History, review of empirical literature, and methodological critique. Headache, 45, 92–109. doi:10.1111/j.1526-4610.2005.4502003.x.CrossRefGoogle Scholar
  32. Rasmussen, B. K., Jensen, R., Schroll, M., & Olesen, J. (1991). Epidemiology of headache in a general population: A prevalence study. Journal of Clinical Epidemiology, 44(11), 1147–1157. doi:10.1016/0895-4356(91)90147-2.PubMedCrossRefGoogle Scholar
  33. Rosenthal, R. (1979). The “file drawer problem” and tolerance for null results. Psychological Bulletin, 86, 638–641. doi:10.1037/0033-2909.86.3.638.CrossRefGoogle Scholar
  34. Rosenthal, R., & Rubin, D. B. (1982). A Simple, General Purpose Display of Magnitude of Experimental Effect. Journal of Educational Psychology, 74, 166–169. doi:10.1037/0022-0663.74.2.166.CrossRefGoogle Scholar
  35. Schwartz, B. S., Steward, W. F., Simon, D., & Lipton, R. B. (1998). Epidemiology of tension-type headache. Journal of the American Medical Association, 279(5), 381–383. doi:10.1001/jama.279.5.381.PubMedCrossRefGoogle Scholar
  36. Shadish, W. R., & Haddock, C. K. (1994). Combining estimates of effect size. In H. Cooper & L. V. Hedges (Eds.), The handbook of research synthesis (pp. 261–281). New York: Russel Sage.Google Scholar
  37. Stovner, L. J., Hagen, K., Jensen, R., Katsarava, Z., Lipton, R. B., Scher, A. I., et al. (2007). The global burden of headache: A documentation of headache prevalence and disability worldwide. Cephalalgia, 27, 193–210. doi:10.1111/j.1468-2982.2007.01288.x.PubMedCrossRefGoogle Scholar
  38. Trautmann, E., Lackschewitz, H., & Kröner-Herwig, B. (2006). Psychological treatment of recurrent headache in children and adolescents—a meta-analysis. Cephalalgia, 26, 1411–1426. doi:10.1111/j.1468-2982.2006.01226.x.PubMedCrossRefGoogle Scholar
  39. Yucha, C. B. (2002). Problems inherent in assessing biofeedback efficacy studies. Applied Psychophysiology and Biofeedback, 27, 99–106. doi:10.1023/A:1014528622061.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Yvonne Nestoriuc
    • 1
    • 2
  • Alexandra Martin
    • 3
  • Winfried Rief
    • 2
  • Frank Andrasik
    • 4
  1. 1.Department of Psychiatry, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA
  2. 2.Department of Clinical Psychology and PsychotherapyPhilipps University of MarburgMarburgGermany
  3. 3.Department of Psychosomatic Medicine and PsychotherapyUniversity of Erlangen-NuernbergErlangenGermany
  4. 4.Department of PsychologyUniversity of West FloridaPensacolaUSA

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