Migraine headache afflicts 18% of women and 7% of men in the United States*. A recent meta-analysis* found that various forms of biofeedback may be an effective treatment for migraine headache. The primary peripheral biofeedback modalities under investigation included electromyography (EMG), skin temperature (TEMP), and heart rate variability (HRV) [referred to as blood-volume-pulse feedback in this article]. The meta-analysis consisted of 55 studies with a total of 2,229 participants. Biofeedback therapies were compared against one another and to placebo conditions, relaxation techniques, and pharmacotherapy. Some participants received biofeedback plus relaxation.
Overall, biofeedback (all combined) produced a robust moderate effect size of .58 (95% CI=.52-.64) in pre vs. post headache conditions. In treatment specific comparisons, biofeedback (all combined) achieved a moderate effect size (.45) compared to a no-treatment (wait-list) control condition, but did not exhibit superiority (nor was biofeedback inferior) over known beneficial treatments (relaxation and pharmacotherapy). The authors noted a “trend” toward significance for biofeedback over pharmacotherapy, as well as few, if any, reported side effects in the biofeedback treatments. Importantly, biofeedback therapies failed to achieve statistical significance when compared to placebo control groups, despite a .25 effect size. This is because the confidence interval (0.00-.49) included zero.
The researchers also compared each biofeedback treatment to another (e.g. EMG vs TEMP, etc.). All biofeedback treatment were equally effective (statistically speaking), though HRV obtained the highest numerical effect size at .68 (medium to large effect size). Another important finding is that biofeedback treatment effects endured at 1 year or more follow-up. Concurrent patient home training sessions improved treatment effect sizes at study completion and at extended follow-up. Additionally, biofeedback significantly reduced anxiety and depression, and significantly improved beliefs of self-efficacy. In fact, gains in self-efficacy were higher than pain improvements.
The authors mentioned how impressed they were with these results given that the participants reported chronic migraines (average of 16 years). They further stated that, “Thus, based on the present results BFB can be recommended to therapists, physicians and healthcare providers as an eﬃcacious non-medical treatment alternative for highly chroniﬁed migraine patients; suitable also for the long-term prevention of migraine attacks” (pg. 122).
In my opinion, a well designed randomized, double-blind, placebo controlled study with a large number of participants is warranted and could help clarify the benefits of biofeedback for migraine headache.
Summary of Important Highlights From The Current Study:
- Study Design: meta-analysis
- Primary Inclusion Criteria: migraine headache (average years suffering: 16.9 years)
- Number of Participants: 2,229 (experimental = 1,718; control = 511)
- Participants’ Average Age: 37.1 (SD=10.0)
- Participants’ Gender: 88.6% female
- Primary Outcome: overall moderate effect size of .58 (95% CI=.52-.64) in pre vs post headache and .45 (95% CI=.26-.63) wait-list control comparisons
- Limitations: biofeedback did not produce statistically meaningful gains over placebo conditions.
*Nestoriuc, Y., & Martin, A. (2007). Efficacy of biofeedback for migraine: A meta-analysis. Pain, 128, 111-127.