• Addictions

• Attention Disorders & Hyperactivity

• Attention, Concentration and Focus

• Anger, Behaviour & Interpersonal skills

• Anxiety

• Autism/Aspergers

• Burn out

• Depression

• Dyslexia

• Epilepsy

• Lupus (Erythematosus)

• Fibromyalgia

• Gastrointestinal Disorders

• Headaches / Migraines

• Hypertension (High blood pressure, low blood pressure)

• Incontinence

• Insomnia

• Irritable Bowel Syndrome

• Language / Speech Development

• Learning Disabilities

• Mental Illness

• Obsessive / Compulsive Disorder

• Pain

• Peak performance- Athletes / CEO’s

• Post-Traumatic Stress Disorder (PTSD)

• Premenstrual syndrome(PMS) / Menopause

• Relaxation

• Stress

• Stroke

• Temporomandibular Disorders

• Trauma/Traumatic Brain Injuries

• Vestibulodynia

Use of Biofeedback for Headaches & Migraines

Headache - Paediatric Migraine

Level 3 Efficacy (Probably Efficacious)

The research support for childhood migraine using biofeedback as an intervention is more plentiful than for adult migraine. Research support for migraine in general, both child and adult, is stronger than that for mixed and tension-type headache.

A recent review article (Hermann & Blanchard, 2002) summarized headache/biofeedback research to date in children and concluded, “With few exceptions…thermal biofeedback has been proven to be highly successful in alleviating headache activity in children. In fact, in most studies more than two thirds of the children could be classified as treatment successes based on the widely accepted criterion of a 50% symptom reduction.” (p. 145). Studies using a credible placebo condition for comparison so far have not been done.

A minority of studies used EMG biofeedback from the frontal area instead of or in addition to hand-warming biofeedback. Most protocols use 10 sessions or fewer and included home practice; some involved the parents also. For example, five children with tension-type headaches (Arndorfer & Allen, 2001) participated in a multiple-baseline, time- lagged, within subject design using thermal biofeedback. All learned the hand warming technique and showed significant clinical improvement, and six months afterward, 80% were headache- free. Labbe (1995) compared thermal biofeedback-assisted autogenic training to autogenic training only, with a wait- list control group, in 30 migrainous children. Eighty percent of the first group had significant improvement; 50% of the second group, and none in the third group.

Headache – Adult

Level 4 Efficacy (Efficacious)

Adult headaches, tension, migraines, or mixed has been the focus of much research. For example, Arena, Bruno, Hannah, & Meader (1995) compared biofeedback training from the forehead and trapezius muscles, with a non-feedback progressive muscle relaxation control group, in 26 tension-headache patients. Clinical improvement was strongest for the trapezius group. Silberstein (2000) published a review of migraine treatment on behalf of the American Academy of Neurology – U.S. Consortium, and concluded thermal and muscle biofeedback, in a general context of relaxation training, was generally effective and recommended as a treatment option. McGrady, Wauquier, McNeil, & Gerard, (1994) and also Vasudeva, Claggett, Tietjen, & McGrady (2003) found superior clinical results for biofeedback assisted relaxation compared to self-directed relaxation. This conclusion was supported by measurement of cerebral flood flow using trans-cranial Doppler monitoring. Rokicki et al (1997) found a significant drop in headaches following six-sessions EMG biofeedback protocol, compared with a control group that showed no improvement. Improvement correlated most with greater sense of self-efficacy rather than with EMG levels. A meta-analysis of research by McCrory, Penszien, & Rains (1996) determined that EMG biofeedback was “modestly effective” for tension-type headaches compared to wait-list controls, but was not significantly different in effect size from cognitive therapy, relaxation training, or hypnosis. Isolating biofeedback as the active element from factors such as general relaxation, emotional improvement, and enhanced self-efficacy has not been challenging so far, but it may facilitate a synergistic effect.

Technical Papers & Abstracts

Holroyd, K. A. & Lipchik, g. L. (1999). Psychological management of recurrent headache disorders: Progress and prospects. In R.J. Gatchel & D.C. Turk (Eds.), Psychosocial Factors in Pain (pp. 193-212). New York: Guilford Press. (IV) (VII)

Holroyd, K. A. & Penzien, D.B. (1990). Pharmachological versus non-pharmacological prophylaxis of recurrent migraine headache: A meta-analytic review of clinical trials. Pain, 42, 1-13. (VII). Retrieved from Medline Database.

Labbe, E. E. (1995). Treatment of childhood migraine with autogenic training and skin temperature biofeedback: A component analysis. Headache, 35(1), 10-13. Retrieved from Medline Database.

Kinart, C. M., Cuppett, M. M., &Berg, K. (Jul. 2002). Prevalence of migraines in NCAA division I male and female basketball players. National Collegiate Athletic Association. Headache, 42 (7), 620-269. Retrieved from Medline Database

McCrory, D. C., Penszien, D. B., & Rains, J. C. (1996). Efficacy of behavioral treatments for migraine and tension-type headache: Meta-analysis of controlled trials [Abstract]. Headache, 36, 272.

McGrady, A., Wauquier, A., McNeil, A., & Gerard, C. (1994). Effect of biofeedback-assisted relaxation on migraine headache and changes in cerebral blood flow velocity in the middle cerebral artery. Headache, 34(7), 424-428.

Rokicki, L. A., Holroyd, K. A., France, C. R., Lipchik, G. L., France, J. L., & Kvaal, S. A. (1997). Change mechanisms associated with combined relaxation/EMG biofeedback training for chronic tension headache. Applied Psychophysiology & Biofeedback, 22(1), 21-41.

Silberstein, S. D. (2000). Practice parameter: Evidence-based guidelines for migraine headache (an evidence-based review): Report of the quality standards subcommittee of the American Academy of Neurology. Neurology, 55, 754-762.

Vasudeva, S, Claggett, A. L., Tietjen, G. E., & McGrady, A. V. (2003). Biofeedback-assisted relaxation in migraine headache: relationship to cerebral blood flow velocity in the middle cerebral artery. Headache, 43(3), 245-50.

Vasudeva, S., Claggett, A. L., Tietjen, G. E., & McGrady, A, V. (Mar. 2003). Biofeedback-assisted relaxation in migraine headache: relationship to cerebral blood flow velocity in the middle cerebral artery. Headache, 43 (3), 245-250. Retrieved from Medline Database.

Schwartz, M. S. (1995) . Headache: Selected issues and considerations in evaluation and treatment. Part A: Evaluation. In Schwartz and Associates (2nd ed.), pp. 313-353

Schwartz, M.S. (1995) . Headache: Selected issues and considerations in evaluation and treatment. Part B: Evaluation. In Schwartz and Associates (2nd ed.), pp. 354-407

Schwartz, M.S. (1995) . Headache: Selected issues and considerations in evaluation and treatment. Part A: Evaluation. In Schwartz and Associates (2nd ed.), pp. 248-287

Blanchard, E. B. & Arena, J. G. (1999). Biofeedback, relaxation training, and other psychological treatments for chronic benign headache. In M. L. Diamond & G. D. Solomon (Eds.), Diamond's and Dalessio's The Practicing Physician's Approach to Headache (6th ed.) (p. 209-224). Philadelphia: W. B. Saunders. (IV)

Blanchard, E. B. & Diamond, S. (1996). Psychological treatment of benig headache disorders. Professional Psychology: Reasearch and Practice, 27, 541-547.

Rokicki, L. A., Holroyd, K. A., France, C. R., et al. (1997). Change mechanisms associated with combined relaxation/EMG biofeedback training for chronic tension headache. Journal of Applied Psychophysiology and Biofeedback, 22, 21-41. Retrieved from SpringerLink Database.