Biofeedback and Relaxation Therapy

Biofeedback therapy involves learning to reduce muscle tension in the head and neck or modifying blood flow, usually by warming the hands (an indirect but easily measured way of reducing stress-related responses). In most cases biofeedback is combined with relaxation training. This involves practicing slow abdominal breathing, focusing on feelings of heaviness and warmth in different parts of the body, or visualizing positive images. While the outcomes of biofeedback and relaxation training are generally similar, there is experimental and clinical evidence that the addition of biofeedback may increase the effectiveness of relaxation, particularly for individuals who do not get good results from relaxation therapy alone. When the method of training is geared to the patient's level, biofeedback and relaxation therapy have been shown to be effective across a wide range of ages from children to the elderly.

Comparisons of results across a large number of studies find average reductions in headache from 45% to 60% for migraine and tension-type headache (depending on how headaches are measured). This response rate is roughly equivalent to the effectiveness of certain drugs, such as beta blockers (propranolol) for migraine and tricyclic antidepressants (amitriptyline) for tension-type headache. The combination of biofeedback and medication may provide superior treatment results. For example, the average improvement in migraine with propranolol is 44% to 55%. When propranolol was added to biofeedback, one recent study found a significant increase in effectiveness for the combination of propranolol and biofeedback (79%) vs. biofeedback alone (54%).

When is biofeedback effective and for whom? Although the definitive answers to these questions are not yet certain, clinical research has indicated a better response to treatment in persons who are able to raise hand temperature above 95°, practice the technique at home, learn to pay close attention to fluctuations in tension throughout the day, and apply brief relaxation techniques on a daily basis. There is some preliminary evidence that individuals who gain a sense of self-efficacy -- a belief that they are in fact capable of exerting some control over their physiology and headaches -- achieve a better outcome regardless of the actual level of physiological control achieved. If this finding holds true, it may be that those who develop such a belief in an internal locus of control are more likely to apply a wide variety of coping techniques in addition to the frequent practice of biofeedback skills, thus increasing their chances of reducing headache.

In a follow-up study of 154 biofeedback patients with combined migraine and tension-type headaches, Dr. Jeff Pingel and I found that 80-84% reported success in preventing stress-related headaches. In contrast, these patients reported less success in preventing migraine (34%) and tension-type headaches (56%) triggered by other factors, such as menstruation or weather changes.

Analgesic rebound (caused by taking large amounts of pain relievers on a near-daily basis) interferes with the effectiveness of biofeedback. Chronic daily high intensity headache rarely responds to biofeedback alone, although it can help in coping with the pain.