| Definition: Biofeedback is a technique used to make the
patient aware of their bodies physiologic responses. Through this training
the patients learn how their body makes maladaptive responses and then finally
how to control this.
Types:
- Thermal--The patient begins with a temperature sensor on their finger.
Through a variety of cognitive techniques the patient learns to control the
temperature of their finger. This "body control" can then be
extrapolated to other areas.
- Frontalis EMG--The frontalis muscle is the predominate muscle of the
forehead. EMG stands for electromyography and measures muscle
contraction via a probe inserted into the muscle belly. The patient,
here, learns to control muscle contractility and is thus a form of
relaxation technique.
- Cephalic Vasomotor--The patient has a sensor of the temporal artery that
is connected to a computer screen to give a visual representation of blood
flow. Through cognitive techniques the patient learns to control the
vasodilation/vasoconstriction and again becomes a relaxation technique.
Sessions typically last 30-60 minutes and typically 4-16 sessions are needed
to achieve the desired affects.
A Sample of Trials:
| Who and When |
What |
Method |
Results |
Problems |
| Sartory G, et al. 1998 |
Psychological vs. pharmacological in pediatric migraine |
43 pediatric patients given cephalic vasomotor biofeedback,
relaxation training or metoprolol (beta blocker). All were coupled with
stress management treatment. |
Decreased frequency and intensity of migraines with all,
however biofeedback was more effective and the results were stable after 8
months follow-up |
16 patients lost in follow-up. Doesn't address the
efficacy of biofeedback alone. |
| LaCroix JM, et al. 1983 |
Thermal biofeedback vs. frontalis EMG biofeedback vs.
relaxation training |
27 patients |
All had improvement in migraines, however thermal appeared
to be most successful and most sustainable after treatment |
Lack of control group as well as a small study |
| Scharff L, et al. 1996 |
Education, relaxation training, thermal biofeedback and
physical therapy |
30 women treated during pregnancy and followed a year later |
~80% decline in headache intensity and
frequency |
Pregnant physiology is different than normal physiology and
no single component was evaluated. |
Benefits: There are several benefits associated with
biofeedback, the most significant of which is patient empowerment. The
patient is taught how to control their body and take control of their own
health; they are forced to take an active role in their healthcare. It is
also safe and a good alternative to patients that are unable to take traditional
medicines (see the pregnant and pediatric studies above). In addition, the philosophy behind the treatment is
preventative in nature and has the goal to make migraines more manageable.
Negatives: First, there are no licensing requirements to provide
this treatment modality and thus no regulation, as well. Also, this
treatment option is usually done by a psychologist. Although this could
seem like a benefit, as things like stress and depression can aggravate
migraines, there is a poor stereotype and stigma about psychology. In
addition, many of the studies regarding biofeedback are small and often have
combining therapies.
Conclusion:
Biofeedback is not truly an alternative choice for migraine treatment, unlike
the other practices evaluated on this site. It has been a known, but
rarely used treatment for migraines. There are plenty of studies that show
its effectiveness when combined with similar treatment modalities and is an
excellent choice for the patient that is refractory or intolerant to traditional
treatment and has proper motivation.
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