Psychophysiological treatment of migraine and tension headaches: A 12-month follow-up.

Conducted a 12-mo follow-up of the present authors' (1983) study population of chronic headache sufferers by telephone interviewing 31 chronic migraine and 25 chronic tension headache patients (aged 18–61 yrs) who had been treated with EMG, muscle relaxation, and fingertip temperature training to test a hypothesis of biofeedback placebo effects. A previous 3-mo follow-up had revealed that all treatments had produced significant improvement, and relaxation was not as good as the biofeedback devices for obtaining a reduction in monthly headache hours. At 12-mo follow-up, the 3-mo improvement was sustained overall, but migraineurs as a group appeared to regress slightly, while tension patients improved significantly in the interim. On the basis of a 50% reduction in symptomatology, biofeedback treatment was significantly superior to relaxation for tension headaches, although this had not been true at the 3-mo assessment. Temperature training was at least as effective as EMG for both headache groups. In view of these results, biofeedback treatment is viewed less as placebo administration and more as a secondary reinforcer of a specific but unknown physiological response. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Two-, three-, and four-year follow-up on the self-regulatory treatment of chronic headache.

Chronic tension and vascular headache patients, initially treated with relaxation and biofeedback, were prospectively followed-up on an annual basis at 2-, 3-, and 4-years posttreatment. Although there was a fair degree of variability, tension headache patients generally showed good maintenance of initial headache reduction at Year 4. Vascular patients showed a nonsignificant trend for gradual deterioration of treatment effects over the 4 years of follow-up. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Biofeedback and relaxation training with three kinds of headache: Treatment effects and their prediction.

After a 4-wk baseline period during which daily ratings of headache activity were made and all participants took several psychological tests, 91 18–68 yr old patients with chronic headache (tension, migraine, and combined tension and migraine) were given a 10-session relaxation-training regimen. Ss who did not show substantial reductions in headache activity from the relaxation therapy were given a 12-session regimen of biofeedback (thermal biofeedback for vascular headaches and frontal EMG biofeedback for tension headaches). Relaxation therapy alone led to significant improvement for all groups, with a trend for the tension headache group to respond the most favorably. Biofeedback therapy led to further significant reduction in headache activity for all who received it, with a trend for combined migraine and tension headache patients to respond the most favorably. Multiple regression analyses revealed that approximately 32% of the variance in end-of-treatment headache diary scores could be predicted after relaxation and that 44% of the variance after biofeedback could be predicted using standard psychological tests. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anatomical studies on the quantitative development of liver, heart and adrenal glands in white New Zealand rabbits

The biofeedback literature affirms the therapeutic efficacy of EMG-biofeedback-assisted relaxation for the treatment of tension headache. However, this form of therapy has failed to focus on the role of cognitive variables in the control and perception of tension headache. The present case study provides a prototype treatment combining cognitive behavior--modification procedures with EMG-biofeedback training to treat a subject with chronic tension headache. Phase I, baseline, involved collecting mean EMG and daily headache activity, emphasizing specification of environmental stressors. Phase II, cognitive skills--training, focused on: (1) identifying negative self-statements (cognitions) related to stressors, and (2) training the subject to replace negative self-statements with coping self-instructions. This treatment resulted in a 33% headache reduction over baseline, with no concomitant changes in frontalis EMG. Phase III, EMG-biofeedback training, resulted in a 38% reduction in mean EMG level and a 66% reduction in mean headache activity when compared to baseline. The results suggest the importance of attending to cognitive factors in the treatment of tension headache.     

The role of home practice in the thermal biofeedback treatment of migraine headache.

Examined the role of home practice of hand warming in the thermal biofeedback treatment of migraine headache. 17 female migraine sufferers were randomly assigned to 1 of the following conditions: thermal biofeedback with regular home practice (HP) or thermal biofeedback without home practice (NHP). Biofeedback treatment consisted of 12 training sessions over a 6-wk period, and all Ss completed 5 wks of headache monitoring before and after treatment. Results indicated that Ss in the HP condition experienced decreases in headache activity and medication intake that were both statistically and clinically significant compared with the NHP condition. None of the outcome measures revealed significant improvement in the NHP condition. Thus, regular HP appears to enhance the efficacy of biofeedback in the treatment of migraine. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Homeostatic reconditioning in stress-related disorders: A preliminary study of migraine headaches.

18 19–55 yr old migraine headache patients were assigned to a group that learned (1) to raise finger temperature, via visual biofeedback, after neutral imaginal experiences or (2) to raise finger temperature after stressful imaginal experiences. At the completion of training, Ss participated in an outcome session without feedback. Laboratory training, combined with home practice using the same respective imaginal experiences, resulted in Ss' being able, with on-task concentration, to raise finger temperature without feedback and also resulted in significant clinical reductions in headache activity. Improvement was more marked at 4-wk follow-up. Ss trained in vascular recovery after stress showed more improvement than did other Ss. Overall, the Ss who showed the most reliable vascular recovery conditioning effects were those whose migraine prodromal symptomatology was not an accurate predictor of headache or absence of headache. The significance of what is called homeostatic reconditioning, after stress, in stress-related disorders, rather than the "aspirin" approach of many biofeedback treatments, is discussed. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spinal manipulation in the treatment of episodic tension-type headache: a randomized controlled trial

CONTEXT: Episodic tension-type headache is common and is often treated using manual therapies. Few data exist for the efficacy of these interventions. OBJECTIVE: To determine the effects of spinal manipulation therapy on adults with episodic tension-type headache. DESIGN: Randomized controlled trial lasting 19 weeks. SETTING: Outpatient facility of a National Health Service-funded chiropractic research institution in Denmark. PARTICIPANTS: Volunteer sample of 26 men and 49 women aged 20 to 59 years who met the diagnostic criteria for episodic tension-type headache as defined by the International Headache Society. INTERVENTION: Participants were randomized into 2 groups, 1 receiving soft tissue therapy and spinal manipulation (the manipulation group), and the other receiving soft tissue therapy and a placebo laser treatment (the control group). All participants received 8 treatments over 4 weeks; all treatments were performed by the same chiropractor. MAIN OUTCOME MEASURES: Daily hours of headache, pain intensity per episode, and daily analgesic use, as recorded in diaries. RESULTS: Based on intent-to-treat analysis, no significant differences between the manipulation and control groups were observed in any of the 3 outcome measures. However, by week 7, each group experienced significant reductions in mean daily headache hours (manipulation group, reduction from 2.8 to 1.5 hours; control group, reduction from 3.4 to 1.9 hours) and mean number of analgesics per day (manipulation group, reduction from 0.66 to 0.38; control group, reduction from 0.82 to 0.59). These changes were maintained through the observation period. Headache pain intensity was unchanged for the duration of the trial. CONCLUSION: As an isolated intervention, spinal manipulation does not seem to have a positive effect on episodic tension-type headache.     

Relaxation therapy, biofeedback, and behavioral medicine.

Discusses the major forms of relaxation and biofeedback and describes the current applications for such conditions as pain, cardiovascular disorders, and neurological abnormalities. It is asserted that while relaxation is not a panacea for all medical problems, it has proven to be a useful adjunct to traditional medical treatments for such medical disorders as chronic pain, hypertension, migraine headache, Raynaud's disease, and epilepsy. In some conditions, such as muscle-contraction headache, relaxation therapy and/or biofeedback is the treatment of choice. Relaxation may be considered a cognitive coping skill that is more a preventive procedure than just a technique to modify specific physiological responses. It is noted that since the field of behavioral medicine involves the integration of behavioral and biomedical science knowledge and the application of this knowledge to prevention and treatment to disease, the boundaries of psychology and medicine are no longer sharply defined. (78 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hyperinsulinaemia in hypertensive subjects: validity of a test for the detection of insulin resistance in clinical practice

Tension-type headache is common in children and adolescents and is generally treated with medication, but emerging literature suggests that various behavioral treatments may provide efficacious alternatives to medication. Juvenile tension-type headache sufferers were randomly assigned to biofeedback-assisted relaxation continued to improve and were superior to the control condition at a 6- and 12-month follow-up (86% versus 50%). Biofeedback-assisted relaxation appears to be an efficacious and durable treatment for juvenile tension-type headache and merits further exploration.     

A double-blind provocative study of chocolate as a trigger of headache

A provocative double-blind study of headache was performed using chocolate as the active agent and carob as the placebo. The chocolate and carob samples were formulated to duplicate products used in an earlier study (1) in which strong differential effects between the ability of chocolate and carob to trigger headache in migraine were shown. Sixty-three women with chronic headache (50% migraine, 37.5% tension-type, 12.5% combined migraine and tension-type) participated in the study. After 2 weeks of following a diet that restricted vasoactive amine-rich foods, each subject underwent double-blinded provocative trials with two samples of chocolate and two of carob presented in random order. Diaries were maintained by the subjects throughout the study, monitoring diet and headache. The results demonstrated that chocolate was not more likely to provoke headache than was carob in any of the headache diagnostic groups (chi2(2)=0.36, p=0.83). Interestingly, these results were independent of subjects' beliefs regarding the role of chocolate in the instigation of headache (chi2(1)=0.73, p=0.39). Headache diagnosis and the concomitant use of additional vasoactive amine-containing foods were also not associated with chocolate acting as a headache trigger. Thus, contrary to the commonly held belief of patients and physicians, chocolate does not appear to play a significant role in triggering headaches in typical migraine, tension-type, or combined headache sufferers.     

Application of electromyographic biofeedback to the relaxation training of schizophrenic, neurotic, and tension headache patients.

Examined the effects of EMG biofeedback on tension reduction by schizophrenic, neurotic, and tension headache patients. 14 patients (mean age 39 yrs) participated voluntarily in at least 10 weekly EMG biofeedback sessions at a public outpatient clinic. All had complained of chronic tension. Ss showed significant decreases in their muscle tension levels with successive biofeedback training sessions. No significant differences were found between the schizophrenic, neurotic, and tension headache groups. A further contribution is the finding that patients with diverse socioeconomic and educational levels benefited similarly from EMG biofeedback training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differential effectiveness of electromyograph feedback, verbal relaxation instructions, and medication placebo with tension headaches.

27 16-64 yr old Ss with chronic tension headaches were divided into 3 groups. Nine were assigned to auditory EMG feedback, 9 to progressive relaxation instructions, and 9 to placebo treatment. Ss came for 2 wks of pre- and posttreatment assessment, with 4 wks of intervening treatment. Measures were taken on headache frequency, intensity and duration, frontalis EMG recordings, medication intake, Nowicki-Strickland Loss of Control Scale, and the Psychosomatic Checklist. Comparison of postassessment and 4-mo follow-up data indicate that biofeedback and verbal relaxation instructions were equally superior to the medicine placebo on all measured variables in the direction of clinical improvement, except for shifts in locus of control. All groups experienced equally significant shifts toward internality. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Biofeedback/relaxation training and exercise interventions for fibromyalgia: a prospective trial

OBJECTIVE: To compare the effectiveness of biofeedback/relaxation, exercise, and a combined program for the treatment of fibromyalgia. METHODS: Subjects (n = 119) were randomly assigned to one of 4 groups: 1) biofeedback/relaxation training, 2) exercise training, 3) a combination treatment, or 4) an educational/attention control program. RESULTS: All 3 treatment groups produced improvements in self-efficacy for function relative to the control condition. In addition, all treatment groups were significantly different from the control group on tender point index scores, reflecting a modest deterioration by the attention control group rather than improvements by the treatment groups. The exercise and combination groups also resulted in modest improvements on a physical activity measure. The combination group best maintained benefits across the 2-year period. CONCLUSION: This study demonstrates that these 3 treatment interventions result in improved self-efficacy for physical function which was best maintained by the combination group.     

Effect of inhibition of nitric oxide synthase on chronic tension-type headache: a randomised crossover trial

BACKGROUND: Studies in animals have shown that nitric oxide plays an important part in central sensitisation and that inhibitors of nitric oxide synthase (NOS) decrease sensitisation in models of persistent pain. The efficacy of inhibitors of NOS has not been tested in patients with tension-type chronic headache. We aimed to show whether N(G)-monomethyl-L-arginine hydrochloride (L-NMMA), an inhibitor of NOS, is effective in relieving pain in such patients. METHODS: We undertook a randomised double-blind, crossover trial of 16 patients with chronic-tension-type headache. Patients were assigned intravenous infusion of 6 mg/kg L-NMMA or placebo on 2 days separated by at least 1 week in a randomised order. Headache intensity was measured on a 100 mm visual analogue scale, and on a verbal rating scale at baseline and at 30 min, 60 min, and 120 min after start of treatment. The primary endpoint was reduction of pain intensity on the visual analogue scale by the active treatment compared with placebo. FINDINGS: L-NMMA reduced pain intensity on the visual analogue scale significantly more than placebo: 120 min after start of treatment, the mean pain score was decreased from 49 to 33 with L-NMMA and from 44 to 40 with placebo (p=0.01). Pain intensity on the verbal rating scale was also significantly lower for treatment with L-NMMA than for treatment with placebo (p=0.02). INTERPRETATION: Inhibition of NOS had an analgesic effect in chronic tension-type headache. Further tests are required before clinical application.     

Biofeedback and relaxation therapy for chronic temporomandibular joint pain: Predicting successful outcomes.

57 patients with chronic temporomandibular joint (TMJ) pain were randomly assigned to receive either relaxation or biofeedback therapy. 27 Ss (mean age 35.6 yrs) listened to tape-recorded relaxation once a week at the therapist's office for 3 sessions and were encouraged to practice daily. 30 Ss (mean age 43 yrs) participated in biofeedback sessions and were instructed to practice relaxation for 20 min/day between sessions. Results show no significant differences in outcomes. However, successful Ss in the 2 conditions differed from each other. Successful relaxation Ss tended to be younger, had TMJ pain for a shorter period of time, and reported problems with other psychophysiologic disorders. Successful biofeedback Ss were older, married, had TMJ pain for a longer period of time, and had not received prior equilibration treatment. Equilibration and presence of other disorders were related to both short- and long-term outcomes, suggesting they may be useful as predictors of outcome. It is also suggested that knowledge of pretherapy factors may allow for optimal assignment to therapy conditions. (30 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A controlled evaluation of thermal biofeedback and thermal biofeedback combined with cognitive therapy in the treatment of vascular headache.

One-hundred-sixteen patients suffering from vascular headache (migraine or combined migraine and tension) were, after 4 weeks of pretreatment baseline headache monitoring, randomly assigned to one of four conditions: (a) thermal biofeedback with adjunctive relaxation training (TBF); (b) TBF plus cognitive therapy; (c) pseudomeditation as an ostensible attention-placebo control; or (d) headache monitoring. The first three groups received 16 individual sessions over 8 weeks, while the fourth group continued to monitor headaches. All groups then monitored headaches for a 4-week posttreatment baseline. Analysis revealed that all treated groups improved significantly more than the headache monitoring group with no significant differences among the three treated groups. On a measure of clinically significant improvement, the two TBF groups had slightly higher (51%) degree of improvement than the meditation group (37.5%). It is argued that the attention-placebo control became an active relaxation condition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of International Headache Society diagnostic criteria: a reliability study

In 1988 the International Headache Society (IHS) introduced new diagnostic criteria for headaches and craniofacial pain. Since headaches can be diagnosed solely on the basis of information provided by the patient, it is essential that the criteria are reproducible and consistent. Two neurologists evaluated the clinical records of 100 consecutive outpatients and transferred the data on headache and associated phenomena to a form designed to reflect the IHS criteria. Interobserver concordance (kappa statistics) in the application of the diagnostic criteria of primary headaches was: (i) "perfect" to "substantial" for the first IHS digit, being kappa = 1.0 for cluster headache and paroxysmal hemicrania; kappa = 0.88 for migraine; kappa = 0.75 for tension-type headache; (ii) "almost perfect" to "substantial" for the second digit (kappa = 0.94 for cluster headache; kappa = 0.90 for migraine with aura; kappa = 0.81 for episodic tension-type headache; kappa = 0.78 for migraine without aura; kappa = 0.71 for chronic tension-type headache; kappa = 0.66 for cluster headache-like disorder not fulfilling the criteria; (iii) "moderate" for migrainous disorder (kappa = 0.48) and headache of the tension-type (kappa = 0.43) not fulfilling the criteria. These results show that the IHS diagnostic criteria are satisfactorily applicable to high quality medical records abstracted by experienced neurologists.     

Helmut Heydt--friend and counsellor

Light and sound-induced discomfort and pain thresholds were measured in 26 patients with cervicogenic headache, in 40 patients with tension-type headache, and in 100 headache-free controls. Neither headache group was significantly different as to photophobia and phonophobia, but both were significantly more sensitive to light and sound than controls (p<0.0001), even when patients were tested in the headache-free period (p<0.05). Episodic and chronic tension-type headache had similar photo- and phonophobia thresholds (p> or =0.7). Tension-type headache patients were more photo- and phonophobic during headache than outside attack (p<0.05), but this was not true for cervicogenic headache (p> or =0.56). In cervicogenic headache patients, photophobia (p<0.05) but not phonophobia (p=0.28) was greater on the symptomatic side than on the non-symptomatic side.     

Relaxation therapy for tension headache in the elderly: A prospective study.

We evaluated the effects of an 8-week progressive muscle-relaxation therapy regimen on the headache activity of 10 elderly tension-headache subjects. Posttreatment assessment at 3 months revealed significant decreases in overall headache activity (50% or greater) in 7 subjects. Significant clinical or statistical prepost differences, or both, were also found for the number of headache-free days, peak headache activity, and medication index. This is the first prospective study of tension headache in an elderly population, and, unlike previous retrospective studies, it suggests that relaxation therapy may be an effective intervention in the treatment of such headaches. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Two studies of the long-term follow-up of minimal therapist contact treatments of vascular and tension headache.

Tension and vascular headache patients, initially treated with biofeedback and/or relaxation training in either a minimal therapist contact protocol (3 visits) or an intensive individual protocol (10 or 16 visits) were followed-up prospectively for 2 years. In the first study, for the first 6 months of follow-up, half of all patients continued to keep headache diaries and were seen monthly and the other half had only minimal contact. The results at 1-year follow-up, based on 4 weeks of daily headache diaries, revealed equally good maintenance from both treatment protocols and from both follow-up conditions. In Study 2, we found that patients remained improved over pretreatment baseline levels at the 2-year follow-up regardless of initial treatment intensity. Approximately three quarters of vascular patients who were initially improved at posttreatment remained improved at 2 years. (PsycINFO Database Record (c) 2010 APA, all rights reserved)