Neurofeedback and headache or migraine management
Chronic pain, including migraines, can have a widespread impact on overall brain function, but also present with co-morbidities that often develop in association with pain e.g. anxiety, depression and sleep disturbances.
Migraine and chronic pain sufferers may require long-term medication, often with undesirable side-effects. The search for better pain management options has made considerable progress in the last few decades, with patients and clinicians alike turning to neurofeedback therapy as a promising option.
Neurofeedback training has been found to be effective in decreasing the intensity and frequency of headaches and migraines, particularly in children and adolescents. Training with neurofeedback can also provide long-term relief for people suffering from migraines, with this lasting alleviation as the main goal.
Nelson and Esty (2015) explored the use of neurofeedback in 9 war veterans with moderate to severe chronic headaches following traumatic brain injury (TBI) sustained in military service. The veterans also presented symptoms of post-traumatic stress. Neurofeedback therapy was undertaken at the Brain Wellness and Biofeedback Center of Washington (in Bethesda, Maryland, USA). Following treatment, the researchers found a significant reduction in headaches and post-traumatic stress in all but one participant. A subset of the group also reported complete cessation of headaches. Overall, this recent study highlights the potential efficacy for chronic post-traumatic headaches sustained in military service. Therefore, this research is promising for the role of neurofeedback in the future widespread treatment of individuals suffering from chronic headaches.
In 2014, Farahani and colleagues evaluated and compared the efficacy of neurofeedback and transcutaneous electrical nerve stimulation (TENS) in the treatment of migraine headaches in 45 healthcare providers. The neurofeedback, TENS, and control group (no treatment) were selected randomly, with all three groups completing a headache diary prior to and throughout the study. The results of the study indicate that neurofeedback and TENS significantly reduced the frequency, severity, and duration of headaches. Furthermore, comparing the two methods, neurofeedback was demonstrated to be more effective in reducing headache frequency and severity.
Mauskop (2012) highlights existing research that supports the efficacy of some nonpharmacologic therapies, including biofeedback interventions. The researcher notes that such nonpharmacologic therapies approach, if not exceed, effectiveness for the prevention of migraine and tension-type headaches. Additionally, the use of an intervention such as biofeedback carries very low risk side effects compared to medication, without the need for life-long treatment (and expense). Overall, it is becoming increasingly convincing that when considering efficacy, minimal side effects, and cost savings, medications should be considered in conjunction with nonpharmacologic therapies.
Walker (2011) examined the effects of neurofeedback therapy versus drug therapy in 71 patients with recurrent migraine headaches. After completion of a quantitative electroencephalogram (QEEG) procedure, all results indicated an excess of high-frequency beta activity (21-30 Hz). Twenty-five patients chose to continue with drug therapy for their recurring migraines, whilst 46 of the 71 patients selected neurofeedback training. Of those who chose neurofeedback therapy, the majority (54%) reported complete abolishment of their migraines, 39% experienced a significant reduction in migraine frequency of greater than 50%, and 4% experienced a decrease in frequency of less than 50%. Only one patient did not report a reduction in headache frequency. The control group of participants who opted to continue drug therapy as opposed to neurofeedback experienced no change in headache frequency (68%), a reduction of less than 50% (20%), or a reduction greater than 50% (8%). Overall, the study demonstrates that neurofeedback is significantly effective in abolishing or substantially reducing the frequency of headaches in patients with recurrent migraine.
Stokes and Lappin (2010) from the Better Brain Centre in Virginia, conducted a longitudinal pre-post treatment study involving 37 migraine sufferers. Participants underwent an average of 40 neurofeedback sessions paired with 10 thermal hand-warming biofeedback sessions, and completed migraine diaries over the course of the study, including symptom severity, frequency, duration and medication use. Following the treatment, reductions in elevated EEG amplitudes of both slow and fast-wave activity were observed, and participants reported feeling a sense of mastery over the prediction and prevention of the occurrence of their migraines, which allowed them to better manage their symptoms. Additionally, 70% of the participants reported a 50% reduction in migraine frequency, and this reduction was sustained at the 14.5 month follow-up assessment. Although the benefits of the treatment cannot be solely attributed to neurofeedback, it is likely that neurofeedback is responsible for the majority of the treatment effect given the small number of thermal biofeedback sessions that were undertaken by the participants. Moreover, the thermal biofeedback sessions are unlikely to account for the observed changes to slow and fast wave brain activity.
In 2007, Nestoriuc and Martin conducted a meta-analysis of 55 previous studies to examine the efficacy of biofeedback interventions in treating migraine. A summary of the research indicates that for all biofeedback interventions, improvements were maintained over an average follow-up period of 17 months. The frequency of migraine attacks and perceived self-efficacy demonstrated the strongest improvements. Overall, this review of research indicates the substantial clinical improvements of individuals with migraine headaches utilising neurofeedback therapy.
A study investigating the use of slow cortical potential (SCP) training by Siniatchkin (2000) examined the efficacy of this therapy in 10 children suffering from migraine without aura. In comparison to healthy control children, the migraine children were characterised by lacking the ability to control cortical negativity. Following 10 feedback sessions, the researchers observed a significant reduction of cortical excitability and an associated reduction of days with migraine/headaches. Therefore, it appears that the normalisation of the threshold regulation of cortical excitability during feedback training may result in clinical improvement.
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Farahani, D. M., Tavallaie, S. A., Ahmadi, K., & Ashtiani, A. F. (2014). Comparison of Neurofeedback and Transcutaneous Electrical Nerve Stimulation Efficacy on Treatment of Primary Headaches: A Randomized Controlled Clinical Trial. Iranian red crescent medical journal, 16(8), e17799. doi:10.5812/ircmj.17799
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Mauskop, A. (2012). Nonmedication, alternative, and complementary treatments for migraine. Continuum: Lifelong Learning in Neurology, 18(4, Headache), 796-806.
Nelson, D. V., & Esty, M. L. (2015). Neurotherapy for chronic headache following traumatic brain injury. Military Medical Research, 2(1). doi:10.1186/s40779-015-0049-y
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Siniatchkin, M., Hierundar, A., Kropp, P., Kuhnert, R., Gerber, W.-D., & Stephani, U. (2000). Self-regulation of slow cortical potentials in children with migraine: an exploratory study. Applied psychophysiology and biofeedback, 25(1), 13-32.
Stokes, D. A., & Lappin, M. S. (2010). Neurofeedback and biofeedback with 37 migraineurs: A clinical outcome study. Behavioral and Brain Functions, 6(1), 9-9. doi:10.1186/1744-9081-6-9
Walker, J. E. (2011). QEEG-Guided Neurofeedback for Recurrent Migraine Headaches. Clinical EEG and Neuroscience, 42(1), 59-61. doi:10.1177/155005941104200112