Progressive Relaxation und EMG-Biofeedback in der Therapie von chronischem Kopfschmerz bei Kindern

A group study on the comparative efficacy of EMG biofeedback and progressive relaxation is presented. Sixteen children aged between 8 and 14 years with chronic tension headache and combined headache participated in the study. Six sessions of relaxation training and 12 (shorter) biofeedback sessions were held with each child. Both treatments had excellent results, which were apparent directly after training. All but one child benefited to a clinically significant extent from the treatment, with a reduction of more than 50% in headache frequency. Other variables indicate further positive effects of treatment (e.g., medication consumption, absence from school). After 6 months of follow-up the children treated by relaxation had achieved event further reductions in headache activity. Suggestions for further improvement in the clinical and economic efficiency of treatment formats are presented, and perspectives for future research are discussed.     

Non-Invasive Treatment of Vascular and Muscle Contraction Headache: A Comparative Longitudinal Clinical Study

The purpose of this investigation was to evaluate the long-term course of non-invasively treated chronic headache. A total of 1015 adult patients with primary diagnosis of vascular/migraine or muscle contraction headache participated in the study investigating symptom frequency and severity over a 36 month period after receiving treatment. Treatment consisted of either: relaxation training (stepwise relaxation/hypnosis/autogenic training/cognitive behavior therapy); biofeedback (thermal/photoplethysmograph/EMG); micro-electrical therapy (TENS/Neurotransmitter Modulation) or multimodal treatment (combination of any of the above two treatments). Seven hundred and ninety-three patients returned sufficient data to be included in the analysis. Patients were randomly assigned to treatment groups and received either short term intervention (15 or less treatments) or long term intervention (greater than 15 treatments). Results indicate that all treatment conditions significantly reduced frequency and intensity of cephalalgia. Repeated measure analysis of variance indicated that grouping variables of Biofeedback treatment, symptoms being evidenced less than 2 years and receiving over 15 treatment sessions best predicted successful intervention.     

Effects of Frontalis EMG Biofeedback and Diazepam in the Treatment of Tension Headache

SYNOPSIS
Frontalis EMG biofeedback and diazepam treatments were compared in tension headache patients; headache scores (intensity and frequency) and frontalis EMG were used as control parameters. The study, conducted in a double blind manner, was split in three equal observation periods (4 weeks): baseline, treatment and follow-up. Four patient groups were chosen, two of which received placebo treatment. In both true conditions, biofeedback and diazepam, treatment effects differentiated from placebo groups; with diazepam the strongest results upon headache and frontalis EMG were observed during treatment, which, however, were lost at the follow-up period; biofeedback although with weaker effects during treatment showed, at follow-up, a long lasting reduction of headache scores even when frontalis activity reached baseline levels; in the false biofeedback group some decrease of EMG activity during treatment and of headache intensity at follow-up were also observed. The data suggest that biofeedback is a complex learning situation, where several uncompletely known factors are possibly at work; it also raises the possibility of a complex relation between frontalis muscular activity and headache since a simple linear relation of both variables was not observed.     

Pharmacological versus non-pharmacological prophylaxis of recurrent migraine headache: a meta-analytic review of clinical trials

In order to generate information about the relative effectiveness of the most widely used pharmacological and non-pharmacological interventions for the prophylaxis of recurrent migraine (i.e., propranolol HCl and combined relaxation/thermal biofeedback training), meta-analysis was used to integrate results from 25 clinical trials evaluating the effectiveness of propranolol and 35 clinical trials evaluating the effectiveness of relaxation/biofeedback training (2445 patients, collectively). Meta-analysis revealed substantial, but very similar improvements have been obtained with propranolol and with relaxation/biofeedback training. When daily recordings have been used to assess treatment outcome, both propranolol and relaxation/biofeedback have yielded a 43% reduction in migraine headache activity in the average patient. When improvements have been assessed using other outcome measures (e.g., physician/therapist ratings), improvements observed with each treatment have been about 20% greater. In both cases, improvements observed with propranolol and relaxation/biofeedback have been significantly larger than improvement observed with placebo medication (14% reduction) or in untreated patients (no reduction). Meta-analysis thus revealed substantial empirical support for the effectiveness of both propranolol and relaxation/biofeedback training, but revealed no support for the contention that the two treatments differ in effectiveness. These results suggest that greater attention should be paid to determining the relative costs and benefits of widely used pharmacological and non-pharmacological treatments.     

Biofeedback and Relaxation Training: The Effect on Headache and Associated Symptoms

SYNOPSIS
Patients suffering with migraine and muscle contraction headaches were treated with EMG and thermal biofeedback and relaxation training. Three groups were formed: Patients whose last contact with the practice was 3–12, 13–24, or 25 or more months prior to the follow-up study. Each group included patients who never attended biofeedback, who attended one session, two to six sessions, or seven or more sessions of biofeedback. A telephone questionnaire revealed that 86% of patients who attended seven or more sessions of biofeedback maintained a 75–100% reduction in headache frequency through time (25 or more months). Of these patients, 65.5% reported a reduction in associated symptoms. Only 31% of patients who never attended biofeedback reported a reduction in headache frequency. Only 16.3% of patients who never attended biofeedback reported a reduction in associated symptoms. The combination of biofeedback and relaxation training clearly results in a reduction of both headache experience as well as in associated symptoms.     

Change mechanisms in EMG biofeedback training: cognitive changes underlying improvements in tension headache

Forty-three college students suffering from recurrent tension headache were randomly assigned to 1 of 4 electromyographic (EMG) biofeedback training conditions. Although all subjects were led to believe they were learning to decrease frontal EMG activity, actual feedback was contingent on decreased EMG activity for half of the subjects and increased EMG activity for the other half. Within these 2 groups, subjects also viewed bogus video displays designed to convince them they were achieving large (high success) or small (moderate success) reductions in EMG activity. Regardless of actual changes in EMG activity, subjects receiving high-success feedback showed substantially greater improvement in headache activity (53%) than subjects receiving moderate success feedback (26%). Performance feedback was also related to changes in locus of control and self-efficacy. Changes in these 2 cognitive variables during biofeedback training were also correlated with reductions in headache activity following treatment, whereas changes in EMG activity exhibited during training were uncorrelated with outcome. These results suggest that the effectiveness of EMG biofeedback training with tension headache may be mediated by cognitive changes induced by performance feedback and not primarily by reductions in EMG activity.     

Relaxation treatment of adolescent headache sufferers: results from a school-based replication series

BACKGROUND: In recent reviews of psychological and drug treatment, relaxation training approaches have been found to be efficacious for children and adolescents suffering from recurrent tension-type headache (TTH), while biofeedback procedures provide effective help for migraine headache sufferers, primarily treated in tertiary clinics. OBJECTIVE: In a school-based replication series, the effectiveness and efficiency of relaxation training provided within school settings were examined, in addition to the effects on various headache features and the maintenance of treatment gains at a 6 to 10-month follow-up. METHODS: Over a 20-year period, 288 adolescents aged 10 to 18 years participated in seven randomized, controlled trials conducted within regular school health service settings. Subjects were included if they had suffered from frequent migraine or TTHs, or from both headache types for at least 1 year. Various formats of standardized relaxation training procedures were contrasted to different attention-control (ATCO) approaches or self-monitoring (SM) of headaches in prospective diary recordings. RESULTS: The results showed that a therapist-administered relaxation approach was superior to self-help or school-nurse administered relaxation training approaches, ATCO conditions or SM of headaches. Students with TTHs responded positively to any form of relaxation training, whereas those with frequent migraine responded well only to therapist-administered relaxation. However, school-nurse administered procedures were found to be the most efficient form of relaxation treatment, in particular for adolescents suffering from TTHs. Total headache activity, the number of headache days and peak headache intensity were significantly reduced after relaxation treatment, in addition to medication usage. Treatment gains were well maintained at the 6 to 10-month follow-up. CONCLUSION: Therapist-assisted relaxation training is an effective treatment for adolescents suffering from frequent TTHs or migraine. However, such treatment administered by school-nurses administered within school health care settings is an efficient treatment approach for adolescents suffering from the most common form of primary headache, ie, TTHs.     

Effects of Self-Hypnosis Training and EMG Biofeedback Relaxation Training on Chronic Pain in Persons with Spinal-Cord Injury

Thirty-seven adults with spinal-cord injury and chronic pain were randomly assigned to receive 10 sessions of self-hypnosis (HYP) or EMG biofeedback relaxation (BIO) training for pain management. Participants in both treatment conditions reported substantial, but similar, decreases in pain intensity from before to after the treatment sessions. However, participants in the HYP condition, but not the BIO condition, reported statistically significant decreases in daily average pain pre- to posttreatment. These pre- to posttreatment decreases in pain reported by the HYP participants were maintained at 3-month follow-up. Participants in the HYP condition, but not the BIO condition, also reported significant pre- to posttreatment increases in perceived control over pain, but this change was not maintained at the 3-month follow-up.     

EMG Activity in Pericranial Muscles During Postural Variation and Mental Activity in Healthy Volunteers and Patients With Chronic Tension Type Headache

EMG activity was recorded over frontalis, temporalis and trapezius muscles in a supine position, a standing position and during a mental task in 32 female patients suffering from chronic tension-type headache and in 20 healthy volunteers. Measurements in patients were made before and after biofeedback therapy. All EMG levels were on average significantly higher in patients than in controls. 62.5% of patients had at least one abnormal EMG level, but only 34% were beyond the normal range, if 1 muscle and 1 recording condition was considered. EMG levels were not correlated with headache severity, anxiety or response to biofeedback treatment. It is therefore suggested that pericranial EMG activity is not pathogenetic in chronic tension type headache, but merely one of several pathophysiologic changes, that are produced by a central dysfunction.     

Psychophysiological Reactivity in Migraine Following Biofeedback

SYNOPSIS
Biofeedback training is assumed to attenuate the psychophysiological effects of cognitive stressors. This study compared the effects of four varieties of biofeedback, namely, frontalis EMG, finger temperature, skin conductance, and false EMG feedback, in the treatment of severe migraine headache. Before and after treatment there was a psychophysiological assessment during attempted relaxation and during exposure to a variety of cognitive stressors. There was a statistically and clinically significant reduction in headache activity after treatment, with the four procedures being equally effective. Frontalis EMG biofeedback was superior to finger temperature, skin conductance, and false EMG biofeedback as a means of reducing scalp muscle tension, and showed some generalization to other physiological measures. There was no evidence that the physiological effects of the cognitive stressors were modified by any of the biofeedback procedures.     

Do the effects of cognitive therapy endure? A two-year follow-up of tension headache sufferers treated with cognitive therapy or biofeedback

This report presents findings from a two-year follow-up of chronic tension headache sufferers treated either with stress-coping training (cognitive therapy, N = 11) or electromyographic biofeedback (N = 8). Clients who had received stress-coping training reported that two years following treatment they continued to use the coping strategies they had been taught, and daily headache recordings indicated they were still significantly improved ( p < .005). About one-half of the clients treated with biofeedback were substantially improved following treatment, with the remaining clients showing minor improvements or increases in headache symptoms. These mixed outcomes were still evident at two-year follow-up, with three of four clients maintaining improvements and the remaining clients showing, at best, minor reductions in headache symptoms. This longterm maintenance of treatment gains following stress-coping training suggests that cognitive therapy deserves the increased attention of investigators interested in the long-term maintenance of therapeutic gains.Grants from NIMH supported the original treatment study (1-R03-MH28939-1) and facilitated preparation of this report (1-F32-MH08327-01).     

The Value of Biofeedback in the Treatment of Chronic Headache: a Four-year Retrospective Study

SYNOPSIS
A four-year retrospective study was completed with 693 headache patients who had completed a specific biofeedback training program. Patients 18 years of age and over were also given a Minnesota Multiphasic Personality Inventory to determine psychopathology, depression and anxiety levels, difficulty to motivate, and dependency. The purpose was to examine the long-term effects of biofeedback training on headache problems. Patients seen between January 1977 and December 1980, ages 6 through 72, with migraine, muscle contraction, mixed migraine and muscle contraction, and cluster headache were mailed an invisibly-coded 20-item questionnaire.The effect of such variables as age at time of training, sex, headache diagnosis, elapsed time since training, periodic follow-up (number of sessions), temperature training with instrumentation reinforcement and relaxation homework, the warm, supportive clinician/therapist relationship with positive expectations for the patient's success, and personality and psychological factors are predictive of success in the application of biofeedback to headache is discussed.     

Comprehensive Biofeedback Versus Self-Monitored Relaxation in the Treatment of Tension Headache

SYNOPSIS
Muscle contraction headaches have been demonstrated to significantly decrease following EMG biofeedback as well as general relaxation practice. This study contrasted the efficacy of a comprehensive biofeedback and stress management strategy and a self-monitored home relaxation program in the treatment of 20 tension headache sufferers. The results suggested that while both treatment strategies successfully increased patients' ability to relax and reduce frontalis EMG levels, only the comprehensive biofeedback program was successful in reducing reports of headache pain and feelings of psychological distress. The findings support the utility of a headache treatment model beginning with simple relaxation and progressing on a case by case basis to more comprehensive tension and stress management strategies (like EMG biofeedback and cognitive stress coping techniques) only when the less costly relaxation proves ineffective in altering subjective feelings of pain or distress.     

CEPHALIC VASOMOTOR AND ELECTROMYOGRAPHIC FEEDBACK IN THE TREATMENT OF COMBINED MUSCLE CONTRACTION AND MIGRAINE HEADACHES IN A GERIATRIC CASE

SYNOPSIS
The effects of cephalic vasomotor response (CVMR) feedback and electromyographic (EMG) feedback on control of CVMR, frontalis EMG and temporal artery vasospasms in muscle contraction and migraine headaches were investigated in a 67 year old woman. Systematic reductions in EMG activity were not achieved during EMG feedback. The frequency of temporal artery vasospams declined. No changes in amplitude of blood volume pulse (BVP) were observed during EMG feedback. A decrease in headache activity was associated with EMG feedback which may have been due to the reduction in temporal artery vasospasms. A treatment withdrawal condition was introduced after six EMG feedback sessions during which an increase in headache activity occurred. When CVMR feedback was introduced, the patient achieved significant BVP reductions. This control was related to the largest reduction in headache frequency and duration. Ratings representing subjective perception of the degree of disability because of headache also decreased during EMG feedback, CVMR feedback, and follow-up. At follow-up, there was a moderate increase in headache activity which was partially attributed to limited home practice.
This case demonstrates the successful use of biofeedback therapy in the treatment of combined vascular and muscle contraction headaches in an elderly patient and suggests that age not be a criterion for eliminating patients from this treatment. In addition, this case further supports the use of cephalic vasomotor feedback as an alternative to temperature training in the treatment of migraine.     

Chronic headaches in adolescents: treatment in a school setting with relaxation training as compared with information-contact and self-registration

An experimental study was conducted on 33 adolescent students with various types of chronic headaches (tension and combined tension and migraine headaches), all treated in a school setting. After a 4-week baseline period during which the subjects rated their headache activity, they were randomly assigned to a 9-session relaxation training programme or to an information-contact condition, both contrasted with an untreated self-registration group. Relaxation therapy alone led to significant improvement in headache activity, particularly in reduction of the frequency of complaints which still was significantly reduced at a 6-month follow-up evaluation. The effects obtained in the information-contact condition were comparable to those in the self-registration group, both achieving only minor improvements after treatment or at the follow-up assessment. The majority of students in the relaxation treatment, however, was much improved, attaining more than 50% reduction in headache activity. The findings in the present study are consistent with results from similar treatment outcome studies, reported on adult populations with chronic headaches, and demonstrate that relaxation training programmes can be of substantial help in a school setting.     

A Controlled Evaluation of the Addition of Cognitive Therapy to a Home-Based Biofeedback and Relaxation Treatment of Vascular Headache

Seventy-six patients with vascular (migraine or mixed migraine and tension) headache (HA) participated in a controlled evaluation of a minimal-therapist-contact, largely home-based, treatment program which combined relaxation (R) training with thermal biofeedback (TBF). One group received TBF + R administered in 3 office visit over 8 weeks, supplemented by audio tapes and manuals. A second group received the TBF + R plus instruction in cognitive stress coping techniques, all of which was administered in 5 office visits over 8 weeks. A third group monitored headache activity for 8 weeks. Evaluations, based on 4 weeks of HA diary at pre-treatment and after treatment, revealed significantly greater reductions in HA activity and medication consumption for both treated groups than the HA monitoring controls who did not change. Significantly more of the treated patients had clinically significant reductions in HA activity than the controls. The two treated groups did not differ on any measure.     

Effects of electromyography biofeedback-assisted relaxation on pain in patients with advanced cancer in a palliative care unit

Most patients with advanced cancer experience pain. However, many cancer patients do not find satisfaction with conventional treatment of pain relief. This study examined the effect of electromyography (EMG) biofeedback-assisted relaxation on cancer-related pain in advanced cancer patients. We hypothesized that changes in EMG activity in frontal muscles underlie the efficacy of EMG biofeedback-assisted relaxation. This was a randomized control study. The experimental group (n = 12) received 6 EMG biofeedback-assisted relaxation sessions over a 4-week period, whereas the control group (n = 12) received conventional care. The primary efficacy measure was the level of pain, measured by the Brief Pain Inventory. Findings from this study show that relaxation training supplemented with visual and auditory EMG biofeedback signals is effective in reducing cancer-related pain in advanced cancer patients, possibly through a mechanism of attenuation of physiological arousal. Electromyography biofeedback-assisted relaxation training may be used along with medications for effective pain management in patients with advanced cancer.     

Pain Response to Voluntary Muscle Tension Increases and Biofeedback Efficacy in Tension Headache

SYNOPSIS
The hypothesis that patients reporting an association between head pain and voluntary muscle tension increases could react more positively to EMG biofeedback was evaluated in 33 tension headache sufferers involved in a program of six training sessions and of a follow-up two months later. These patients were taught to increase their frontal muscle tension over 10 μvolts through biofeedback for a period of one minute at the first session and of two minutes at the second one. According to their subjective pain response, 14 patients were considered to show a positive association between head pain and muscle tension increases while the 19 others did not show such an association. The group of patients with a positive association between head pain and muscle tension showed a rapid symptomatic improvement which was partially lost as the training progressed, while the other reported a more linear gradual improvement. At follow-up, there was no difference in headache, drug usage and frontal EMG between the two groups. The differences in the shapes of the symptomatic responses are discussed in terms of patients' expectations from the training.     

The Differential Effects of Biofeedback in the Treatment of Menstrual and Nonmenstrual Migraine

The aim of the present study was to investigate the effects of biofeedback training in the treatment of menstrual and nonmenstrual migraine. Accordingly, 39 female patients suffering from both migraine associated, and migraine not associated, with menstrual periods were drawn from a pool of research volunteers enrolled in a biofeedback treatment program for migraine headaches. All patients were required to complete 5 weeks of daily self-monitoring of headache and menstruation activity immediately before and after treatment, and again at 6-month follow-up. Within-subjects comparisons of the effects of biofeedback on menstrual and nonmenstrual migraine, and between-subjects comparisons of the effects of biofeedback on patients suffering predominantly from either menstrual or nonmenstrual migraine showed that biofeedback is just as effective in reducing menstrual migraine as it is in reducing nonmenstrual migraine. Questions as to whether or not these conclusions can apply to patients who experience migraine headaches only during, or shortly before or after, menstruation, are raised.     

Altered skin temperature and electromyographic activity in the irritable bowel syndrome

A prospective study to determine the presence or absence of any difference in skin temperature and electromyographic (EMG) activity in 20 patients with irritable bowel syndrome (IBS) compared with 20 age- and sex-matched controls was conducted. A representative digital temperature and EMG activity during 4 phases, baseline, mental activity (arithmetic), unpleasant thoughts and audio biofeedback relaxation, were recorded using standard biofeedback equipment. Results showed the IBS group to have a significantly lower digital temperature and significantly higher EMG activity during the baseline and arithmetic phases. No difference was found in EMG activity for the unpleasant thought or audio biofeedback relaxation phases. Indeed, the IBS group were able to achieve a level of EMG activity during the audio feedback relaxation phase that approximated very closely that of the control group. These results provide further evidence suggestive of altered autonomic nervous system function in IBS patients and indicate that further studies should be undertaken to determine whether the reduction achieved in EMG activity post-relaxation is sustained, and if so, if it is associated with a corresponding improvement in symptoms.