Effectiveness of biofeedback in treatment of chronic tension type headache and chronic migraine

10.5 % of the population in Russia suffers from chronic headache, which is complicated by a drug abusus and significantly reduces the quality of life. The search remains for highly effective non-pharmacological methods of treatment. The most evidential method for the prevention of headache is biofeedback (BFB). The aim of this study was to evaluate the effectiveness of isolated biofeedback therapy and its combination with other methods of the stress management program (SM) compared with standard drug therapy in patients with chronic migraine (CM) and chronic tension type headache (CTTH) based on neurological and psychological studies. Materials and methods. The study included 44 patients suffering from CTTH (n = 22) and CM (n = 22). Patients were divided into two groups. The treatment method in the main group was a complex SM program which includes biofeedback course, self-help relaxation techniques, lifestyle and thinking modification, art therapy; in the second group patients received standard drug therapy. According to a single scheme the examination included: clinical and neurological survey, study of qualitative and quantitative headache characteristics and its impact on life (psychological examination, stress diagnostics). Additionally, patients’ compliance was assessed. Results. In both treatment groups there was a statistically significant decrease in the headache frequency (p ≤ 0.01), pain intensity (in SM group p ≤ 0.01, in drug therapy group p < 0.05), anxiety and depression level (p ≤ 0.01), pain catastrophizing (p ≤ 0.01), increase in the General Health Index WHO-5 (p ≤ 0.01). But only in SM group there was a statistically significant decrease in stress level by PSM-25 (p < 0.01), pericranial muscles tention (p ≤ 0.01), and increase in stress resistance (p ≤ 0.01). At the same time, effectiveness of the complex SM program directly depended on the patients’ compliance: treatment effectiveness was significantly reduced using biofeedback exclusively. Conclusion. The combination of the BOS method with other CM methods is required to achieve a clinically significant high-level effect on the prevention of chronic headache. The complex program of CM (BF, relaxation techniques, lifestyle modification and thinking, art therapy) leads to the clinical improvement in the qualitative and quantitative characteristics of headache comparable to the results of drug therapy, whereas the effect obtained from stress management on the psychological state of patients and the quality of their life far exceeds the action of standard drugs used to prevent headaches.

biofeedback, neurofeedback, stress, stress management, headache, temporomandibular joint dysfunction syndrome, comorbidity

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