48.: The effect of brief biofeedback intervention on headache disability and analgesic use in episodic or chronic migraine and chronic tension type headache

Abstract

Chronic headache and migraine are highly prevalent in Australia. Pharmacological treatment has low efficacy, often compounded by overuse of medication, and psychological distress in this population is common. Thus, easily accessible, non-pharmacological interventions that address psychological components of headache and migraine are needed. This study explored the effectiveness of biofeedback as a mechanism for change in analgesic use. Forty people diagnosed by a neurologist as experiencing either chronic or episodic migraine or tension type headache were given psycho-education and relaxation during two sessions of biofeedback. The present study utilized two sessions of biofeedback (which has shown promise in meta-analysis) as a mechanism for change. Biofeedback sessions were of 1 hour duration and repeated at 1 month. Using a pre-post experimental design, the Migraine Disability Score (MIDAS), affective distress (DASS5) and analgesic use were recorded before commencing biofeedback and by mail survey at 3 month follow up. Paired sample t-test was used to explore differences in MIDAS score and analgesic use from baseline to 3 month follow-up using 95% confidence intervals. Mean difference from baseline to follow-up in MIDAS scores was 23.43 (8.53, 38.3), t(1, 36) = 3.19, p = .003. Mean analgesic use difference was 9.47 (4.02, 14.92), t(1, 34) = 3.53, p = .001. These changes indicate a 56% improvement in headache disability scores and 58% reduction in analgesic use. Psychological interventions such as biofeedback may reduce both the burden of headache and reliance on medication for patients, simultaneously impacting on the cost of health care provision and lost work days due to headache disability. The 56% reduction in MIDAS scores could not be attributed to medication prophylaxis, which remained unchanged, or analgesic usage, which was reduced by 58% at 3 months. Further studies with a control group, larger cohort of patients and longer follow-up may determine a clinical benefit of biofeedback in the treatment of episodic and chronic migraine and chronic tension type headache.