Steven Baskin, PhD, and Alan Rapoport, MD

What types of headache and other illnesses respond to biofeedback training?

Migraine affects about 12% of the US and most Western populations, and is 3 times more common in women than men. Migraine can be treated with a variety of strategies that include medications and nonpharmacologic therapies such as biofeedback, as well as other behavioral therapies and devices. Biofeedback refers to the use of instrumentation to monitor and display physiologic responses that the patient may not be aware of so that they can be “modified” in a more adaptive direction. Feedback gives immediate objective information and is usually combined with a relaxation-based therapy. The most common biofeedback treatments for migraine include feeding back muscle activity in the face and neck to help people relax contracted muscles and teach them a “low-arousal” response; they learn to increase finger temperature, which coincides with modifying the “stress” nervous system. Biofeedback has been shown to be helpful for migraine and tension-type headache. It is also helpful to decrease anxiety and stress levels and lower blood pressure.

Can patients use biofeedback treatments in conjunction with migraine medication?

Research has shown that migraine, in particular higher-frequency migraine, is best treated by a combination of medications and behavioral strategies. Biofeedback is a good option for use in conjunction with medication for migraine.

Who is trained to provide biofeedback treatments?

Biofeedback for migraine is something usually performed by psychologists and other professionals with specialized training. Many practitioners are certified by the Biofeedback Certification Institute of America (BCIA). It is important to find an experienced biofeedback practitioner who also has some expertise in treating headache disorders. 

How are biofeedback treatments performed?

Biofeedback is a therapy that follows a learning model whereby the patient gradually learns a self-regulation skill that impacts their headaches. 

Patients come to an office, typically once per week, where they are attached to instruments that measure physical responses associated with migraine. The patient typically sits in a comfortable chair or recliner, and numerous physiologic responses are monitored with surface electrodes. 

When treating headache, sensors are typically placed on the head and neck to monitor muscle responses and a thermistor is placed on a finger to measure temperature. Feedback is given via visual cues (computer graphics) or a change in auditory tone as the patient is taught various relaxation techniques.  

Patients use the feedback to learn a physiologic relaxation response that may be beneficial for their headache management. Most of the research on biofeedback is related to treatment to prevent migraine; however, these techniques can be helpful to use during an acute attack, ideally paired with an acute care migraine medication. 

Can children with migraine have biofeedback treatments as well?

 Most children typically have a lower frequency of migraine than adults, although some have frequent migraines with associated disability and are candidates for preventive medication (although no medications are yet approved for children by the US Food and Drug Association). Most children are good candidates for behavioral therapies such as biofeedback. There are many computer games utilized in biofeedback training that children easily learn to modify physical responses. There are some fairly recent data suggesting that behavioral treatments, some of which include biofeedback, are effective strategies for children and may be more effective than preventive medication.  

What other types of illnesses could benefit from biofeedback training?    

There are data showing that biofeedback therapy can be helpful for anxiety disorders, insomnia, and functional bowel disorders and may help in modifying high blood pressure. It can also be a very effective stress-management strategy.  

Do you refer some of your patients with migraine to a psychologist for biofeedback treatments?      

 Yes, but it is always good for the referring physician to check on the credentials of the person performing the biofeedback treatment. Some headache specialists might do it themselves, but we do not. It takes a while—at least several sessions—and psychologists are better at it. Patients’ perspectives are also important. We communicate with the referred biofeedback treatment specialist to get more insight on the patient. For example, some patients are anxious and depressed, and they are not sleeping at night. The doctor we referred the patient to may recommend an antidepressant for the patient to help address those issues. It is a team effort.

What is the average cost per treatment?      
The costs vary throughout the country and range from $75 to $400 per session. Insurance coverage varies.  

How many times should a patient go in for treatment?    

Most protocols are about 10 to 12 sessions, depending on patient response. 

Have there been clinical trials on biofeedback treatments/devices?  

There have been many clinical trials that have been positive, so there is good evidence that biofeedback can be an effective treatment for migraine and tension-type headache. There are many types of biofeedback devices that measure different modalities. The most common one used in migraine is measuring scalp muscle contraction with surface electromyography or measuring peripheral blood flow with a temperature gauge. The goals are to relax muscles and learn to increase finger temperature, which is related to decreased arousal of the sympathetic nervous system or stress system. Other modalities include learning to modulate brain waves (electroencephalography or neurofeedback) and certain cardiovascular measures that reduce the stress response by a different mechanism. The goal is for patients to learn a low arousal response that they can utilize in their natural environment. Certain breathing techniques and visualization exercises are also helpful, but biofeedback refers to using physiologic recording equipment to help learn to change physical responses related to headache disorder. 

Over our years of experience, we have found that biofeedback can help a large percentage of our patients with migraine and tension-type headache, and it is associated with almost no adverse events.

What types of headache and other illnesses respond to biofeedback training?

Migraine affects about 12% of the US and most Western populations, and is 3 times more common in women than men. Migraine can be treated with a variety of strategies that include medications and nonpharmacologic therapies such as biofeedback, as well as other behavioral therapies and devices. Biofeedback refers to the use of instrumentation to monitor and display physiologic responses that the patient may not be aware of so that they can be “modified” in a more adaptive direction. Feedback gives immediate objective information and is usually combined with a relaxation-based therapy. The most common biofeedback treatments for migraine include feeding back muscle activity in the face and neck to help people relax contracted muscles and teach them a “low-arousal” response; they learn to increase finger temperature, which coincides with modifying the “stress” nervous system. Biofeedback has been shown to be helpful for migraine and tension-type headache. It is also helpful to decrease anxiety and stress levels and lower blood pressure.

Can patients use biofeedback treatments in conjunction with migraine medication?

Research has shown that migraine, in particular higher-frequency migraine, is best treated by a combination of medications and behavioral strategies. Biofeedback is a good option for use in conjunction with medication for migraine.

Who is trained to provide biofeedback treatments?

Biofeedback for migraine is something usually performed by psychologists and other professionals with specialized training. Many practitioners are certified by the Biofeedback Certification Institute of America (BCIA). It is important to find an experienced biofeedback practitioner who also has some expertise in treating headache disorders. 

How are biofeedback treatments performed?

Biofeedback is a therapy that follows a learning model whereby the patient gradually learns a self-regulation skill that impacts their headaches. 

Patients come to an office, typically once per week, where they are attached to instruments that measure physical responses associated with migraine. The patient typically sits in a comfortable chair or recliner, and numerous physiologic responses are monitored with surface electrodes. 

When treating headache, sensors are typically placed on the head and neck to monitor muscle responses and a thermistor is placed on a finger to measure temperature. Feedback is given via visual cues (computer graphics) or a change in auditory tone as the patient is taught various relaxation techniques.  

Patients use the feedback to learn a physiologic relaxation response that may be beneficial for their headache management. Most of the research on biofeedback is related to treatment to prevent migraine; however, these techniques can be helpful to use during an acute attack, ideally paired with an acute care migraine medication. 

Can children with migraine have biofeedback treatments as well?

 Most children typically have a lower frequency of migraine than adults, although some have frequent migraines with associated disability and are candidates for preventive medication (although no medications are yet approved for children by the US Food and Drug Association). Most children are good candidates for behavioral therapies such as biofeedback. There are many computer games utilized in biofeedback training that children easily learn to modify physical responses. There are some fairly recent data suggesting that behavioral treatments, some of which include biofeedback, are effective strategies for children and may be more effective than preventive medication.  

What other types of illnesses could benefit from biofeedback training?    

There are data showing that biofeedback therapy can be helpful for anxiety disorders, insomnia, and functional bowel disorders and may help in modifying high blood pressure. It can also be a very effective stress-management strategy.  

Do you refer some of your patients with migraine to a psychologist for biofeedback treatments?      

 Yes, but it is always good for the referring physician to check on the credentials of the person performing the biofeedback treatment. Some headache specialists might do it themselves, but we do not. It takes a while—at least several sessions—and psychologists are better at it. Patients’ perspectives are also important. We communicate with the referred biofeedback treatment specialist to get more insight on the patient. For example, some patients are anxious and depressed, and they are not sleeping at night. The doctor we referred the patient to may recommend an antidepressant for the patient to help address those issues. It is a team effort.

What is the average cost per treatment?      
The costs vary throughout the country and range from $75 to $400 per session. Insurance coverage varies.  

How many times should a patient go in for treatment?    

Most protocols are about 10 to 12 sessions, depending on patient response. 

Have there been clinical trials on biofeedback treatments/devices?  

There have been many clinical trials that have been positive, so there is good evidence that biofeedback can be an effective treatment for migraine and tension-type headache. There are many types of biofeedback devices that measure different modalities. The most common one used in migraine is measuring scalp muscle contraction with surface electromyography or measuring peripheral blood flow with a temperature gauge. The goals are to relax muscles and learn to increase finger temperature, which is related to decreased arousal of the sympathetic nervous system or stress system. Other modalities include learning to modulate brain waves (electroencephalography or neurofeedback) and certain cardiovascular measures that reduce the stress response by a different mechanism. The goal is for patients to learn a low arousal response that they can utilize in their natural environment. Certain breathing techniques and visualization exercises are also helpful, but biofeedback refers to using physiologic recording equipment to help learn to change physical responses related to headache disorder. 

Over our years of experience, we have found that biofeedback can help a large percentage of our patients with migraine and tension-type headache, and it is associated with almost no adverse events.

What types of headache and other illnesses respond to biofeedback training?

Migraine affects about 12% of the US and most Western populations, and is 3 times more common in women than men. Migraine can be treated with a variety of strategies that include medications and nonpharmacologic therapies such as biofeedback, as well as other behavioral therapies and devices. Biofeedback refers to the use of instrumentation to monitor and display physiologic responses that the patient may not be aware of so that they can be “modified” in a more adaptive direction. Feedback gives immediate objective information and is usually combined with a relaxation-based therapy. The most common biofeedback treatments for migraine include feeding back muscle activity in the face and neck to help people relax contracted muscles and teach them a “low-arousal” response; they learn to increase finger temperature, which coincides with modifying the “stress” nervous system. Biofeedback has been shown to be helpful for migraine and tension-type headache. It is also helpful to decrease anxiety and stress levels and lower blood pressure.

Can patients use biofeedback treatments in conjunction with migraine medication?

Research has shown that migraine, in particular higher-frequency migraine, is best treated by a combination of medications and behavioral strategies. Biofeedback is a good option for use in conjunction with medication for migraine.

Who is trained to provide biofeedback treatments?

Biofeedback for migraine is something usually performed by psychologists and other professionals with specialized training. Many practitioners are certified by the Biofeedback Certification Institute of America (BCIA). It is important to find an experienced biofeedback practitioner who also has some expertise in treating headache disorders. 

How are biofeedback treatments performed?

Biofeedback is a therapy that follows a learning model whereby the patient gradually learns a self-regulation skill that impacts their headaches. 

Patients come to an office, typically once per week, where they are attached to instruments that measure physical responses associated with migraine. The patient typically sits in a comfortable chair or recliner, and numerous physiologic responses are monitored with surface electrodes. 

When treating headache, sensors are typically placed on the head and neck to monitor muscle responses and a thermistor is placed on a finger to measure temperature. Feedback is given via visual cues (computer graphics) or a change in auditory tone as the patient is taught various relaxation techniques.  

Patients use the feedback to learn a physiologic relaxation response that may be beneficial for their headache management. Most of the research on biofeedback is related to treatment to prevent migraine; however, these techniques can be helpful to use during an acute attack, ideally paired with an acute care migraine medication. 

Can children with migraine have biofeedback treatments as well?

 Most children typically have a lower frequency of migraine than adults, although some have frequent migraines with associated disability and are candidates for preventive medication (although no medications are yet approved for children by the US Food and Drug Association). Most children are good candidates for behavioral therapies such as biofeedback. There are many computer games utilized in biofeedback training that children easily learn to modify physical responses. There are some fairly recent data suggesting that behavioral treatments, some of which include biofeedback, are effective strategies for children and may be more effective than preventive medication.  

What other types of illnesses could benefit from biofeedback training?    

There are data showing that biofeedback therapy can be helpful for anxiety disorders, insomnia, and functional bowel disorders and may help in modifying high blood pressure. It can also be a very effective stress-management strategy.  

Do you refer some of your patients with migraine to a psychologist for biofeedback treatments?      

 Yes, but it is always good for the referring physician to check on the credentials of the person performing the biofeedback treatment. Some headache specialists might do it themselves, but we do not. It takes a while—at least several sessions—and psychologists are better at it. Patients’ perspectives are also important. We communicate with the referred biofeedback treatment specialist to get more insight on the patient. For example, some patients are anxious and depressed, and they are not sleeping at night. The doctor we referred the patient to may recommend an antidepressant for the patient to help address those issues. It is a team effort.

What is the average cost per treatment?      
The costs vary throughout the country and range from $75 to $400 per session. Insurance coverage varies.  

How many times should a patient go in for treatment?    

Most protocols are about 10 to 12 sessions, depending on patient response. 

Have there been clinical trials on biofeedback treatments/devices?  

There have been many clinical trials that have been positive, so there is good evidence that biofeedback can be an effective treatment for migraine and tension-type headache. There are many types of biofeedback devices that measure different modalities. The most common one used in migraine is measuring scalp muscle contraction with surface electromyography or measuring peripheral blood flow with a temperature gauge. The goals are to relax muscles and learn to increase finger temperature, which is related to decreased arousal of the sympathetic nervous system or stress system. Other modalities include learning to modulate brain waves (electroencephalography or neurofeedback) and certain cardiovascular measures that reduce the stress response by a different mechanism. The goal is for patients to learn a low arousal response that they can utilize in their natural environment. Certain breathing techniques and visualization exercises are also helpful, but biofeedback refers to using physiologic recording equipment to help learn to change physical responses related to headache disorder. 

Over our years of experience, we have found that biofeedback can help a large percentage of our patients with migraine and tension-type headache, and it is associated with almost no adverse events.