Biofeedback Training

Therapy 2: Biofeedback Training

What is it?

It involves the monitoring and voluntary control of physiologic processes, allowing patients to take an active role in managing their pain.

All forms of BFB involve the conversion of biologic or physiologic information into a signal that is then “fed back” in auditory form (such as clicks varying in rate) or visual form (such as bars varying in length).

In migraine, peripheral skin temperature feedback (TEMP-FB), blood-volume-pulse feedback (BVP-FB), and electromyographic feedback (EMG-FB) are most commonly used.¹

How does it work?

Biofeedback training uses the principle of Operant Conditioning, in which positive feedback is used to reinforce the actions that are desirable and negative feedback is used to discourage the actions that are not desired.

The first step involves selecting the appropriate modality and establishing a baseline parameter. The next step is learning to control the parameter and practicing until the action becomes ingrained in memory.¹

What is the efficacy?

Method: The following studies were done to assess the effectiveness of biofeedback in managing menstrual or migraine headaches.

1. A systematic review and meta-analysis that analyzed 9 randomized controlled trials involving 558 participants. It compared biofeedback interventions (like thermal biofeedback and EMG) with controls (such as no treatment, medications, or cognitive therapies).²

2. Another was a randomized controlled clinical study, with 100 migraine patients, including patients with menstrual migraine. Participants were divided into three groups:³

   1. Conventional therapy (medications)

   2. Biofeedback alone (breathing and relaxation training)

   3. Combination of biofeedback and pharmacotherapy Headache frequency, intensity, and quality of life were tracked for up to 24 months.

Results: The meta-analysis found that biofeedback significantly reduced migraine frequency and severity when compared to no treatment. However, when compared to active treatments like medications or CBT, the difference was not statistically significant, suggesting similar effectiveness.

In the clinical trial, improvements were observed in all groups, but the highest improvement (about 74%) was seen in the group that received biofeedback along with conventional therapy. The group with biofeedback alone also showed good results (around 43% improvement), though not as high as the combination group. Those on medication alone saw about 57% improvement.

Conclusion: The combined findings from both studies support that biofeedback training is an effective and safe method for managing menstrual migraine. It helps reduce headache frequency, intensity, and the need for medications. The benefits are especially noticeable when biofeedback is combined with conventional treatments.

Side-Effects

Biofeedback techniques offer a safe and effective way to relieve symptoms and enhance quality of life without significant adverse effects.¹

Reference

1. Malik K, Dua A. Advancing Patient Care With Biofeedback. StatPearls; StatPearls Publishing: Treasure Island, FL, USA. 2025.

2. Paudel P, Sah A. Efficacy of biofeedback for migraine: A systematic review and meta-analysis. Complementary therapies in medicine. 2025 Mar 8:103153.

3. Ashwith B. Efficacy of biofeedback in treatment of migraine. International Journal of Research in Medical Sciences. 2023 Feb;11(2):1.