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The effectiveness of biofeedback therapy in treating headache has been explored in various clinical settings. However, few studies in the literature focused on well-diagnosed patients who failed properly applied analgesic treatment. The aim of the study is to explore whether the combination of biofeedback and analgesics is more effective than analgesics alone in treating patients with pharmacologically uncontrolled tension type headache and migraine. The hypothesis is that the combination of biofeedback and analgesics is more effective than analgesics alone in treating patients with uncontrolled tension type headache and migraine. Electromyographic and thermal biofeedback was utilized as an add-on treatment for 25 patients whose tension type headache and migraine was pharmacologically uncontrolled. The effect of the combination therapy was compared with the treatment effect of 25 similar patients, who continued receiving pharmacological treatment alone. All the subjects from the two groups were randomly selected from the pool of patients with uncontrolled tension type headache and migraine. The progress of two groups was closely monitored and data was collected for statistical analysis, which consists of Chi Square, non - parametric ANOVA, and Mann-Whitney U test. Some positive results were observed from the group of patients receiving combination therapy of biofeedback and analgesics, including: reduced use of analgesics, reduced muscle tension, reduced pain score, decrease in intensity, frequency, and duration of headache. These positive outcomes were rarely observed from the comparison group, in which pharmacological treatment was continued alone. The results indicate that the addition of biofeedback to standard analgesic therapy may be more effective than analgesics alone in treating patients with uncontrolled tension type headache and migraine. Further research is suggested to validate these findings and improve treatment effectiveness. ABSTRACT Biofeedback is a process of gaining greater awareness of many physiological functions for patients looking for a lifelong way to control headache beyond medications. Biofeedback allows the patient to play an active and integral role in maintaining his or her health. Within the last 35 years, continued research has shown biofeedback to be a viable therapeutic tool in the treatment of many disorders, including headache, high blood pressure, Reynaud’s disease, muscle spasm, chronic anxiety, neuro- muscular dysfunction, epilepsy, insomnia, asthma and numerous conditions (Yucha, 2002). Biofeedback is a non- drug therapy that patients use every day to control headache symptoms and reduce headache frequency. Biofeedback teaches you how to control bodily functions, such as heart rate, blood pressure and muscle tension, which once were considered to be beyond voluntary control. INTRODUCTION This is a retrospective, single blind, single centered controlled trial, composed of the analysis of a study group and ongoing treatment group • Group A (study group) - 25 patients were randomly selected from the pool of patients in our clinic who failed standard analgesic therapy for Tension and Migraine headaches. Each was offered the opportunity to receive biofeedback therapy for their headaches along with the standard medical treatment. • Group B (comparison group)- 25 similar patients who continued to receive standard medical care for their headaches. • All patients suffered from headaches with at least 2 episodes of chronic headaches per month. • Mean age in group A was 29.6 years and 31.2 years in the group B. The duration of study lasted one year between pre/during/post studies. • Social variables like marital status, rural/ urban domicile and educational status were comparable between the groups. • Each patient in group A received electromyographic biofeedback for 30 minutes and thermal biofeedback for 10 minutes during weekly sessions, for 10 sessions. • Headache intensity/duration/frequency and medication compliance was monitored with headache diary. • An overall statistical difference in universal pain scores with (p <0.05) between pre, post, and follow -up pain ratings for the two groups was identified using a non -parametric ANOVA. • Individual Mann-Whitney “U” tests were run to identify the source of change. STUDY DESIGN • • • At the start of the study, 19/25 patients receiving biofeedback scored above 50 on the headache impact test while 20/25 patients in the ongoing treatment group had scored above 50. By the end of the study, only 3/25 patients receiving biofeedback scored above 50 compared to 15/25 in the ongoing treatment group (p value: < 0.0001). There was a significant difference in the pre and post study value of F statistic in group A as compared to group B. RESULTS CONCLUSIONS • As shown by the statistical data in our study, biofeedback is effective treatment modality that provided additional benefit when compared to taking analgesics medication alone for migraine and tension-type headache in adults. Electromyographic and thermal biofeedback not only helps to avoid dependency on analgesics but also significantly improves pain management by the patient. • The results of this study also show that addition of biofeedback to standard analgesic therapy could help to treat uncontrolled chronic headache patients. REFERENCES 1. Stovner LJ, Hagen K, Jensen R, Katsarava Z, Lipton RB, Scher AI, Steiner TJ, Zwart J-A: The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia 2007, 27: 193– 210. 2. Lipton RB, Scher AI, Kolodner K, Headaches Liberman J, Steiner TJ, Stewart WF. Migraine in the United States: epidemiology and patterns of health care use. Neurology. 2002 Mar 26. 58(6):885-94. 3. Madsen BK, Søgaard K, Andersen LL, Skotte JH, Jensen RH. Neck and shoulder muscle strength in patients with tension-type headache: A case-control study. Cephalalgia. 2015 Apr 1. 0 5 10 15 20 25 30 Group A Group B s t n e i t a P f o r e b m u N N Pre-study HIT >50 Post-Study HIT >50 Group Mean Change Biofeedback (Group A) 3.88 Gain Tradi�onal (Group B) 1.76 Gain 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 3.88 1.76 Biofeedback Traditional Mean COMPARISON OF TRADITIONAL THERAPY VERSUS BIOFEEDBACK FOR TENSION TYPE AND MIGRAINE HEADACHES A ONE YEAR RETROSPECTIVE STUDY OF 50 PATIENTS Ghazala Nathu, MS, MD, PhD, FACB Adila Nathu, MD,PA, TC(NRCC) Post Treatment Differences Biofeedback Treatment(Gp A) and Ongoing Treatment(Gp B) NEI PRESENTATION
