Mechanism of the Biofeedback Therapy of Migraine: Volitional Manipulation of the Psychophysiological Background

Abstract

SYNOPSIS Twenty‐nine female migraineurs were assigned to biofeedback and 20 to drug therapy. The average personality profile of the two groups showed neuroticism, with scores on scales 1, 2 and 3 statistically equal between the two groups. Following the therapy, neuroticism significantly improved in the clinically improved biofeedback group, but remained unchanged in clinically unimproved biofeedback and medication, as well as medication improved groups. Neuroticism thus seems to be an integral part of migraine etiology rather than a result of chronic pain. Therefore, volitional alteration of the psychophysiological background of migraineurs by biofeedback as a causative therapy should be preferred to the drugs whenever possible.

Psychological Functioning in Headache Sufferers

“…To determine direction of effect, researchers would need to assess individuals either 1) prior to development of headache or 2) following a course of treatment designed to alter a) the frequency and severity of pain alone or b) the person's personality or psychological makeup alone (of course, it is difficult to separate these factors in treatment). Sovak et al (32) recently carried out investigational strategy "2a" by treating a group of migraineurs with a standard drug treatment and administering the MMPI both prior to and following treatment. Subjects successfully treated revealed minimal changes on the MMPI, suggesting, as indicated by the authors, that certain psychological characteristics may be an integral etiological feature of migraine.…”

Three studies of the psychologic changes in chronic headache patients associated with biofeedback and relaxation therapies.

“…Following a convention established earlier (4), a patient was labeled "successful" if he or she had at least a 50% reduction in headache activity. [This is the same criterion used by Sovak et al (1).] Treatments All patients received ten sessions of progressive relaxation training, spread over approximately 8 weeks.…”

“…Moreover, since Sovak et al (1) did not directly compare successfully and unsuccessfully treated patients, we do not know if successful treatment leads to significantly greater improvement in psychologic status than does unsuccessful treatment. Finally, neither study (1,2) controlled for the passage of time or regression effects due to repeated psychologic testing.…”

“…In the first, Sovak et al (1) compared thermal biofeedback combined with autogenic training to propranolol (and occasional analgesics) in the treatment of migraine headache. All patients took the MMPI prior to the beginning of treatment and approximately 1 month after the end of treatment.…”

Nonpharmacologic treatment of migraine

“…However, most of these studies were done before the first International Headache Classification and used measures to quantify improvement that are difficult to compare with the methods used today. Holroyd et al [9] showed a superiority of TBF therapy and relaxation combined with propranolol 80 to 160 mg daily compared with the behavioral therapies alone; in another study, TBF and relaxation were not significantly different from propranolol [10].…”