Cognitive changes of migraine headache patients receiving biofeedback and coping skills treatments

This study investigated cognitive changes associated with migraine treatments and changes in pain experiences after receiving biofeedback and coping skills treatment. Specifically, several questions were addressed. Firstly, which treatment produced the best outcome? Secondly, what particular coping strategies do migraine sufferers use? Thirdly, how are the groups similar and different in their beliefs of physiological control, headache control and cognitive coping strategies? Finally, how were these beliefs related to headache outcome? Participants were 44 females presenting with chronic migraine headache who volunteered for a research project at Sunnybrook Hospital. They were randomly assigned to one of three groups—hand temperature biofeedback, a headache coping skills group or headache monitoring control. All individuals completed a questionnaire package at pre- and post-treatment along with a progress form at post-treatment. They also recorded daily their headache activity, medications and hand skin temperature. The questionnaire packages were also completed 3 months after treatment. The recorded headache data revealed that participants receiving either hand temperature biofeedback or a headache coping skills treatment showed a tendency to decrease headache activity (i.e., an average decrease of 20% and 3%, respectively). Migraine sufferers receiving biofeedback reported significant improvement in overall headache and headache frequency whereas there was only a tendency for the coping skills training group to report improvement in overall headache and headache duration. The levels of headache activity obtained after treatment were maintained at follow-up. Contrary to previous findings, participants did not become more internal about their belief to control their headaches. Participants receiving biofeedback did, however, feel more in control of their physiological processes after treatment. Prior to treatment, the particular coping strategies most frequently used were coping self-statements, ignoring pain sensations and diverting attention. Participants were also catastrophizing. The least used strategies were reinterpreting pain sensations and praying. After treatment, the treatment groups were catastrophizing less and there was a trend for them to utilize more coping self-statements and to engage in more behavioral activities than those who simply monitored their headaches. On average, both treatment groups reported they were coping better with their headaches. Beliefs of headache control and beliefs of physiological control were correlated with improvement in ratings of overall headache condition, headache frequency and intensity. In other words, the more one felt in control, the more one reported improvement in their overall headache condition as well as fewer and less painful headaches. Also, the less one catastrophized and ignored their pain, the fewer headaches were reported. The cognitive changes that occurred were not specific to the treatments but resulted from participating in a treatment. The association of these cognitive changes to reduced headache activity are consistent with theories that stress cognitive factors as central mechanisms to explain the efficacy of these treatments.