Efficacy of Biofeedback in the Treatment of
Migraine and Tension Type Headaches
Authors: Mullally William J. 
Published: March 2021

Background: Biofeedback is an established non-pharmacologic technique commonly used in the
treatment of migraine and tension type headaches. Multiple published studies have suggested that
biofeedback is effective in reducing the frequency and severity of headaches, often allowing patients
to decrease their dependence on medication. Studies have also suggested that biofeedback may
effect a decrease in medical utilization.
Objective: Assess the efficacy of biofeedback in reducing the frequency and severity of migraine
and tension type headaches.
Design: Randomized, prospective, single blind, single center controlled trial.
Methods: Sixty-four patients with migraine with or without aura and/or tension type headaches,
by ICHD-1 criteria, age 18 to 55, who had suffered from headaches for more than one year, were
entered into the study. Patients were randomly assigned to receive biofeedback in addition to the
basic relaxation instruction or relaxation techniques alone. All patients received instruction in pain
theory. Biofeedback training consisted of 10 50-minute sessions utilizing standard EMG feedback
from the frontalis and trapezius muscles and temperature from the third finger of the dominant
hand. Visual and auditory feedback was provided. Thirty-three patients were assigned to receive
biofeedback plus the relaxation techniques and 31, the relaxation techniques alone.
All patients were asked to respond to periodic questionnaires for 36 months. The primary analysis
was an intention-to-treat (ITT) analysis. The subsidiary analyses were not and the 11 subjects (7 in the
relaxation alone and 4 in the biofeedback group) who received no treatment at all were analyzed and
the results were qualitatively the same.
Results: Patients who completed the program with education in pain theory and relaxation
techniques showed a statistically significant decrease in the frequency and severity of the headaches
in the first 12 months that continued to 36 months. Biofeedback provided no additional benefit,
specifically no change in the frequency or severity of the headaches. After 3 months 48% of those
in the relaxation group reported fewer severe headaches, while 35% of those in the biofeedback
group reported fewer severe headaches; after 6 months, 52% of those in the relaxation group
reported fewer severe headaches as compared with 57% reporting fewer severe headaches in the
biofeedback group.
The number of medications used by the patients and the utilization of medical care decreased in both
groups over 36 months suggesting a regression to the mean.
Limitations: Compliance was an issue throughout the study. Patients dropped out from the outset
and that increased over time. Recovery of questionnaires was difficult and fewer were completed at
each 3-month interval. Lack of a large control group who did not receive biofeedback or instruction
in relaxation techniques.
Conclusion: Biofeedback is an extremely costly and time-consuming treatment modality that, in
our study, provided no additional benefit when compared to simple relaxation techniques alone, in
the treatment of migraine and tension type headaches in adults.
Key words: Biofeedback, relaxation techniques, tension type headache, migraine, pain program,
non-pharmacologic treatment of headache