Biofeedback therapy for pediatric headache: factors associated with response
Heidi K Blume1, Libby N Brockman, Cora C Breuner
1Division of Pediatric Neurology, University of Washington, Seattle Children's Hospital, Center for Integrative Brain Research, Seattle, WA, USA. heidi.blume@seattlechildrens.org
Insights
Biofeedback therapy (BFT) effectively reduces headache frequency in children and adolescents. Factors like improved hand temperature and SSRI use correlate with positive outcomes in pediatric headache management.
Area of Science:
- Pediatric Neurology
- Behavioral Medicine
- Pain Management
Background:
- 17% of US children experience frequent or severe headaches.
- Biofeedback therapy (BFT) is a recommended treatment for pediatric headaches, but evidence is limited.
- Identifying patient subgroups that benefit most from BFT is crucial.
Purpose of the Study:
- To evaluate the efficacy of BFT in pediatric headache patients.
- To identify predictors of positive response to BFT in this population.
Main Methods:
- Retrospective analysis of 132 pediatric patients (aged 8-18) treated with BFT for headaches (2004-2008).
- Data collected included headache characteristics, medication use, and psychosocial factors (depression, anxiety, somatization).
- Response defined as ≥50% reduction in headache frequency/duration or ≥3-point decrease in severity.
Main Results:
- Median headache frequency decreased from 3.5 to 2 days/week.
- Overall response rate was 58% (73% for episodic, 48% for chronic headaches).
- Positive response associated with increased hand temperature and SSRI use; nonresponse linked to preventive medication use.
Conclusions:
- BFT demonstrates efficacy for both episodic and chronic headaches in children and adolescents.
- Further research is needed to compare BFT with other treatments for chronic pediatric headaches.
- The association between SSRI use and BFT response warrants further investigation.
Objectives:
The goal of this study was to measure the effect of biofeedback therapy on pediatric headache and to identify factors associated with response to biofeedback therapy.
Background:
In the United States, 17% of children have frequent or severe headaches. Biofeedback therapy (BFT) appears to be an effective treatment for headaches in adults and is often recommended for children with headaches, but there are few data in the pediatric population. It is also not clear which patients are most likely to benefit from biofeedback therapy.
Methods:
We examined the records of patients, aged 8 to 18 years old, who were referred to a pediatric BFT clinic for management of headache between 2004 and 2008. We extracted data regarding patient and headache characteristics, medication use, family history, and measures of depression, anxiety, and somatization. Chronic headache was defined as ≥4 headache days/week. Positive response to biofeedback was defined as a 50% reduction in number of headache days/week or hours/week, or ≥3-point decrease in severity (0-10 scale) between first and last visits. We analyzed the responder rate for those with episodic and chronic headaches and performed multivariable analysis to determine what factors were associated with headache response to biofeedback therapy.
Results:
We analyzed records from 132 children who attended ≥2 biofeedback sessions. Median headache frequency dropped from 3.5 to 2 headache days/week between the first and last visits. The response rate was 58% overall; 48% for chronic headaches and 73% episodic headaches. In multivariate analysis, ability to raise hand temperature by >3°F at the last visit and use of selective serotonin reuptake inhibitors (SSRIs) were associated with a positive response, and preventive medication use was associated with nonresponse. Anxiety, depression, and somatization were not significantly associated with response to biofeedback therapy.
Conclusions:
Biofeedback therapy appears to be an effective treatment for children and adolescents with both episodic and chronic headaches. Further study is warranted to compare biofeedback with other treatments for chronic pediatric headache. Use of SSRIs appears to be associated with a positive response to biofeedback therapy, but the reasons for this relationship are unclear and merit further study.
