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Biofeedback as Prophylaxis for Pediatric Migraine: A Meta-analysis
Anker Stubberud1, Emma Varkey2, Douglas C McCrory3
1Department of Neuroscience, NTNU Norwegian University of Science and Technology, Trondheim, Norway;
Insights
Biofeedback effectively reduces migraine frequency, duration, and intensity in children and adolescents. Further research is recommended due to study limitations and the need for increased confidence in results.
Area of Science:
- Neurology
- Pediatrics
- Behavioral Medicine
Background:
- Migraine is a prevalent neurological condition in children and adolescents.
- Existing prophylactic treatments for pediatric migraine are limited.
- Biofeedback offers a potential non-pharmacological intervention.
Purpose of the Study:
- To evaluate the pooled evidence on the effectiveness of biofeedback for reducing childhood migraine.
- To assess the impact of biofeedback on migraine frequency, duration, and intensity in pediatric populations.
Main Methods:
- Systematic search of multiple databases (Medline, Embase, CENTRAL, CINAHL, PsychINFO).
- Inclusion of prospective, randomized controlled trials (RCTs) of biofeedback for pediatric migraine.
- Data extraction included attack frequency, secondary outcomes, and risk of bias assessment.
Main Results:
- Five studies with 137 participants met the inclusion criteria.
- Biofeedback significantly reduced migraine frequency (MD, -1.97), attack duration (MD, -3.94), and headache intensity (MD, -1.77) compared to a waiting-list control.
- No significant adjuvant effect or advantage over active treatments was observed; 40% of studies had low risk of bias.
Conclusions:
- Biofeedback demonstrates efficacy in reducing migraine symptoms in children and adolescents.
- Methodological limitations, including small study numbers and incomplete data reporting, necessitate cautious interpretation.
- Further high-quality research is required to confirm these findings and enhance confidence in biofeedback as a pediatric migraine intervention.
Context:
Migraine is a common problem in children and adolescents, but few satisfactory prophylactic treatments exist.
Objective:
Our goal was to investigate the pooled evidence for the effectiveness of using biofeedback to reduce childhood migraine.
Data Sources:
A systematic search was conducted across the databases Medline, Embase, CENTRAL, CINAHL, and PsychINFO.
Study Selection:
Prospective, randomized controlled trials of biofeedback for migraine among children and adolescents were located in the search.
Data Extraction:
Data on reduction of mean attack frequency and a series of secondary outcomes, including adverse events, were extracted. Risk of bias was also assessed.
Results:
Forest plots were created by using a fixed effects model, and mean differences were reported. Five studies with a total of 137 participants met the inclusion criteria. Biofeedback reduced migraine frequency (mean difference, -1.97 [95% confidence interval (CI), -2.72 to -1.21]; P < .00001), attack duration (mean difference, -3.94 [95% CI, -5.57 to -2.31]; P < .00001), and headache intensity (mean difference, -1.77 [95% CI, -2.42 to -1.11]; P < .00001) compared with a waiting-list control. Biofeedback demonstrated no adjuvant effect when combined with other behavioral treatment; neither did it have significant advantages over active treatment. Only 40% of bias judgments were deemed as "low" risk.
Limitations:
Methodologic issues hampered the meta-analyses. Only a few studies were possible to include, and they suffered from incomplete reporting of data and risk of bias.
Conclusions:
Biofeedback seems to be an effective intervention for pediatric migraine, but in light of the limitations, further investigation is needed to increase our confidence in the estimate.
