Efficacy of biofeedback for migraine: A systematic review and meta-analysis

Migraine, a severe headache accompanied by nausea, photophobia and phonophobia, can be controlled with pharmacological as well as non-pharmacological therapies. In biofeedback, patients learn to voluntarily modify their bodily reactions through feedback mediated awareness of physiological parameters, thus promoting relaxation, reducing stress and preventing migraine attacks. We aim to assess the efficacy of biofeedback on adult patients with migraine. Study protocol was registered on PROSPERO with reference number CRD42024606671. PubMed, Embase and Google Scholar were searched for randomized controlled trials from 2000 to 2024 in English that have evaluated the administration of biofeedback to the adult patients with migraine. High quality studies were included after RoB 2.0 Risk of Bias assessment. ANOVA with inverse variance weighting was used to compare mean differences across groups with 95 % confidence interval. Nine studies (558 participants) and three studies (278 participants) respectively qualified for comparison of biofeedback with waiting list control and active treatment. Biofeedback significantly reduced headache frequency and severity compared to waiting-list control. However, it showed no significant difference in headache frequency when compared to active treatments such as pharmacotherapy or cognitive behavioral therapy. Additionally, improvements in migraine-related disability, depression, anxiety, and quality of life were reviewed. This meta-analysis confirms that biofeedback is an effective non-pharmacological intervention for reducing headache frequency and severity in migraines. Additionally, it appears to provide synergistic benefits when combined with pharmacotherapy. However, future studies should focus on the cost-effectiveness and accessibility of home-based and app-based biofeedback to determine its broader clinical applicability.