A comparison of EMG biofeedback and a credible pseudotherapy in treating tension headache

Thirty-one tension headache sufferers were assigned to frontalis electromyographic (EMG) biofeedback training, to a highly credible pseudotherapy providing no opportunity to learn control of EMG activity, or to a symptom-monitoring control group. Participants receiving biofeedback showed significant reductions in frontalis EMG within and across treatment sessions and exhibited reduced EMG activity following treatment. Participants receiving pseudotherapy showed no changes in EMG activity. Although biofeedback and pseudotherapy were rated as equally credible treatments, only the headache activity of the biofeedback group was significantly improved following treatment. These results suggest that outcomes obtained with biofeedback do not result merely from exposure to a credible treatment procedure. Evidence suggesting that headache improvements may be mediated by cognitive and behavioral changes and not the learned control of physiological activity is discussed.