Biofeedback with VR cuts acute medication use in chronic migraine

“Though the other variables did not meet statistical significance, they trended toward improvement, suggesting that patients with CM may benefit from biofeedback-VR treatment,” the researchers said, pertaining to the frequency of headaches and related psychological distress.

“Biofeedback-VR is a safe, noninvasive therapy that holds promise for many patients, including those with medically refractory CM, those interested in non-medication approaches, and/or those inclined toward an integrative treatment strategy,” they added.

The present randomized controlled study enrolled 50 patients (aged 18–85 years) who had been diagnosed with CM according to the 3rd edition of the International Classification of Headache Disorders. Twenty-five patients were given the active intervention, including frequent use of the biofeedback-VR device on top of standard medical care. The remaining 25 were set as waitlist controls.

Over the 12-week study period, researchers reported a statistically significant drop in the use of acute medication as compared with controls (55 percent vs 32 percent; p=0.028). [Cuneo A, et al, AAN 2022]

However, no such significant changes were reported in other efficacy outcome parameters, such has headache days, depression (Patient Health Questionnaire-8), anxiety (Perceived Stress Scale), and insomnia (Patient-Reported Outcomes Measurement Information System). Catastrophizing, as quantified by the Concerns About Pain scale, also did not differ between intervention and control patients.

Biofeedback, a technique by which patients use information from electrical sensors to control some of their bodily functions, has been posited as a nonpharmacological, noninvasive technique to alleviate symptoms of migraine. However, conclusive evidence supporting or disproving its value has yet to be established.

A 2009 trial, for instance, has found that despite being costly and time-consuming, biofeedback “provided no additional benefit when compared to simple relaxation techniques alone.” However, in 2015, a real-time assessment of biofeedback therapy showed significant symptom improvement, including headache-related disabilities and psychological distress. [Pain Physician 2009;12:1005-1011; Int J Behav Med 2015;22:748-754]

In the present study, biofeedback was combined with VR technology, which is known to help with pain management. Indeed, a 2013 study suggested that the combination of VR and biofeedback was feasible and could potentially be clinically effective in children with headaches. However, the overall literature regarding this subject remains sparse. [Pain Manag 2011;1:147-157; Pain Medicine 2013;14:621-627]

Though no significant impact on headache frequency and mental health were reported, the current findings help expand the knowledge base regarding the use of VR and biofeedback to address headache in CM patients.